Conservative treatment of condylar fracture combined with intermaxillary traction in children (with pictures)

Mandibular condylar fractureFracture of mandibular condyle of temporomandibular joint is involved, the weak parts of the structure of the ma


Mandibular condylar fracture

Fracture of mandibular condyle of temporomandibular joint is involved, the weak parts of the structure of the mandible, under the direct or indirect impact, can appear the condylar fracture, mandibular condylar fractures accounted for 20%-30% of mandibular fracture, the fracture is handled improperly, may appear complications such as ankylosis.

After the end of mandibular condyle for surgical anatomy, the upper condylar enlargement for the condylar head, the condylar head and temporal bone of the mandibular fossa formation of temporomandibular joint. The joint between the condyle and the mandibular branch is the condylar neck, and the anterior superior part of the condylar neck is the joint pterygoid fossa. After the condylar fracture, the lateral pterygoid muscle is pulled down and is often moved forward. Temporomandibular joint by temporal bone articular fossa and nodules with mandibular condyle, articular peripheral wrapping articular capsule and ligament, fibrous cartilage articular disc between the articular surface. The main function of the joint is involved in chewing, language, swallowing and other functions. Condylar fracture is bound to damage the structure of other joints, the occurrence of traumatic arthritis, the latter may also appear ankylosis.

The fracture causes of traffic accidents, violence, hurt especially high fall falls can be caused by condylar fracture

(1) the clinical manifestations of preauricular swelling and pain of condylar fractures of very often have tenderness, and accompanied by bone fricative, but for fracture dislocation, the condyle may not touch. Some of the condylar fractures can occur in the external auditory canal injury, at this time, should be with the skull base fracture, cerebrospinal fluid leakage identification. (2) disordered occlusion of unilateral condylar fracture, fracture of lateral deflection to the occlusal contact with the posterior teeth, early bilateral condylar fracture, mandibular retrusion, bilateral posterior anterior teeth early contact, opening and closing. (3) dysfunction is mainly restricted by mouth opening, which affects normal eating and language function. (4) after the displacement of the facial deformity fracture, the mandibular deviation and the deformity.

The treatment of condylar fractures in children with condylar fractures is to promote the functional reconstruction of the condyle, prevent ankylosis, and avoid the development of the jaw. The incidence of ankylosis was about 1%, and the incidence of jaw deformity was about 20%~30%. Condylar fracture in children has a strong ability of dislocation fracture healing after reconstruction, can form an approximate normal form of the new condyle through shaping function. Therefore, in the early stage of fracture, almost all types of fractures should be treated conservatively. You can wear a 1~2mm thick pad to reduce the condyle and relieve acute symptoms. At the same time, the traction of the mandibular forward, upward, under the guidance of the occlusal pad to correct the wrong, and appropriate braking, 7~10 days after the beginning of mouth training, especially the training of the front opening. If the displacement of the fracture, the vertical height of the ascending branch is reduced, and the appearance of the mandibular retraction or deflection is obvious, it is necessary to use a splint or an orthodontic device for intermaxillary traction. The children of condylar deciduous dentition and fracture reduction does not require strict occlusal relationship, the key to restore the vertical ramus height, and on the basis of early functional training. Such as the discovery of persistent trismus in 4~8 weeks, forced opening training has little effect, should be alert to joint adhesion and early ankylosing may consider surgical release of joint adhesion, and then combined with physiotherapy for opening exercise.

Postoperative attention should be paid attention to choose the appropriate period of intermaxillary fixation, appropriate review period and frequency. Early detection of possible complications, scientific and reasonable postoperative physical therapy and postoperative guidance for patients. Wound healing, oral hygiene, and reasonable dietary intake should also be monitored. It is also necessary to manage the occlusion of patients who require further stabilization and to encourage early exercise in patients with stable occlusion.

The patient was born in October 2001 in Hubei, Jianli, 6 years old due to falling height, facial injuries, mouth opening for a week, on admission in October 19, 2007. Opening degree 15mm, opening down. Bilateral condylar fracture (sagittal). Traction nail. October 26th hospital discharge No. 55434. Postoperative traction was admitted to hospital in 40 days in December 5th.

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