A pitfall in the radiological diagnosis of paediatric mandibular condylar fractures

Horizontal paediatric condylar fractures are a relatively common injury, which can have lifelong consequences, if not managed properly at initial presentation. Successful management relies on accurate diagnosis of the fracture, which leads to the determination of optimal treatment. We present a case of a fractured mandible with vertical fractures of both condyles and the parasymphisis in a child, which was difficult to diagnose using conventional radiological interpretation. The initial radiographs did not fully reveal the nature of the condylar trauma and computed tomography was necessary to clarify the extent of the injuries. Management was a combination of open reduction internal fixation for the parasymphyseal fracture, and orthodontic brackets were cemented to the teeth to allow elastic traction and conservative management of the condylar fractures, which involved both temporomandibular joints. The patient made an unremarkable postoperative recovery and had regained excellent range of motion within 2 weeks of surgery. This case highlights a diagnostic difficulty using orthopantograms and mandible radiographs, and illustrates a useful management strategy for bilateral vertical fractures of the mandibular condyles.