The importance of early recognition of condylar fractures in children: a study of 2 cases

Maxillofacial fractures in general and mandibular fractures in particular seem to be less common in children than in adults; however, this finding might be influenced by the fact that condylar fractures in children are often undiagnosed and so the true incidence is likely to be higher than that reported in literature. Traumatic lesions of the temporomandibular joint often are overlooked as they can apparently occur with relatively little pain, few clinical signs, and insufficient reaction by the child to alert an adult to the seriousness of the injury. Only 1 to 2 years later, when growth disturbances appear, are they perceived as a problem, but by that time, the dysplastic growth pattern has stabilized and will continue over a period of years. The problem is frequently underestimated because of the difficulties inherent in pediatric pain assessment. The fact that the mechanisms of pain perception in children differ somewhat from adult pain perception mechanisms is one factor that can make pediatric pain assessment difficult. This paper outlines 2 case reports that draw attention to pain in children in the case of temporomandibular joint injury. The inability to assess pain adequately may lead to a delay in diagnosis and treatment and possibly result in future growth disturbances and facial asymmetries.