Esthetic Splint - A Novel Concept for the Management of Bilateral Condylar fracture

Mandibular condyle is one of the most common sites of injury in the facial skeleton. But many condylar injuries remain undiagnosed. In rare situations, these injuries may result in serious adverse sequel in the patient's growth and development that are more difficult to treat at a later stage. In growing individuals, conservative management results in better functional outcome and good remodelling of the condyle. The aim of this article is to present a case report of a bilateral sub-condylar injury in a young child with a novel concept--an esthetic splint.

Mandibular Condyle, Dental Injury, Trauma, Fractures, Esthetic Splint

1. GuÈven  O,  Keskin  A.  Remodelling  following  condylar  fractures  in children. J Cranio-Maxillofac Surg, 29: 232–7, 2001.

2. Dimitroulis G. Condylar injuries in growing patients. Australian Dent J, 42: 367–71, 1997.

3. Reil  B,  Kranz  S.  Traumatology  of  the  maxillofacial  region  in  childhood. (Statistical evaluation of 210 cases in the last 13 years.) J Max Fac Surg, 4: 197–200, 1976.

4. Oji C. Fractures of the facial skeleton in children: a survey of patients under  the  age  of  11  years.  J  Cranio-Maxillofacial  Surg,  26:  322–5, 1998.

5. Amaratunga NA, De S: Mandibular fractures in children. A study of clinical aspects, treatment needs, and complications. J Oral Maxillofac Surg, 46: 637–40, 1988.

6. GuÈ ven O: Fractures of the maxillofacial region in children. J Cranio-Maxillo-Facial Surg, 20: 24–7, 1992.

7. Bradley  PF.  Condylar  injuries.  In:  Rowe  NL,  Williams  JL,  eds. Maxillofacial injuries. Edinburgh: Churchill Livingstone, 1985.

8. Myall  RWT.  Condylar  injuries  in  children:  What  is  different  about them? In: Worthington P, Evans JR, eds. Controversies in oral and maxillofacial surgery. Philadelphia: WB Saunders, 191–200, 1994.

9. Myall RWT, Sandor GKB, Gregory CEB. Are you overlooking fractures of the mandibular condyle? Pediatr, 79: 639–41, 1987.

10. Proffit  WR,  Vig  KWL,  Turvey  TA.  Early  fracture  of  mandibular condyles: Frequently an unsuspected cause of growth disturbances. Am J Orthod, 78: 1–24, 1980.

11. Posnick  JC.  Craniomaxillofacial  fractures  in  children.  Atlas  Oral Maxillofac Surg Clin NorthAm, 6: 169–185, 1994.

12. Blakey GH III, Ruiz RL, Turvey TA. Management of facial fractures in growing  patient.  In:  Fonseca  RJ,  Walker  RV,  eds.  Oral  and Maxillofacial Trauma. 2nd ed. Vol. 2. Philadelphia, Pa: WB Saunders, 1003–41, 1997.

13. Coccaro  PJ  Restitution  of  mandibular  form  after  condylar  injury  in infancy: A 7-year study of a child. Am J Orthod, 55: 32–49, 1969.

14. Lindahl L. Condylar fractures of the mandible IV. Function of the masticatory system. Int J Oral Surg, 6: 195–203, 1977.

15. Khosla VM, Boren W. Mandibular fractures in children and their management. J Oral Surg, 29: 116–21, 1971.

16. James  RB,  Fredricson  C,  Kent  JN:  Prospective  study  of  mandibular fractures. J Oral Surg, 39: 275–81, 1981.

17. Sahm G, Witt E. Long-term results after childhood condylar fractures. A computer-tomographic study. Europ J Orthod, 11: 154–60, 1989.

18. Boyne  PJ.  Osseous  repair  and  mandibular  growth  after  subcondylar fractures. J Oral Surg, 25: 300–9, 1969.

19. Leake D, Doykos J, Habal MB, Murray JE. Long term follow-up of fractures of the mandibular condyle in children. Plast Reconstr Surg, 47: 127–31, 1971.

20. Shaikh  S,  Worall  SF.  Epidemiology  of  facial  trauma  in  a  sample  of patients aged 1-18 years. Injury, 33: 669–71, 2002.

21. Thompson  A,  Kent  G.  Adjusting  to  disfigurement:  The  processes involved in dealing with being visibly different. Clin Psychol Rev, 21: 663–82, 2001.

22. De Sousa A. Psychological issues in acquired facial trauma. Indian J Plast Surg, 43: 200–5, 2010.

23. Rowe NL. Fractures of the facial skeleton in children. J Oral Surg, 26: 505–15, 1968.

24. Hardt N, Gottsauner A. The treatment of mandibular fractures in children. J Craniomaxillofac Surg, 21: 214–9, 1993.

25. Gussack  GS,  Luterman A,  Rodgers  K,  et al.  Pediatric  maxillofacial trauma: Unique features in diagnosis and treatment.Laryngoscope, 97: 925–30, 1987.

26. Lindahl L, Hollander L. Condylar fractures of the mandible II. A radiographic study of the remodelling process in the temporomandibular joint. Int J Oral Surg, 6: 153–65, 1977.

27. Raustia  AM,  Pythinen  J,  Oikarinen  KS,  et  al  .  Conventional  radiographic and computed tomographic findings in cases of fracture of the mandibular  condylar  process.  J  Oral  Maxillofac  Surg,  48:  1258–64, 1990.

28. Takenoshita Y, Ishibashi H, Oka M. Comparison of functional recovery after nonsurgical and surgical treatment of condylar fractures. J Oral Maxillofac Surg, 48: 1191–5, 1990.

29. Hidding J, Wolf R, Pingel D. Surgical versus non-surgical treatment of fractures of the articular process of the mandible. J Craniomaxillofac Surg, 20: 345–7, 1992. 

30. Konstantinovic VS, Dimitrijevic B. Surgical versus conservative treat-ment of unilateral condylar process fractures: Clinical and radiographic evaluation of 80 patients. J Oral Maxillofac Surg, 50: 349–52, 1992.

31. Krenkel  C.  Biomechanics  and  osteosynthesis  of  condylar  neck  fractures of the mandible. Chicago: Quintessence, 1994.

32. Zide MF, Kent JN. Indications for open reduction of mandibular condylar fractures. J Oral Maxillofac Surg, 41: 89–98, 1983.

33. T. Lloyd, C. Nightingale, R. Edler. The use of vacuum-formed splints for temporary intermaxillary fixation in the management of unilateral condylar fractures. Brit J Oral Maxillofac Surg, 39: 301–3, 2001.

34. Blakey GH III, Ruiz RL, Turvey TA. Management of facial fractures in growing  patient.  In:  Fonseca  RJ,  Walker  RV,  eds.  Oral  and Maxillofacial Trauma. 2nd ed. Vol. 2. Philadelphia, Pa: WB Saunders, 1003–41, 1997.

35. Magennis P, Craven P. Modification of orthodontic brackets for use in intermaxillary fixation. Br J Oral Maxillofac Surg, 28: 136–7, 1990.

36. Wood DP, Paleczny GJ, Johnson LN. The effect of sandblasting on the retention of orthodontic bands. Angle Orthod, 66: 207–14, 1996.

37. Binahmed A,  Sansalone  C,  Garbedian  J,  Sándor  GKB.  The  Lingual Splint: An Often Forgotten Method for Fixating Pediatric Mandibular Fractures. JCDA, 73: 521–4, 2007.

38. Cunningham SJ. The psychology of facial appearance. Dent Update, 26: 438–43, 1999.

39. Enqvist B, Von Konow OL, Bystedt OH. Stress reduction, preoperative hypnosis  and  perioperative  suggestion  in  maxillofacial  surgery: Somatic responses and recovery. Stress Med, 11: 229–33, 1995.

40. McGrouther DA. Facial disfigurement. BMJ, 314: 991–2, 1997.

41. Newell R, Marks I. Phobic nature of social difficulty in facially disfigured people. Br J Psychiatry, 176: 177–81, 2000.

42. Koster ME, Bergsma J. Problems and coping behavior of facial cancer patients. Soc Sci Med, 30: 569–78, 1990.

43. Macgregor  FC.  Facial  disfigurement:  Problems  and  management  of social  interaction  and  implications  for  mental  health. Aesthetic  Plast Surg, 14: 249–57, 1990.

44. Sainsbury DC. Body image and facial burns. Adv Skin Wound Care, 22: 39–44, 2009.

45. Carr A, Harris D, James C. The derriford appearance scale: A new scale to measure individual responses to living with problems of appearance. Br J Health Psychol,  5: 201–15, 2000.

46. Caldas AF  Jr,  Burgos  ME. A  retrospective  study  of  traumatic  dental injuries  in  a  Brazilian  dental  trauma  clinic.  Dental  Traumatol,  17: 250–3, 2001.

47. Trabert J, Peres MA, Blank V, Böell RDA S, Pietruza JA. Prevalence of  traumatic  dental  injury  and  associated  factors  among  12-year-old school children in Florianópolis, Brazil. Dental Traumatol, 19: 15–8, 2003.

48. Marcenes W, Al Beiruti N, Tayfour D, Issa S. Epidemiology of traumatic injuries to the permanent incisors of 9-12-year-old schoolchildren in Damascus, Syria. Endod Dent Traumatol, 15: 117–23, 1999.

49. Marcenes  W, Alessi  ON,  Traebert  J.  Causes  and  prevalence  of  traumatic  injuries  to  the  permanent  incisors  of  school  children  aged  12 years in Jaraguá do Sul, Brazil. Int Dent J, 50: 87–92, 2000.

50. Zuhal K, Semra OE, Hüseyin K. Traumatic injuries of the permanent incisors  in  children  in  southern  Turkey:  a  retrospective  study.  Dent Traumatol, 21: 20–5, 2005.

51. Cortes MIS, Marcenes W, Sheiham A. Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-years-old children. Community Dent Oral Epidemiol, 30: 193–8, 2002.

52. Soriano EP, Caldas Ade F Jr, Diniz De Carvalho MV, Amorim Filho Hde A. Prevalence and risk factors related to traumatic dental injuries in Brazilian schoolchildren. Dent Traumatol, 23: 232–40, 2007.