PRACTICE
case report
Vertical-split fracture of mandibular
condyle and its sequelae
1
2
J. F. Hackett, and D. J. Sleeman,
The orthodontic treatment was com-
pleted successfully without any complica-
A case of vertical-split fracture of the right mandibular condyle and
its sequelae is presented. The patient was a 16-year-old female being tions.
assessed for orthodontic treatment. Orthopantomograph and plain
Comment
joint view radiographs showed a remodelled condyle which had
suffered trauma 10 years previously. This type of fracture is unusual
in nature but has not led to any secondary lack of growth, restriction
of movement or facial asymmetry.
The incidence of facial fractures in the
paediatric population is 1.4–15% of all
maxillofacial trauma. Forty-one per cent
of facial fractures involve the mandible.
The condyle is affected in 20–30% of these
1
–2
mandibular fractures.
Conventional radiographs are accurate
She was discharged from the hospital enough to diagnose condylar fractures.
tial consultation. The medical ques- with minimal swelling and a good range However, one prospective study in
tionnaire revealed no medical problems of mandibular movement. Germany involving 182 patients with
or medication. On examination, her den- During the 10 years since the trauma 249 fractures of the mandibular condyles
1
6-year-old female attended for ini-
A
tal and oral health were excellent. She was her facial growth has been normal and she underwent conventional and computed
interested in undergoing orthodontic has not experienced any dysfunction-type tomography scans as diagnostic proce-
treatment and a panoramic radiograph sequelae. In view of the fact that she was dures. It was found that all clinically iden-
(
OPG) was taken as a preliminary investi- about to begin orthodontic treatment a tified fractures were detected by means of
gation. This revealed an irregular head of specialist maxillofacial and orthodontic both conventional and computed tomog-
the right mandibular condyle ( Figs 1, 2 ). opinion was sought on the possible effects raphy imaging. However, only computed
The consultant radiologist’s report of such treatment on the pre-existing tomography scanning could correctly
3
stated that this was a ‘ partially healed injury. The consensus was that orthodon- classify high condylar neck fractures.
intracapsular vertical-split fracture of the tic therapy should not affect the stability
Management of condylar fractures is
either surgical or non-surgical. An Aus-
trian study comparing surgical and non-
surgical treatment found no significant
difference in mobility, joint problems,
occlusion, muscle pain or nerve disorders
between the two. The only significant dif-
ference was in subjective discomfort. Sur-
gically treated patients reported more
‘weather sensitivity’ and pain on maxi-
head of the right mandibular condyle.’
On questioning, the patient’s mother
volunteered that she had fallen from her
bicycle at 6 years of age. She had injured
her chin and was taken to the Accident
and Emergency unit of the local hospital
where sutures were inserted. However, the
following day the right side of her face
became very swollen and painful. She was
unable to open her mouth and she was
referred to a maxillofacial unit and admit-
ted for observation and radiographic
examination.
The latter diagnosed a fracture of the
right condylar head and the surgeon felt
that because she was able to achieve a nor-
mal dental occlusion that surgical inter-
vention was not necessary. The symptoms
and signs abated over the following week.
of the condyle and joint.
In brief
•
The use of panoramic radiography is
becoming increasingly common in
general dental practice. This report
reminds the practitioner to assess all
aspects of the radiograph including
joints
In this patient’s case there was no
long-term morbidity. However there
is a significantly increased risk of the
development of premature
4
mum opening. In another study, 25
patients were followed over a period of 15
years having been treated by instruction,
exercises and observation. It concluded
that non-surgical treatment of condylar
fractures in children was still the method
•
osteoarthrosis in the presence of
post-traumatic articular surface
changes
Orthodontic tooth movement may
precipitate dysfunctional symptoms
5
of choice.
This particular case is unusual in that
the trauma caused an intracapsular verti-
cal split fracture of the condyle head.
Interestingly a retrospective study of pae-
diatric condylar fractures in Finland
found that intracapsular fractures were
more common in 6-year-olds and under
•
(
facial arthromyalgia + or – internal
temporomandibular joint
1
*General Dental Practitioner, Waterford, Ireland,
Professor of Maxillofacial Surgery, University
dysfunction) in a previously normal
individual. This is more likely in a
masticatory mechanism which has
compensated following injury
2
College, Cork, Ireland
Correspondence to: J. F. Hackett, St. Catherine’s
6
*
than any other type of condylar fracture.
Hall, Catherine Street, Waterford, Ireland
REFEREED PAPER
In the literature condylar fractures are
frequently associated with long-term
sequelae eg pain, restricted mandibular
Received 16.02.01; Accepted 22.05.01
©
British Dental Journal 2001; 191: 557–558
BRITISH DENTAL JOURNAL VOLUME 191, NO. 10, NOVEMBER 24 2001
557