Radiological Healing Patterns and Functional Outcomes After Conservative Treatment of Unilateral Condylar Fractures: A Report of Two Cases

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The article titled "Can the radiological healing pattern be associated with functional recovery after conservative treatment of pediatric unilateral condylar fractures? A case series" addresses an important clinical question regarding the management of unilateral condylar fractures in pediatric patients. However, a few flaws have been observed and need to be clarified or corrected: 

1. The title appears to be overly ambitious in relation to the content of the article and does not clearly convey the specific focus or scope of the study. A case series - and you have only two cases? It points the reader in the wrong direction. 
2. I would recommend further developing the structure of the introduction by organizing the content in a more systematic manner. This will help to clearly outline the key concepts, establish the context of the research, and provide a more cohesive framework for understanding the study's objectives and significance. Please correct this.
3. Your exclusion and inclusion criteria should not be in a table, it is usually part of a text. I don't see a reason why it should be in the table, specially since you have 2 patients. 
4.  You only assessed two clinical parameters for TMJ function. I think it is too scarce, since there are: evaluating range of motion (e.g., jaw opening, lateral excursion, protrusion), pain (e.g., pain on palpation or jaw movement), jaw function (e.g., bite function, jaw deviations), TMJ sounds (e.g., clicking, popping, crepitus), muscle function (e.g., palpation of masticatory muscles, bite strength), joint mobility (e.g., tenderness, capsular tightness), neurological assessments (e.g., sensory or motor deficits), and the functional impact on daily activities, often supplemented by patient-reported outcome measures. Could you kindly provide additional information regarding the functional aspects of the temporomandibular joint (TMJ)?

The significance of the sample size in this study should be emphasized, as it plays a crucial role in the generalizability and robustness of the findings.

Author Response

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Reviewer 2 Report

Comments and Suggestions for Authors

Authors report a case series on the radiological healing pattern of unilateral pediatric condylar fractures after conservative treatment.

The chosen topic is important and relevant.

When a publication describes only two cases, it is incorrect to write "all included patients"; instead, it should say, for example, "both cases" (line 125, 421 etc).

Please modify line 127 to "(Figure 1 a-f)".

Based on the results obtained from two patients in this study, there is a need to conduct the same investigation on a larger patient population. If the low number of cases in a single center is a limiting factor, a multicentric study should be considered.

Why was the observation of occlusion and any potential midline deviation resulting from the injury not included as part of the clinical examination?

After answering the above questions and making minor modifications, I recommend the manuscript for publication.

Author Response

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Reviewer 3 Report

Comments and Suggestions for Authors

1. Consider expanding your sample, 2 cases is low.
2. Patient had two fractures? the 3D recon seems it has a symphysis fractures

Author Response

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Reviewer 4 Report

Comments and Suggestions for Authors

1.The study is titled as a “case series” but includes only two patients. A case series typically requires at least three cases; thus, this study should be more appropriately classified as a “case report.” The small sample size severely limits the study’s statistical power and generalizability. The authors should either increase the sample size or reclassify the study as a case report.

2.The abstract uses inconsistent terms to describe patient age (e.g., “growing patients” vs. “young patients”). The authors should standardize this terminology to avoid confusion and clearly define the patient population.

3.The abstract lacks information on follow-up duration after treatment, which is critical for assessing outcomes. Additionally, the term “unchanged” is ambiguous regarding whether it refers to pre-injury or post-injury status.

4.The Introduction section of the manuscript is poorly structured, with each sentence forming a separate paragraph. This format is unconventional and detracts from the clarity and flow of the text. A more concise and cohesive structure is recommended. The authors should briefly outline the prevalence of condylar fractures and the common use of conservative treatment, then quickly transition to the current knowledge gap. This approach will effectively set the stage for the study’s rationale and objectives.

5.The Methods section contains inconsistencies and redundancy in the description of the study population. Specifically, the text initially describes the study as involving two growing patients (<16 years old), but later presents inclusion and exclusion criteria.

Author Response

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Round 2

Reviewer 4 Report

Comments and Suggestions for Authors

The protocol described by Cesur et al. selects Region 1 as the condylar process; the subcortical area of the condyle. However, the region shown in the figures of this study is inconsistent with that in the reference. The rectangle seems to include the cortical bone and overlaps with the root of the zygomatic arch of the temporal bone.

Author Response

Comments 1: The protocol described by Cesur et al. selects Region 1 as the condylar process; the subcortical area of the condyle. However, the region shown in the figures of this study is inconsistent with that in the reference. The rectangle seems to include the cortical bone and overlaps with the root of the zygomatic arch of the temporal bone.

Response 1: We strongly agree with the reviewer's suggestion. Therefore, we have added a more explicative and pertinent image accordingly, so that the afore-mentioned ROI is more clear and visible. Please see figure 6 (page 8, lines 257-259) in the full text.