Temporomandibular joint morphology in children after treatment of condylar fractures with functional appliance therapy: a follow-up study us computed tomography.

The consequences of treating fractures of the temporomandibular joint in children by means of functional appliance therapy remain controversial. In this retrospective study we evaluated the temporomandibular joint morphology of 19 children and adolescents who had sustained a total of 21 condylar fractures between three and nine years previously and who had been treated in this way. Restoration of function was assessed clinically by measurement of mandibular movements, and palpation and auscultation of the joint. Spiral CT was used for the radiological examination with 2D and 3D reconstructions. Eleven patients with 13 fractures of different types showed restoration of normal function with favourable remodelling. The remaining eight patients had only good function with a deformed condyle and significant asymmetry in condylar angle and length of the condylar neck. Four of these cases had also developed bony spurs, neo-arthrosis and a bifid condyle. On the basis of these results, spiral CT imaging appears to be a valuable diagnostic aid in cases of condyle fractures where severe morphological changes are not recognized in earlier conventional X-ray examinations. The authors recommend a quantitative and qualitative analysis of the temporomandibular joint in order to encourage patients' compliance and, in cases of poor cooperation, to extend the treatment time.