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Radiographic Assessment of Pediatric Condylar Fractures after Conservative Treatment with Functional Appliances—A Systematic Review

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  • Edoardo Staderini

    (Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy)

  • Romeo Patini

    (Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy)

  • Michele Tepedino

    (Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Viale S.Salvatore, Edificio Delta 6, 67100 L’Aquila, Italy)

  • Giulio Gasparini

    (Maxillofacial Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy)

  • Maria Antonietta Zimbalatti

    (Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy)

  • Francesca Marradi

    (Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy)

  • Patrizia Gallenzi

    (Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy)

Abstract

Background: To evaluate the effectiveness of conservative treatment with functional appliances for condylar fractures in pediatric age. Methods: Four electronic databases (PubMed, EBSCO, Scopus, and Web of Science) were consulted with no restriction of publication status or year, up to 31 August 2020. Selection criteria: based on the PICOS criteria, the selection criteria were set for observational human studies, with at least 10 patients and six months of follow-up. The study population included pediatric patients (aged 5–16 years), with unilateral or bilateral condylar fracture, treated with functional appliances. Condylar remodeling and mandibular growth were analyzed through sequential radiographic examinations. Data collection and analysis: Two independent reviewers carried out title-abstract screening, and a senior investigator was involved to solve any disagreement. The quality of the evidence was assessed through the Canada Institute of Health Economics (IHE) quality appraisal checklist, and the National Institutes of Health (NIH) quality assessment tool. Results: A total of 971 articles were retrieved from the electronic search; among them, three studies met the eligibility criteria. A moderate risk of bias was detected in all the studies, due to common limitations (absence of multicenter studies, prospective design, blindness of the investigators, patients’ drop-out). At follow-up examinations (between 6 months and 4.9 years), the difference of condylar neck length between the “injured” and “healthy” side was approximately 2 mm, while the anteroposterior condylar width discrepancy was recorded up to 1 mm. Conclusions: Short- and long-term data revealed that conservative treatment with functional appliances led to partial or full radiological recovery of the joint morphology, along with good to excellent functional results. Patients’ age has a crucial role on the treatment choice, and the type of fracture (presence of condylar displacement, or dislocation) is also a major prognostic indicator of the radiologic outcome. Limitation: To confirm the effectiveness of functional appliances, more prospective clinical long-term follow-up studies with homogeneous samples of condylar fractures are deemed necessary. Registration: The study protocol was registered on PROSPERO (CRD42020205650).

Suggested Citation

  • Edoardo Staderini & Romeo Patini & Michele Tepedino & Giulio Gasparini & Maria Antonietta Zimbalatti & Francesca Marradi & Patrizia Gallenzi, 2020. "Radiographic Assessment of Pediatric Condylar Fractures after Conservative Treatment with Functional Appliances—A Systematic Review," IJERPH, MDPI, vol. 17(24), pages 1-13, December.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:24:p:9204-:d:459343
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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Jovana Kuzmanovic Pficer & Slobodan Dodic & Vojkan Lazic & Goran Trajkovic & Natasa Milic & Biljana Milicic, 2017. "Occlusal stabilization splint for patients with temporomandibular disorders: Meta-analysis of short and long term effects," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-21, February.
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    1. Rohan Diwakar & Anuraj Singh Kochhar & Harshita Gupta & Harneet Kaur & Maninder Singh Sidhu & Helen Skountrianos & Gurkeerat Singh & Michele Tepedino, 2021. "Effect of Craniofacial Morphology on Pharyngeal Airway Volume Measured Using Cone-Beam Computed Tomography (CBCT)—A Retrospective Pilot Study," IJERPH, MDPI, vol. 18(9), pages 1-11, May.

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