The Management of a Pediatric Condylar Fracture With Dynamic Elastic Therapy

Robert P. Lesko, BA; Brandon J. De Ruiter, BS; George N. Kamel, MD; Edward H. Davidson, MD


ePlasty. 2019;19(ic16) 

In This Article

Case Description

An 8-year-old male patient presented after suffering blunt trauma to the left side of the face during a football game. On initial evaluation, the patient denied malocclusion or chin deviation. Computed tomography (CT) identified a displaced intracapsular left-sided mandibular condylar fracture (Figure 1), and conservative treatment was attempted. After 1 week, the patient developed malocclusion and chin deviation (5 mm) (Figure 2) and subsequently was started on a 3-phase protocol utilizing elastic therapy. Phase I used 6-oz ¾-inch "fixating elastics" (class II ipsilateral to injury, class I contralaterally) (figure-of-eight configuration) (Figure 3). In phase II, 6-oz ¼-inch "guiding elastics" were placed (class II ipsilaterally, class I contralaterally) (non–figure-of-eight configuration). In phase III, 6-oz ¼-inch "supportive elastics" were placed (class I bilaterally) (non–figure-of-eight configuration). Each phase lasted 2 weeks, with advancement criteria including centric occlusion without chin deviation. Diet was advanced with phase of therapy from liquid to blenderized to soft. At conclusion of therapy, centric occlusion with congruency of dental and facial midlines (0-mm deviation) was achieved (Figure 4).

Figure 1.

Maxillofacial computed tomographic scan, coronal cut, shows a displaced intracapsular left condylar fracture.

Figure 2.

Preoperative intraoral physical examination shows significant malocclusion and chin deviation to the left on mouth opening.

Figure 3.

Maxillomandibular fixation with dynamic elastic therapy; fixating elastics; class I elastics on the right and class II elastics on the left.

Figure 4.

Left image illustrates preoperative malocclusion; right image illustrates midline congruency after completion of dynamic elastic therapy.