Sequential Guiding Reduction Splint Treating Children’ Bilateral Intracapsular Condylar Fractures

At present, most of the patients with intracapsular condylar fracture choose immobilization and follow-up observation therapy. If needed, adulthood two-stage operation would be taken. High incidence of facial deformity and dysfunction, and even joint stiffness occurs.In our case, serial reduction occlusal splints combined with orthodontic functional orthodontic appliance were used and idea results obtained. A 10-year-old girl suffered bilateral condylar fractures due to trauma, with limited mouth opening(17mm), chin shift right, nearly non mandible movement of accentric occlusion and disordered occlusion. CBCT imaging revealed comminuted fractures, displaced condylar heads, and reduced mandibular ramus height. Pivot splint (8 mm separation of incisors) + headgear (400g chin compression), protrude splint, and orthodontic bimaxillary splint were used sequentially, with regular follow-ups.1 month after, mouth opening increased to 21 mm with mild pain; at 4 months, to 30mm without pain; at 7 months, CBCT imaging shows good fracture healing. There’re 2 key elements which includs (1)to guide well healing of the dislocated condyle and (2) to match the shape modification of the condyle-fossa relationship. Through joint cavity decompression,extension guidance and mandibular anterior guidance to promote growth and other measures, the ideal fracture healing and functional recovery of children were finally obtained. The sequential treatment of resetting guided occlusal plate combined with orthodontic functional appliance avoids surgical trauma and potential risks, opens up treatment mode, saves family burden, and is expected to be popularized in clinic.