Surgical vs. Non-Surgical Management of Mandibular Condyle Fractures in Adolescent

Downloads
Highlights
- Non-surgical treatments can involve various appliances. However, all non-surgical treatments are typically supplemented with mouth-opening exercises.
- Surgical treatments usually consist of open reduction and internal fixation, which can be implemented using various anatomical approaches.
Abstract
Background: Mandibular condyle fractures are common among adolescents, often resulting from trauma such as falls or road traffic accidents. These fractures, which involve the articular surface of the mandible, can lead to complications like malocclusion, restricted mouth opening, and temporomandibular joint dysfunction. Treatment for mandibular condyle fractures varies, with non-surgical management, including closed reduction and functional therapy, often favored for its less invasive nature, especially in growing adolescents. Surgical interventions, such as open reduction and internal fixation, are considered for more complex fractures or when non-surgical methods fail. However, the decision between surgical and non-surgical treatment remains contentious, particularly in adolescents, whose condylar fractures might heal better due to the regenerative capacity of their growing bones. Objective: This review aimed to compare the outcomes of surgical and non-surgical management of mandibular condyle fractures. Material and Method: This review was conducted by searching the Scopus database for case reports published between 2014 and 2024, which described either surgical or non-surgical treatment of adolescent mandibular condyle fractures. Result: A total of 7 case reports were included, highlighting the use of various treatment approaches. Non-surgical methods, including functional appliances and mouth-opening exercises, showed promising results, with improved mouth opening and condylar remodeling. Similarly, surgical approaches, though more invasive, resulted in good functional and aesthetic outcomes, with minimal complications when proper anatomical understanding was applied. Conclusion: Both non-surgical and surgical approaches can be used to treat condylar fractures in adolescents, provided that proper evaluation, planning, and a thorough understanding of the condyle's anatomy and surrounding tissue are ensured.
Abdullayev, E., Rahimov, C., Farzaliyev, I., et al. 2020. Non-surgical treatment of condylar fractures in children. Oral and Maxillofacial Surgery Cases, 6(1): 100134. doi: 10.1016/j.omsc.2019.100134.
Badar, M. A., Shah, S. A. A., Wahid, A. 2014. Etiology of mandibular condylar fractures: A study from Tertiary Care Hospital of Lahore. Pakistan Oral and Dental Journal, 34(1): 42–45. Available at: https://www.researchgate.net/publication/260998429_Etiology_of_Mandibular_Condylar_Fractures_A_Study_From_Tertiary_Care_Hospital_of_Lahore
Bedoya-Rodriguez, A., Ramirez-Yanez, G. O. 2020. Bilateral condylar fracture: A case treated with a conservative myofunctional approach. Journal of Clinical Pediatric Dentistry, 44(6): 464–468. doi: 10.17796/1053-4625-44.6.12.
Chrcanovic, B. R. 2015. Surgical versus non-surgical treatment of mandibular condylar fractures: A meta-analysis. International Journal of Oral and Maxillofacial Surgery, 44(2): 158–179. doi: 10.1016/j.ijom.2014.09.024.
Cunningham, C., Scheuer, L., Black, S. 2016. Developmental juvenile osteology, in. Elsevier: 149–176. doi: 10.1016/B978-0-12-382106-5.00006-2.
Deng, T., Liu, C. K., Liu, P., et al. 2016. Influence of the lateral pterygoid muscle on traumatic temporomandibular joint bony ankylosis. BMC Oral Health, 16(1): 62. doi: 10.1186/s12903-016-0220-1.
García-Guerrero, I., Ramírez, J. M., Gómez de Diego, R., et al. 2018. Complications in the treatment of mandibular condylar fractures: Surgical versus conservative treatment. Annals of Anatomy - Anatomischer Anzeiger, 216: 60–68. doi: 10.1016/j.aanat.2017.10.007.
Hamada, M., Nomura, R., Yano, H., et al. 2017. Mandibular condyle fracture in Japanese girl and 10-year follow-up findings. Pediatric Dental Journal, 27(3): 169–172. doi: 10.1016/j.pdj.2017.08.002.
Junior, P. R., Padovan, L., Momesso, N., et al. 2018. Non-surgical management of bilateral mandibular condyle fracture: Six-year follow-up. A case report. Revista Portuguesa de Estomatologia, Medicina Dentária e Cirurgia Maxilofacial, 59. doi: 10.24873/j.rpemd.2018.05.215.
Kamath, A. T., Roy, S., Pai, D. 2023. Paediatric condylar trauma - primary management considerations - A review. Journal of Oral Biology and Craniofacial Research, 13(2): 236–242. doi: 10.1016/j.jobcr.2023.01.011.
Khalifeh, B., Ballout, N., Arab, A. Al. 2022. Tissue engineering in injured facial nerve: A narrative review. Journal of Neuroscience Research and Alzheimer’s Disease, 1(1): 1–26. Available at: https://www.researchgate.net/publication/363799386_Tissue_Engineering_in_Injured_Facial_Nerve_A_Narrative_Review
Kolk, A., Scheunemann, L. M., Grill, F., et al. 2020. Prognostic factors for long-term results after condylar head fractures: A comparative study of non-surgical treatment versus open reduction and osteosynthesis. Journal of Cranio-Maxillofacial Surgery, 48(12): 1138–1145. doi: 10.1016/j.jcms.2020.10.001.
Kozakiewicz, M., Walczyk, A. 2023. Current frequency of mandibular condylar process fractures. Journal of Clinical Medicine, 12(4): 1394. doi: 10.3390/jcm12041394.
Lauand, G. A., Meneses-Santos, D., Santos, F. T., et al. 2020. Surgical correction of ankylosed TMJ in a child: Case report. Oral and Maxillofacial Surgery, 24(4): 509–514. doi: 10.1007/s10006-020-00864-5.
Lee, Sung-Jae., Chun, Y. J., Lee, S. J., et al. 2022. Modified high-submandibular appraoch for open reduction and internal fixation of condylar fracture: Case series report. Journal of the Korean Association of Oral and Maxillofacial Surgeons, 48(5): 267–276. doi: 10.5125/jkaoms.2022.48.5.267.
Liang, M., Simelane, S., Fillo, G. F., et al. 2019. The state of adolescent sexual and reproductive health. Journal of Adolescent Health, 65(6): S3–S15. doi: 10.1016/j.jadohealth.2019.09.015.
Marji, F. P., Anstadt, E., Davit, A., et al. 2020. Pediatric mandibular condylar fractures with concomitant cervical spine injury: A treatment protocol for prevention of temporomandibular joint ankylosis. Journal of Craniofacial Surgery, 31(3): e248–e250. doi: 10.1097/SCS.0000000000006178.
McLeod, N. M. H., Van Gijn, D. 2018. Use of ultrasound-activated resorbable sheets and pins in the management of fractures of the condylar neck of the mandible: A case series. British Journal of Oral and Maxillofacial Surgery, 56(3): 182–185. doi: 10.1016/j.bjoms.2018.01.003.
Monteiro, J. L. G. C., Guastaldi, F. P. S., Troulis, M. J., et al. 2021. Induction, treatment, and prevention of temporomandibular joint ankylosis—A systematic review of comparative animal studies. Journal of Oral and Maxillofacial Surgery, 79(1): 109-132.e6. doi: 10.1016/j.joms.2020.07.018.
Moorthy, A., Krishna, S. 2021. Management of medical comorbidities in maxillofacial surgery. in Oral and Maxillofacial Surgery for the Clinician. Singapore: Springer Nature Singapore: 25–48. doi: 10.1007/978-981-15-1346-6_3.
Nagori, S. A., Jose, A., Bhutia, O., et al. 2014. Undiagnosed mandibular condylar fractures causing temporomandibular joint ankylosis: A problem in northern India. The National Medical Journal of India, 27(5): 251–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/26037423
Nayak, S. S., Arun, S., Taranath Kamath, A., et al. 2021. The influence of the mandibular chin angle on the occurrence of mandibular condylar fracture: A retrospective study. The Scientific World Journal. Edited by D. Endoh, 2021: 1–7. doi: 10.1155/2021/2380840.
Netter, F. H. 2018. Atlas of human anatomy. Elsevier. Available at: https://shop.elsevier.com/books/atlas-of-human-anatomy/netter/978-0-323-39322-5
Nota, A., Caruso, S., Ehsani, S., et al. 2020. Three-dimensional volumetric analysis of mandibular condyle changes in growing subjects: A retrospective cross-sectional study. CRANIO®, 38(5): 320–326. doi: 10.1080/08869634.2018.1537088.
Ren, R., Dai, J., Zhi, Y., et al. 2020. Comparison of temporomandibular joint function and morphology after surgical and non-surgical treatment in adult condylar head fractures. Journal of Cranio-Maxillofacial Surgery, 48(3): 323–330. doi: 10.1016/j.jcms.2020.01.019.
Shakya, S., Zhang, X., Liu, L. 2020. Key points in surgical management of mandibular condylar fractures. Chinese Journal of Traumatology, 23(2): 63–70. doi: 10.1016/j.cjtee.2019.08.006.
Snyder, S. K., Cunningham, L. L. 2017. The biology of open versus closed treatment of condylar fractures. Atlas of the Oral and Maxillofacial Surgery Clinics, 25(1): 35–46. doi: 10.1016/j.cxom.2016.10.006.
Stähli, C., Eliades, T., Papageorgiou, S. N. 2021. Functional appliance treatment for mandibular fractures: A systematic review with meta‐analyses. Journal of Oral Rehabilitation, 48(8): 945–954. doi: 10.1111/joor.13178.
Tuna, E. B., Dündar, A., Çankaya, A.B., et al. 2012. Conservative approach to unilateral condylar fracture in a growing patient: A 2.5-year follow up. The Open Dentistry Journal, 6(1): 1–4. doi: 10.2174/1874210601206010001.
Vanpoecke, J., Dubron, K., Politis, C. 2020. Condylar fractures: An argument for conservative treatment. Craniomaxillofacial Trauma & Reconstruction, 13(1): 23–31. doi: 10.1177/1943387520902881.
Walker, C. J., MacLeod, S. P. R. 2017. Anatomy and biomechanics of condylar fractures. Atlas of the Oral and Maxillofacial Surgery Clinics, 25(1): 11–16. doi: 10.1016/j.cxom.2016.10.002.
Copyright (c) 2025 Abdurrahman Adirhesa, Carolina Cita Brilliani, Fredy Mardiantoro

This work is licensed under a Creative Commons Attribution 4.0 International License.
1. The journal allows the author(s) to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions.
3. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution 4.0 International License (CC-BY).