Trauma to the temporomandibular joint (TMJ) in pediatric patients presents unique diagnostic and therapeutic challenges because of the dynamic nature of craniofacial growth and the anatomic differences between children and adults. This review of epidemiology, mechanisms of injury, developmental implications, and management strategies for pediatric TMJ trauma emphasizes the importance of early diagnosis and prevention. Pediatric TMJ trauma differs significantly from adult cases because of variations in anatomy, physiology, and developmental stages. The pediatric facial skeleton is more elastic and less ossified, which alters the presentation and treatment of maxillofacial injuries. These differences necessitate tailored approaches to diagnosis and management to prevent long-term complications such as facial asymmetry, malocclusion, and impaired mandibular growth. Maxillofacial fractures in children account for a relatively small proportion of all facial injuries but exhibit distinct patterns. The mandible is the most frequently affected site, with condylar fractures being particularly common because of the biomechanical forces transmitted during trauma. Iida and Matsuya reported that pediatric facial fractures comprise 1% to 15% of all fractures in children, with falls being the predominant cause in those under 6 years of age.

The mechanism of injury plays a critical role in determining fracture type. Direct trauma to the chin often results in bilateral condylar fractures, while lateral impacts may cause unilateral injuries or dislocations. The presence of unerupted dentition and increased bone elasticity in children contributes to unique fracture patterns, such as greenstick fractures and condylar neck involvement. The mandibular condyle serves as a secondary growth center, contributing to mandibular length and symmetry through endochondral ossification. Trauma to this region during critical growth periods can disrupt normal development, leading to asymmetry or hypoplasia. Children under 10 years of age are particularly vulnerable to growth disturbances following condylar injury. Zimmermann and colleagues emphasized the adaptive nature of condylar cartilage, which responds to functional loads and environmental factors during development. Misalignment or restricted mobility resulting from trauma can redirect growth patterns, underscoring the importance of accurate diagnosis and timely intervention.

TMJ trauma in children is rarely isolated and often coexists with dental injuries, soft tissue trauma, or additional mandibular fractures. High-energy trauma may also result in systemic injuries such as head trauma or cervical spine involvement, necessitating a multidisciplinary approach to care. Clinical signs of TMJ trauma in children may be subtle, including preauricular swelling, limited jaw movement, deviation during opening, and pain during mastication. Because of the child’s adaptive musculature and potential for spontaneous remodeling, symptoms may not be immediately apparent, leading to delayed diagnosis.

Beyond clinical outcomes, pediatric TMJ trauma can have significant socioeconomic implications. Repeated medical visits, imaging, and potential surgical interventions place financial and emotional burdens on families. Facial deformities resulting from untreated trauma may also affect psychosocial development and self-esteem during adolescence.

Preventive strategies are essential to reduce the incidence of pediatric facial trauma. These include parental education, safe play environments, and the use of protective gear during sports and recreational activities.

Pediatric TMJ trauma requires careful evaluation and management because of its potential impact on craniofacial growth and long-term function. Early diagnosis, appropriate treatment, and preventive measures are critical to minimizing complications and ensuring optimal outcomes for affected children.

Understanding the anatomy and pathophysiology of the pediatric TMJ is essential for appreciating the vulnerability of the condyle to trauma and the consequences of injury during growth. The TMJ is one of the most complex synovial joints in the body, functioning in hinge and gliding motions that facilitate mastication, speech, and respiration. In children, this joint is a mechanical articulation and a critical growth site, undergoing continuous remodeling and adaptation. Trauma to the TMJ during early development can therefore disrupt structure and function, with consequences that extend into adolescence and adulthood. The TMJ consists of the mandibular condyle, glenoid fossa of the temporal bone, fibrocartilaginous articular disc, and supporting capsule and ligaments. In children, the condyle is largely cartilaginous, with secondary ossification centers that contribute to mandibular length and symmetry. Morphologic variability in the shape and contour of the mandibular condyle influences susceptibilities to fracture and remodeling capacity. The condylar head is relatively small in young children, and the thin cortical bone surrounding a cartilaginous core provides limited resistance to traumatic forces.

The pediatric glenoid fossa is shallower and less developed than in adults, which alters the biomechanics of joint loading. A shallow fossa may predispose the condyle to displacement or subluxation following trauma, but it also allows a degree of adaptation. The articular disc, composed of dense fibrous connective tissue, functions as a cushion between the condyle and temporal bone. In children, this disc is more elastic, enabling energy dissipation but also potentially complicating potential injury patterns Surrounding the joint is a capsule reinforced by the temporomandibular, sphenomandibular, and stylomandibular ligaments, which stabilize the condyle during functional loading. It is important to note, however, that these structures are not fully mature in children, limiting their ability to resist excessive translational forces. The mandibular condyle serves as an articular surface and a growth site. Unlike primary growth centers, the condyle functions as a secondary growth center that responds to environmental and functional demands. This capacity for adaptation provides a remarkable ability for pediatric patients to recover from condylar trauma. Experimental work in rhesus monkeys demonstrated that condylar fractures could remodel substantially over time. However, the remodeling potential is limited. Severe fractures, ankylosis, or displacement of the condyle out of the glenoid fossa can compromise the adaptive process.

A patient’s age is a critical determinant of remodeling potential. Younger children generally demonstrate greater plasticity, with the capacity for near-complete recovery following minor condylar fractures. As skeletal maturity approaches, this capacity diminishes. The timing of trauma associated with the time of growth spurts is particularly important. The biomechanics of condylar injury in children reflect external force vectors and the intrinsic properties of the developing mandible. Blunt trauma to the chin transmits force posteriorly along the mandibular body, concentrating stress at the condylar neck. In children, the relative weakness of this region makes it the most common fracture site. The condylar head may deform or sustain greenstick fractures rather than complete cortical disruption. Immediate consequences of condylar trauma include hemorrhage, inflammation, and disruption of the fibrocartilaginous surface. Depending on severity, the injury may result in fracture, dislocation, or contusion. Inflammatory mediators can initiate fibrosis, which may progress to ankylosis. Healing depends on early mobilization, proper alignment, and prevention of intra-articular adhesions.

Trauma can also interfere with the vascular supply of the condyle. The pediatric condyle receives its blood supply primarily from the posterior and inferior attachments, which are vulnerable during fractures or dislocations. Vascular compromise may result in ischemic necrosis and impaired remodeling. One of the most significant consequences of pediatric condylar trauma is interference with mandibular growth. Unilateral injury may produce facial asymmetry, while bilateral injuries can result in mandibular retrognathia and class II malocclusion. These outcomes illustrate the long-term implications of condylar trauma for craniofacial development. Mechanical stimulation promotes remodeling, while abnormal loading patterns may perpetuate dysfunction. Altered occlusal relationships following trauma can redirect mandibular growth trajectories. These anatomic features highlight the importance of functional rehabilitation in management of TMJ injuries.

A comprehensive evaluation of pediatric TMJ trauma is essential for accurate diagnosis and effective management. The American Academy of Pediatric Dentistry (AAPD) emphasizes a structured approach that begins with a detailed history and screening for symptoms such as pain, joint sounds, and functional limitations. Clinicians are encouraged to palpate the masticatory muscles and TMJ capsules, assess mandibular range of motion, and document occlusal relationships. Incorporating AAPD guidelines into clinical practice ensures that pediatric patients receive developmentally appropriate care. Early identification of dysfunction and timely intervention can mitigate long-term consequences such as chronic pain, facial asymmetry, and occlusal disturbances. This integrative approach complements the anatomic and pathophysiological understanding of TMJ trauma, reinforcing the need for structural and functional assessment in growing children. Imaging plays a pivotal role in diagnosis, particularly when joint degeneration, asymmetry, or persistent symptoms are suspected.

A study by Leuin and colleagues, studied the 10-year follow up of 164 pediatric patients with condylar and subcondylar fractures of the mandible. This study concluded that female patients were more likely to have TMJ dysfunction. Also, bilateral condylar fractures resulted in more complex treatment such as closed reduction. It is consistent with the findings of most studies that pediatric TMJ injuries tend to require careful evaluation considering the patient is still growing.

Accurate diagnosis of TMJ trauma in children is critical to ensuring proper management and preventing long-term sequelae. Unlike adults, pediatric patients present with unique anatomic considerations and clinical features that can complicate recognition of condylar fractures or dislocations. Additionally, the radiographic evaluation of the developing TMJ poses challenges because of ongoing growth, incomplete ossification, and the need to minimize radiation exposure in children. Diagnosis therefore requires a thoughtful integration of history, clinical examination, and judicious use of imaging modalities, tailored to the pediatric context.

Initially, a complete medical history, dental history, and description of the traumatic event should be obtained. TMJ injuries can occur because of a direct blow to the temporomandibular region, or a blow to the mandible that transfers the force to one or both joints. Therefore, it is helpful to determine the mechanism of injury, including the energy and force vector of the object that caused the injury and the time of onset during the history taking. The history provided by patients or parents/caregivers of a macrotrauma such as a motor vehicle accident or sports injury tends to be more accurate than the history of microtraumas such as those that occur during bruxing or clenching one’s teeth. ^, The practitioner should also elicit associated symptoms such as pain, difficulty in mastication, restricted opening, or deviation of the mandible during function. ^, In children, parents or caregivers may report behavioral cues, including refusal to eat, irritability, or avoidance of jaw movement, which may indicate underlying joint injury. Another important consideration when taking the history of the trauma is the possibility of child abuse. More than 50% of child abuse cases present with craniofacial, face, head, and neck injuries. If the history provided by the parent/caregiver is not consistent with the injury, medical and dental professionals in the United States are required to report suspected child abuse to the appropriate authorities.

On physical examination, signs of TMJ trauma may include preauricular swelling or ecchymosis in the external auditory canal. The examination should include extraoral and intraoral palpation of the TMJs and muscles of mastication, checking for pain and symmetry. Palpation during mandibular movements can also reveal irregular condylar translation, while auscultation may detect crepitus or clicking. Additionally, children who have experienced trauma to the TMJ may exhibit limited mouth opening, deviation of the mandible on opening, malocclusions, or an open bite in cases of condylar fractures or articular luxation. However, clinical findings alone are often insufficient to distinguish between fractures, dislocations, or soft tissue injuries, necessitating radiographic confirmation.

Imaging the pediatric TMJ is uniquely challenging because of technical and developmental factors. Young children may have difficulty remaining still during scans, leading to motion artifacts that compromise image quality. In addition, interpreting pediatric TMJ imaging requires familiarity with normal developmental variations. For instance, in a growing child, secondary ossification centers may appear irregular or fragmented during certain growth stages, which can mimic fracture lines. Furthermore, incomplete ossification can confound radiographic interpretation. ^,,

Clinicians must distinguish between normal variations and true pathology to avoid misdiagnosis.

In pediatric patients, radiation safety is an overriding concern, necessitating adherence to the as low as reasonably achievable (ALARA) principle and the as low as diagnostically acceptable being indication-oriented and patient-specific (ALADA-IP).

Panoramic radiography has historically been used as a first-line imaging tool for suspected pediatric TMJ trauma, because it provides a broad view of the mandible, condylar processes, and dentition with relatively low radiation exposure. ^, Although panoramic radiographs can reveal fractures of the condylar region, the sensitivity of panoramic radiography in identifying a sagittal splitting fracture of the condylar head was 50% compared to 90% for a condylar neck fracture in a study by Cho and colleagues

Moreover, the superimposition of structures reduces the diagnostic accuracy of panoramic radiographs in children. ^, If advanced imaging techniques are not available, Singer and Mupparapu and colleagues describe a technique using a panoramic image along with a reverse Towne view to view subcondylar fractures. In the context of TMJ trauma, panoramic radiographs are best regarded as a screening tool to guide further investigation rather than a definitive diagnostic modality.

Computed tomography (CT) remains the gold standard for evaluating complex condylar fractures and dislocations. Its ability to provide 3-dimensional details of the osseous anatomy allows for precise assessment of fracture location, displacement, and comminution. It is also useful in detecting small erosions and subtle morphologic changes.

Although the American Academy of Oral and Maxillofacial Radiology and the American Academy of Orofacial Pain recommend panoramic radiography as the initial imaging in patients who experience trauma, they recommend that cone beam CT (CBCT) imaging be used in cases of known or suspected mandibular condylar fractures. A study by Szczesniak and colleagues found that CBCT scans were comparable or superior to traditional CT scans in evaluating the osseous components of the TMJ with a substantially lower radiation dose. Chacon and colleagues found that the diagnostic accuracy of CT scans in diagnosing mandibular condylar fractures was 90%, with a sensitivity of 92% and a specificity of 87%. This was compared to panoramic radiographs with an accuracy of 73%, sensitivity of 70%, and a specificity of 77%. Schimming and colleagues found that conventional radiographs and CT scans were able to diagnose mandibular condyle fractures; however, the conventional radiographs were not as reliable in classifying fractures, particularly high condylar neck fractures.

There are concerns about radiation exposure during the use of CT in pediatric populations. Dose reduction strategies, including the use of low-dose protocols and field of view scans are essential.

With a lower cost than traditional CT scanners and the increasing availability of CBCT systems in private dental practices, it presents a practical diagnostic tool in cases in which clinical and panoramic findings suggest complex or displaced fractures, or when surgical planning is required.

Magnetic resonance imaging (MRI) offers unparalleled visualization of soft tissue structures, including the articular disc, retrodiscal tissue, and the joint capsule. In pediatric TMJ trauma, MRI is particularly valuable for identifying disc displacement, hemarthrosis, and early fibrotic changes that may predispose to ankylosis. Dwivedi and colleagues evaluated the use of MRI after acute condylar injuries and concluded that there is a significant relation between the degree of injury and an MRI finding of hemarthrosis. They also found that hemarthrosis alone does not result in long-term complications, but that hemarthrosis combined with disc displacement can lead to possible ankylosis. Cunha and colleagues state that “diagnosis of fibrous-ankylosis is possible with the use of MRI.” In addition to the value of MRI in the analysis of soft tissue changes caused by trauma of the TMJ, several authors emphasize the diagnostic ability of MRI with or without contrast in assessing the TMJ in patients with juvenile idiopathic arthritis. ^,,

The absence of ionizing radiation makes MRI especially attractive in pediatric imaging. Nevertheless, the need for patient cooperation, longer scan times, and higher cost may be barriers to its use. In younger children, sedation may be required, which introduces additional risks. For this reason, MRI may be reserved for cases where soft tissue pathology is suspected.

Although not traditionally employed for TMJ trauma, ultrasonography has gained interest as an inexpensive, noninvasive, radiation-free modality for pediatric assessment. It allows dynamic evaluation of condylar movement and can detect joint effusion or disc displacement in experienced hands. However, its diagnostic accuracy is operator-dependent, and it remains less reliable for identifying fractures compared with CT. ^, At present, ultrasonography is considered an adjunct rather than a primary imaging tool in TMJ trauma.

The management of TMJ trauma in children is particularly complex because of the dual role of the condyle as a functional joint structure and a mandibular growth center. Treatment decisions must balance immediate restoration of joint function with the long-term preservation of mandibular development and symmetry. Approaches to management range from conservative, nonsurgical modalities to open surgical interventions, with the choice determined by the patient’s age, fracture type, displacement, functional limitations, and risk of growth disturbances. ^,,

The overarching goals of treatment in pediatric TMJ trauma are to restore mandibular mobility, maintain normal occlusion, prevent long-term growth disturbances, and minimize the risk of ankylosis. Unlike adults, children often exhibit a remarkable capacity for remodeling, which supports the use of conservative approaches in many cases. However, not all injuries remodel predictably, and improperly managed fractures can lead to facial asymmetry, malocclusion, or joint dysfunction. Treatment must therefore be individualized, guided by the severity of injury and the developmental stage of the patient. ^,

Closed management remains the cornerstone of treatment for many pediatric condylar fractures. That closed reduction, consisting of functional therapy and early mobilization, allows the condyle to remodel along growth trajectories while avoiding surgical risks. Techniques may include soft diets, physiotherapy, guiding elastics, or short-term maxillomandibular fixation (MMF) in selected cases. ^,,

The conservative treatment of unilateral condylar fracture discussed in the article by Goel and colleagues emphasizes a nonsurgical approach tailored for pediatric patients, leveraging their high potential for bone remodeling. In the reported case of an 8-year-old girl, the treatment involved initial physiotherapy and a semiliquid diet, followed by orthodontic intervention using brackets and guiding elastics. This method facilitated functional stimulation of the temporomandibular joint, promoting natural healing and alignment without rigid fixation. The guiding elastics allowed controlled mandibular movement, minimizing discomfort and enhancing compliance. Over a 2-year follow-up, the patient showed complete functional recovery with no signs of relapse or ankylosis, highlighting the effectiveness of conservative therapy in managing pediatric condylar fractures while preserving growth potential and avoiding surgical risks.

Functional therapy, which encourages active mandibular movements, is particularly important in preventing intra-articular fibrosis and ankylosis. Elastic traction or occlusal splints may be used to re-establish normal occlusion and guide mandibular growth. Theologie-Lygidakis and colleagues, in their large retrospective study, reported favorable outcomes with nonsurgical treatment in most pediatric condylar fractures, underscoring the adaptive capacity of the growing mandible. One of the main advantages of conservative treatment is the avoidance of surgical risks, including facial nerve injury and interference with growth centers. However, conservative management is not without limitations. Displaced fractures, especially those with significant loss of ramus height or intra-articular displacement, may not remodel adequately, resulting in long-term asymmetry or functional impairment.

Surgical intervention is generally reserved for cases where conservative management is unlikely to yield satisfactory outcomes. Indications for open reduction and internal fixation (ORIF) in children include severely displaced fractures, bilateral condylar fractures with functional compromise, associated midfacial fractures requiring stable occlusion, and cases where conservative therapy fails. This is a controversial approach often chosen when there is significant dislocation or displacement in as pediatric condylar fracture. Some authors view ORIF as the treatment option for displaced and dislocated fractures, while other authors prefer other approaches.

One of the most debated topics in pediatric TMJ trauma management is the relative value of open versus closed treatment. Advocates for conservative therapy cite the condyle’s remodeling capacity and the risks of surgery, while proponents of ORIF argue that anatomic reduction reduces the likelihood of long-term asymmetry.

Recent literature reflects a shift toward individualized management protocols that integrate patient age, fracture severity, and functional demands. D’Alessandro and colleagues, in their literature review, noted that the trend is away from rigid adherence to either conservative or surgical methods, and toward a hybrid approach that emphasizes functional outcomes and long-term growth considerations. ^,,,

The timing of intervention is another area of debate. Although early mobilization is universally encouraged. prolonged immobilization risks ankylosis and impaired growth, and insufficient immobilization may compromise fracture healing. Current consensus favors minimal immobilization, with rapid transition to guided mobilization. Bera and colleagues note that pediatric condylar fractures require special consideration because of the ongoing growth and development of the jaw, which can influence treatment outcomes and long-term joint function. It highlights the lack of robust pediatric-specific data and calls for more focused research to guide clinical decisions in managing TMJ injuries in children.

The long-term consequences of temporomandibular joint trauma in pediatric patients can be profound, with outcomes extending far beyond the initial injury and acute treatment phase. Because the mandibular condyle is a joint surface and a major growth center, trauma sustained during development may affect mandibular function, symmetry, and overall craniofacial growth. Longitudinal studies and case reports have highlighted a spectrum of sequelae, ranging from complete functional recovery to severe deformity and recurrent ankylosis. Proffit and colleagues expressed concern regarding individuals who sustained undiagnosed condylar fractures as children. They found that 5% to 10% of patients presenting to their clinic with severe mandibular deficiency or mandibular asymmetry had previous mandibular condyle fractures. The authors add that contrary to the previous belief that future growth disturbances are more likely the younger the child is at the time of the injury, better regeneration occurs in patients younger than 12 years.

One of the unique aspects of pediatric condylar fractures is the capacity for adaptive remodeling. The developing condyle often undergoes partial or complete reshaping in response to functional demands after trauma. Functional outcomes vary widely depending on the severity of injury and the adequacy of management. According to an article by Steed and colleagues between the ages of 0 to 2 years, the condylar neck is “resistant to fracture,” and “the regenerative capacity is significant.” From age 3 to 12 years, there remains “an enormous potential for regeneration and remodeling,” and between the ages of 13 to 18 years, the ability to form new bone is present, and the “capacity for condylar remodeling” is diminished. Another example of the ability of condyles to remodel in pediatric patients is presented in a study by Chang and colleagues. They compared the remodeling capacity of patients under the age of 18 years with that of adults after conservative treatment of fractured mandibular condyles. The pediatric patients underwent complete remodeling, with the time frame dependent on the location of the fracture, whereas no remodeling was found in the adults. A complication noted in this study was the occurrence of ankylosis in 3 pediatric patients. Corroboration of the compensatory adaptation in children was found by Zhu and colleagues. Tuna and colleagues presented the case of a 10-year-old boy with a green-stick fracture of the left condyle. The patient was treated using closed reduction, and the patient wore a nonrigid mandibular splint for 1 month. Clinical and radiographic examinations after 27 months confirmed healing with reduction of the condylar head and remodeling of the condylar process. Similarly, in a retrospective study, Malinge and colleagues demonstrated that most children with unilateral or bilateral condylar fractures recovered near-normal function without surgical intervention, provided that early mobilization and functional therapy were applied. The results presented by Lekven and colleagues also found generally successful results of nonsurgical treatment; however, 26% of their patients had an unfavorable clinical outcome with a follow-up period of at least 2 years. All of the cases with unfavorable outcomes presented in patients with unilateral mandibular fractures, compared with no unfavorable outcomes in those with bilateral fractures. Similar to other studies, they found that radiographic evaluations showed complete remodeling in 87% of individuals, moderate remodeling in 9%, and poor remodeling in 4%.

Despite this adaptive capacity, remodeling and compensation are not universally reliable. Factors such as the degree of displacement and the need for surgical intervention may influence postoperative results. The review of literature presented by Esposito and colleagues found that in patients presenting with more significant fractures who were treated with surgical treatment, postoperative results included a deviation of the mandible on opening in 13% of patients and mandibular retrusion in 6%.

Giannakopoulos and colleagues described the following possible sequelae to TMJ trauma: facial asymmetry, malocclusion, growth disturbance, osteoarthritis, and ankylosis. Bottini and colleagues, agree with this assessment and add chronic pain to the list of possible negative results.

Ellis and colleagues evaluated the occlusion of 137 patients with unilateral fractures of the mandibular condyle treated with either open or closed procedures. They found that at the 6-week and 2- and 3-year periods there was a significantly higher percentage of poor occlusion in the closed treatment group. Awad and colleagues collected data on the post-traumatic complications of pediatric patients who had condylar fractures. Although they found that the most common complication was malocclusion, which occurred in 21 out of 186 patients, only 1 patient presented with facial asymmetry. Nys and colleagues studied sequelae of mandibular condylar fractures that were still present 6 weeks after the initial treatment. When they evaluated isolated condylar fractures, the complication reported most frequently was malocclusion, which was present in 20.2% of the patients. This percentage of malocclusion increased to 28.4% when an associated mandibular fracture was present. In another study by Al Hassani and colleagues that investigated complications after open reduction and internal fixation of mandibular condylar fractures, malocclusion presented in 14.7% of the patients, and 10.3% experienced restricted mouth opening. Another finding of this study was that 18.1% of the patients had transient facial palsy; however, all of these cases resolved completely in 5 months. In contrast to the previously mentioned studies describing malocclusion after TMJ trauma, Demianczuk and colleagues concluded that the percentage of patients who had experienced mandibular fractures as a child and subsequently required orthodontic treatment was similar to the percentage of children in the general population who had not experienced a fracture, but were receiving orthodontic treatment. The same study, however, found that 17% to 22% of patients who had experienced mandibular fractures between the ages of 4 and 11 years required future orthognathic surgery to correct facial asymmetry. Additional cases requiring orthognathic surgical intervention because of post-traumatic malocclusion were presented by Becking and colleagues. Twenty-one patients were treated surgically, with 20 successful results after 1 year. One patient who had presented initially with an anterior open bite experienced a recurrence of the open bite 3 months after surgery. In contrast to the previously mentioned studies, Lekven and colleagues noted no obvious mandibular or facial asymmetries after at least 2 years of follow-up in their patient population.

TMJ ankylosis represents one of the most severe and debilitating long-term complications of condylar trauma. It can occur as a sequela of a diagnosed condylar fracture but has also been reported after fractures that were overlooked at the time of the trauma. The condition severely restricts mandibular mobility, impairs mastication, and can significantly affect speech, appearance, and psychosocial development in children. ^,,

Case reports have demonstrated the diversity of ankylosis presentations. The ankylosis may be caused by bony, fibrous or fibro-osseous adhesions and may be present unilaterally or bilaterally. Ukwas and colleagues presented a case of a 5-year-old boy who presented with unilateral ankylosis after trauma. Akama and colleagues published a case of bilateral TMJ ankylosis in a 9-year-old boy. Prabhu and colleagues described a case of unilateral ankylosis in a 7-year-old girl who had the inability to properly open her mouth for 2 to 3 years. Additionally, Hegde and colleagues offered a case of unilateral ankylosis in a 12-year-old girl.

Once ankylosis develops, immediate surgical intervention is recommended. Kaban, Bouchard, and Troulis proposed a systematic approach for treating pediatric TMJ ankylosis beginning with excision of the ankylotic block and a coronoidectomy on the ankylosed side. This would be followed by distraction osteogenesis or a costochondral graft. Dowgierd and colleagues proposed a multistage treatment protocol tailored to the age of the patient and the severity of the ankylosis. These authors recommend gap arthroplasty with aggressive rehabilitation before the placement of a temporomandibular prothesis over the use of costochondral autografts. There are numerous additional reports of successful treatment of ankylosis using costochondral grafts, gap arthroplasty, and interpositional gap arthroplasty. ^,,,,,, Liu and colleagues performed a meta-analysis, which determined that interpositional gap arthroplasty was more effective than joint reconstruction or gap arthroplasty. A common theme in the articles is the importance of postsurgery physiotherapy.

Despite the successful treatment of ankylosis reported by many authors, Guven mentions high rates of repeat ankylosis. Additionally, Kalita and colleagues described a case of repeat ankylosis that resulted from trauma at the age of 6 years that required surgical intervention at the age of 11 years and again at the age of 21 years. Cho and colleagues illustrated the challenge of recurrent ankylosis in a case report, where repeated surgical procedures were necessary to maintain mandibular function in a growing child.

Though less common, TMJ trauma in children can also lead to unusual complications such as dislocation of the joint. Dhiman and colleagues described an unusual case of traumatic unilateral anterior dislocation of the TMJ in a 4-year-old female patient. The patient was managed successfully using closed reduction to relocate the condyle into the fossa under general anesthesia. Such cases underscore the variability of TMJ trauma outcomes and the importance of individualized treatment strategies.

Beyond physical complications, pediatric TMJ trauma can have lasting psychosocial effects. Children with facial asymmetry or restricted mandibular movement often experience social stigma, difficulties with speech, reduced self-esteem, anxiety, and depression. ^,, Chronic pain or functional limitation can impair quality of life well into adulthood. Thus, management should not only aim to restore joint function but also consider the broader developmental and psychosocial needs of the patient.

A consistent theme throughout the literature is the necessity for long-term monitoring of children with TMJ trauma. ^,,, Growth-related complications may not manifest until years after the injury, necessitating periodic clinical and radiographic evaluations. Bottini and colleagues recommend yearly follow-up until growth is complete. Multidisciplinary care, involving oral surgeons, orthodontists, pediatric dentists, and speech therapists, is often required to address the complex sequelae.