“TMJ internal derangement following condylar fractures in the growing patient: impact on facial growth

Introduction: Many clinical studies have shown how jaw injuries are the single most important cause of subsequent TMJ internal derangement. Proper function of the masticatory system is certainly the most influential variable in facial growth. The aim of the study was to evaluate relationships between post-traumatic internal derangement and disturbed facial growth in children. Patients and methods: 25 children, 16 boys, 9 girls, 14 year of age or younger – (mean age: 5.7; range: 3–9 at the time of injury) were selected out of a group of 74. They all referred a history of major face injury. None of them referred a history of TMJ pain, mechanical dysfunction, orthognatic treatment or TMJ surgery before the trauma. They all had been treated by physiotherapy following a specific treatment protocol and underwent combined clinical and radiographic standardized evaluation for 5 years. None of them was treated orthodontically after the trauma. Results: 19 patients were found to have at least one abnormal and internally deranged TMJ on imaging studies; symptoms included – either individually or in various combination – pain and/or mechanical TMJ dysfunction. Out of this group, 11 patients showed a mandibular asymmetry with chin deviation to the smaller or more degenerated TMJ. Three patients showed an evident mandibular retrognathia with marked bilateral TMJ remodelling; three patients showed normal TMJ(s) with normal facial structure. Conclusion: These data suggest that in children TMJ derangement may potentially alter mandibular growth.