This document describes a case study of a 9-year-old girl who suffered bilateral vertical fractures of the mandibular condylar heads after falling from a height. Plain radiographs did not clearly show the fractures. A CT scan revealed a sagittal fracture in the left condylar head and an undisplaced fracture in the right. The girl underwent open reduction and internal fixation surgery with titanium plates and screws to treat the fractures. Post-operatively, she followed a soft diet for 4 weeks and underwent range of motion exercises to prevent ankylosis, showing satisfactory healing of the fractures after 6 months. The case illustrates the difficulty of diagnosing paediatric mandibular condylar fractures with conventional radiography and the

1. A PI TFALL I N THE RADI OLOGI CAL
DI AGNOSI S OF PAEDI ATRI C
MANDI BULAR CONDYLAR
FRACTURES
INDIAN DENTAL ACADEMY
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2. INTRODUCTION

Paediatric facial fractures are not common.

Mandibular condylar fractures are relatively common site
of injury.

Conservative management of such fractures has been
shown to be successful.
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3. 
Minimally displaced condylar fractures of neck without
surgery allowing the condylar head to remodel itself
naturally.

Following case outlines the management of a usual
case of bilateral vertical fractures of the condylar heads,
and illustrates the difficulty in diagnosis with conventional
radiography.
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4. CASE REPORT

9 yr old girl fell from a height of about 4 feet.

3cm laceration on her chin with swelling and tenderness
along the left side of her mandible.

Derangement of occlusion with open bite.

Tenderness bilaterally at the TMJ.
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5. Pre operative photograph
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6. 
Plain radiographs were taken including orthopantogram
and facial views.

Film demonstrated a displaced left parasymphyseal
fracture on the left and were suspicious for left condylar
fracture as well.

Computed tomography was performed, which
demonstrated a sagittal fracture in the lt. condylar head
with medial displacement of # medial segment.

Undisplaced # noticed in the right condylar head.

Ramus height appeared of same height.
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7. Pre operative 3 Dimensional view
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8. Pre operative OPG and AP View
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9. 
Treatment was done with open reduction and internal
fixation using 2 titanium plates below the level of
developing teeth and tooth roots.

Monocortical screws were used on both the plates.

To treat condylar fractures orthodontic brackets were
placed on molars on each side to be used for rubber
1bands.

These bands serve to guide the pt. back into normal
occlusion.
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10. 
Provide relief of muscular spasm for first two weeks.

Jaw motion to prevent ankylosis.

Within I week comfortable mouth opening and inter
incisal mouth opening of around 25mm.

Soft diet for 4 weeks.

Follow of 6 months revealed satisfactory occlusion with
lower teeth per. Erupting.
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11. Post operative OPG and AP View
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12. Post operative photographs
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13. DISCUSSION

Paediatric mand. # can often be difficult to assess and
repair due to developing permanent dentition.

CT Scan has clear advantage than OPG as it has
diagnostic accuracy with respect to condylar #.

With regard to the condylar # early range of motion
exercises are of paramount importance in avoiding
ankylosis.

Rubber bands are helpful in maintaining occlusion and
providing relief of massetric swelling and spasm.
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14. CONCLUSION

The case represents an injury sustained from a traumatic
blow to the chin, condylar fractures should be suspected
in such injuries, such # are best seen using a CT Scan.

Conservative management of such injuries has been
found to be successful and should be the first choice for
non-displaced condylar # or those that do not
significantly affect occlusion of mand. height and
symmetry.
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15. THAN K YOU
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