Radiological Healing Patterns and Functional Outcomes After Conservative Treatment of Unilateral Condylar Fractures: A Report of Two Cases

Background: Condylar fracture healing pattern classification in children and adolescents is primarily based on the radiological assessment of condylar morphology; however, recent studies showed the presence of a poor correlation between post-treatment radiological findings and clinical temporomandibular joint (TMJ) dysfunction. The present case series aimed to correlate the condylar morphology, shape, and trabecular bone density with the skeletal asymmetry and the clinical recovery of two growing patients with unilateral condylar fractures undergoing orthopedic treatment with the Balters Bionator appliance. (2) Methods: Pre- and post-treatment (12 months) cone-beam computed tomography (CBCT) scans of two growing patients with unilateral condylar fracture were retrieved; both patients were treated with the Balters Bionator appliance for one year. Morphological evaluation of the condylar healing pattern was carried out on CBCT reconstructions of the mandible. Condylar remodeling and skeletal asymmetry were assessed through linear measurements performed on pre- and post-treatment CBCT scans; then, fractal analysis (FA) was employed to assess the condylar trabecular bone density on orthopantomographies (OPTs). Clinical and TMJ functional evaluation were retrieved from patients’ records from before and at the end of the treatment (12 months). (3) Results: Conservative treatment of condylar fractures in growing patients led to an increased bone density of the condylar heads, regardless of the post-treatment size and morphology of the injured condyles. Patient one presented an unchanged condylar morphology on the affected side, while patient two’s condyle was slightly spherical. The qualitative results were confirmed by quantitative measurements on CBCTs. The radiological healing patterns were associated with slightly different functional outcomes. Both patients also exhibited an improvement in skeletal asymmetry and TMJ function. (4) Conclusions: According to the findings in the present study, the condylar remodeling and bone apposition after conservative treatment of condylar fractures in growing patients can exhibit different radiological and functional outcomes. Indeed, an unchanged morphology of the condylar head is more likely to determine a physiological TMJ recovery.