RESUMO
In pediatric patients with mandible fractures and concomitant cervical spine injury (CSI), treatment strategies may occasionally compete: condylar fractures require functional therapy with range of motion exercises of the temporomandibular joint (TMJ), while CSI requires neck immobilization. The authors report the case of a child presenting with bilateral condylar head fractures, a right parasymphyseal fracture, and concomitant CSI treated with cervical collar immobilization, who ultimately developed TMJ ankylosis. Here, the authors review mandibular condylar fracture management and suggest an approach for the pediatric patient presenting with condylar fractures and concomitant CSI requiring immobilization. To preserve range of motion at the TMJ, it is critical to prevent external restriction by prolonged cervical collar use. Instead, these patients benefit from a protocol utilizing conventional halo or noninvasive, pinless halo cervical spine stabilization. Without limitation of the TMJ, condylar fracture rehabilitation and healing may proceed unhindered.
Assuntos
Anquilose/prevenção & controle , Côndilo Mandibular/lesões , Fraturas Mandibulares/diagnóstico por imagem , Lesões do Pescoço/diagnóstico por imagem , Traumatismos da Coluna Vertebral , Transtornos da Articulação Temporomandibular/prevenção & controle , Criança , Protocolos Clínicos , Humanos , Masculino , Côndilo Mandibular/diagnóstico por imagem , Fraturas Mandibulares/complicações , Lesões do Pescoço/complicações , Fatores de Risco , Coluna VertebralRESUMO
BACKGROUND: Carpal tunnel syndrome (CTS) is a rare finding in children, but heavily represented in pediatric patients with mucopolysaccharidoses. Diagnosis is a challenge due to lack of the stereotypical symptomatic complaints and relies on examination and objective nerve conduction studies. METHODS: We present a case of delayed presentation of CTS in a 12-year-old boy with Hunter syndrome, followed by a review of the literature. RESULTS: Patient Z.D. presented with minimal reported CTS symptoms but advanced median nerve damage on electromyography. He underwent bilateral carpal tunnel release with median nerve neurolysis and flexor tenosynovectomies. Intraoperative examination demonstrated the presence of a "waist sign" of the median nerve and moderate flexor tenosynovial hypertrophy bilaterally. Parents reported mild subjective improvement of dexterity and fine motor skills postoperatively. CONCLUSION: To optimize functional outcome, routine screening for CTS and intervention at an early age are emphasized in the mucopolysaccharidoses population.