Mandibular Condyle Dislocation Into the Middle Cranial Fossa: A Case Report and Review of Literature

Superior Dislocation of the Mandibular Condyle into the Middle Cranial Fossa: A Comprehensive Review of the Literature

The superior dislocation of the condyle into the cranium occasionally requires invasive procedures due to the absence of a timely diagnosis. This review analyzed the available clinical data to provide information on treatment decisions. The reports were assessed using electronic medical databases from inception to 31 October 2022. A total of 116 cases from 104 studies were assessed; among the patients, 60% and 87.5% of the affected women and men required open reduction, respectively. The ratio of closed to open procedures within 7 days after injury was maintained; however, closed reduction decreased over time, and all cases required open reduction after 22 days. Eighty percent of the patients with a total intrusion of the condyle required open reduction, whereas the frequency for both procedures was comparable in the remaining patients. Open reduction was significantly more frequently performed for men (p = 0.026, odds ratio; 4.959, 95% confidence interval; 1.208-20.365) and less frequently performed in cases with partial intrusion (p = 0.011; odds ratio: 0.186; 95% confidence interval: 0.051-0.684); the frequency varied according to the time until treatment (p = 0.027, odds ratio; 1.124, 95% confidence interval; 1.013-1.246). Appropriate diagnostic imaging and prompt diagnosis are indispensable for minimally invasive treatment of this condition.

Maxillofacial trauma in children: Association between age and mandibular fracture site

PURPOSE

To describe the association between age and location of facial fractures in the pediatric population.

MATERIALS AND METHODS

A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) from the 2016 Kids' Inpatient Database (KID) in children aged ≤18 years was conducted. International Statistical Classification of Diseases, 10th Revision (ICD-10) codes were used to extract facial fracture diagnoses. Logistic regression was used to evaluate and compare the contribution of various demographic factors among patients who had different types of facial fractures.

RESULTS

A total of 5568 admitted patients were identified who sustained any type of facial bone fracture. Patients who had facial fractures were significantly more likely to be male (68.2% versus 31.8%; p<0.001) and were older with a mean age of 12.86 years (95% confidence interval [CI]: 12.72-12.99). Approximately one-third of patients with a facial fracture had a concomitant skull base or vault fracture. Maxillary fractures were seen in 30.9% of the cohort while mandibular fractures occurred in 36.9% of patients. The most common mandibular fracture site was the symphysis (N=574, 27.9% of all mandibular fractures). Condylar fractures were more common in younger children while angle fractures were more common in teenagers. Regression analysis found that age was the only significant contributor to the presence of a mandibular fracture (β=0.027, p<0.001) and race was the only significant contributor to maxillary fractures (β=-0.090, p<0.001).

CONCLUSIONS

Facial fractures increase in frequency with increasing age in children. The mandible was the most commonly fractured facial bone, with an age-related pattern in fracture location.

Temporomandibular Joint Disorders: A Pictorial Review

Temporomandibular joint (TMJ) disorders are commonly encountered in the general population but often ignored or unrecognized. The detection and characterization of lesions has drastically improved over the years due to technological advances in cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI). However, adequate knowledge of the normal imaging appearance on different imaging modalities as well as the broad variety of pathology is required to provide a proper radiologic assessment. This pictorial review focuses on TMJ pathology and its appearance on CBCT and MRI. A short overview of the technical aspects and normal anatomy are provided to round out this complete summary on the subject.

Chronic Long-Standing Temporomandibular Joint Dislocation: Report of Three Cases and Review of Literature

Purpose

To present three cases of chronic long-standing TMJ dislocation and discuss our treatment protocol with other options in the literature.

Patients and methods

Three cases of chronic TMJ dislocation (more than 4 months) that has never been reduced previously were treated by open reduction, meniscectomy or meniscoplasty and lateral pterygoid muscle myotomy. After a short period of MMF, TMJ physiotherapy was performed.

Results

During 3 years of follow-up, the condition had not recurred at all and all patients were functional and symptom free.

Conclusion

Based on other therapeutic options in the literature, our treatment protocol seems to be an effectual operation with fewer complications.

Delayed Management of Unrecognized Bilateral Temporomandibular Joint Dislocation: A Case Report

Temporomandibular joint (TMJ) dislocation is a common occurrence, but diagnosis can be missed if patients do not complain. Delayed presentation complicates the management of a straightforward reduction. We present a case of a 24-year-old man who had bilateral TMJ dislocation of unknown duration after motor vehicle accident. The accident left him bedridden with speech difficulty. He was totally dependent on Ryles' and percutaneous endoscopic gastrotomy tubes for feeding. Computed tomography revealed dislocation of condyles anterior to articular eminences. The bilateral TMJ dislocations were reduced surgically via bicoronal with preauricular extension approaches. However, the surgery was challenging due to tissue changes around the joint accompanied by masticatory muscles atrophy. Postoperatively, he was placed on intermaxillary fixation for 2 weeks followed by elastics training. Three months later, the patient's mastication returned completely to function. Delayed management of bilateral TMJ dislocation is undoubtedly challenging and somewhat frustrating; nevertheless, we manage to achieve satisfactory outcome in improving the patient's quality of life.

A Conservative Surgical Approach in the Management of Longstanding Chronic Protracted Temporomandibular Joint Dislocation: A Case Report and Review of Literature

Chronic protracted dislocation of the TMJ is a relatively uncommon but extremely unpleasant and distressing condition for a patient. It is also particularly challenging and difficult to treat as it worsens with time due to continuing spasm of the masticatory muscles and progressive fibrosis, adhesions and consolidation in and around the dislocated joint. No definite guidelines or treatment protocols have been laid down in literature till date, towards management of such dislocations. A range of extensive and invasive surgical procedures such as eminectomy, condylectomy, menisectomy, and various osteotomies of the mandibular ramus and body have been performed to reduce these dislocations. A chronic longstanding unilateral TMJ dislocation in a 64-year-old woman was managed successfully and effectively using a modified, rather conservative surgical technique. The aim was to reduce the dislocated condyle (without excessive manipulation of the intra-articular space or extra-articular joint components); and at the same time, to limit further excessive translation of the condyle and restore physiological TMJ biomechanical constraints, to prevent future recurrence. This was achieved by surgically exposing the dislocated joint and manipulating the anterosuperiorly positioned condyle back into the glenoid fossa, aided by a downward distraction of the mandible; followed by soft tissue tethering of the meniscus and fibrous capsule of the joint to the temporal fascia above. The procedure yielded excellent results without any functional limitations or recurrence, and can hence constitute a viable and effective treatment option which can be attempted prior to resorting to the more invasive surgical procedures as described in literature.

A Case of Glenoid Fossa Fracture, Progressive Ankylosis, Total Joint Reconstruction with Alloplastic Prosthesis to Normalized Function Including Evaluation with F18-PET/CT-a Four Year Follow-up

Temporomandibular joint replacement (TJR) with alloplastic prosthesis has shown promising long-term results in end stage joint disorders. We present a case of young woman with painful ankylosis that where reconstructed with TJR, due to a complex mandibular fracture with dislocation of the left condyle into the middle cranial fossa two years earlier. At the age of 18 the subject underwent a total joint replacement with custom-made alloplastic TMJ prosthesis. To determine the bone response and remodeling activity around the prosthesis, a F18 PET/CT-scan was used. No sign of increased remodeling or pathology were seen in the imaging after the reconstruction. Four years postoperatively the subject reports no pain and excellent jaw function.

Temporomandibular joint dislocation

Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and can be managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss the comprehensive review of the different treatment modalities in managing TMJ dislocation.

Bilateral temporomandibular joint dislocation in a 26-month-old child: A rare emergency

Bilateral temporomandibular joint (TMJ) dislocation is very rare in children with only three cases previously reported in the literature. We report a case of a 26-month-old female child who presented to the emergency department of a tertiary care hospital with complaints of inability to close her mouth and drooling of saliva for the last two hours. Clinical examination and X-ray of the TMJ revealed bilateral TMJ dislocation. Bilateral TMJ reduction was achieved with the Hippocratic method after giving analgesia and procedural sedation. The child was able to close her mouth post-reduction, and was discharged with post-TMJ reduction instructions given to the mother and with maxillofacial clinic follow up. Our report is the first case of a child presenting to the emergency department with bilateral TMJ dislocation.

An alternative surgical procedure for anterosuperior dislocation of intact mandibular condyle

Superolateral and anterolateral dislocations of the intact mandibular condyle can be easily overlooked because of their rarity among maxillofacial injuries. In this report, we present the surgery of delayed anterosuperior dislocation of intact mandibular condyle into the temporal fossa. A 17-year-old adolescent girl with anterosuperior dislocation of left intact condyle and associated mandible and zygomatic body fracture underwent surgery 33 days after trauma because of priority accompanied life-threatening intracranial and intra-abdominal injuries. Temporalis muscle shortening with soft tissue attachment prevented closed reduction of the temporomandibular joint; therefore, the temporalis muscle was divided from its insertion on coronoid in a process that, to our knowledge, has never before been described. Although good occlusion was achieved at operation, open bite deformity and laterognathism were observed at the sixth month of follow-up.

Features and management of intracranial mandibular condyle dislocation after trauma

BACKGROUND

Dislocation of the mandibular condyle into the middle cranial fossa is rare in clinics. It often occurs when the mouth is open wide during the injury. It causes restriction of mandibular motion, lower facial asymmetry, pain in the temporomandibular joint (TMJ), etc.

OBJECTIVE

To introduce the features of intracranial mandibular condyle dislocation and discuss the management to this kind of trauma.

MAJOR FINDINGS

In this paper, the authors present two cases, describing the diagnosis, surgical management, and 1-year follow-up evaluation. The results of the authors' treatment to intracranial mandibular condyle dislocation were satisfactory and stable, and no surgical complications were detected.

CONCLUSION

Advanced imaging studies are mandatory for exact diagnosis and successful treatment of intracranial mandibular condyle dislocation, and individualized management is recommended.

Dislocation of the mandibular condyle into the middle cranial fossa: a case report

INTRODUCTION

A 32-year-old woman was admitted to our hospital following a motor vehicle accident. Her chief complaint was severe limited mouth opening and unilateral open bite on the left.

METHODS

Axial and coronal CT scans showed penetration of right condyle into the middle cranium through the fractured roof of glenoid fossa. A craniotomy exactly above the glenoid fossa was done.

RESULTS

The condyle was reduced and the glenoid fossa was reconstructed.

CONCLUSION

On postoperative follow-up at 6 months, the patient had no complaint, but there was a small deviation to the affected side on opening.

Traumatic dislocation of intact mandibular condyle into middle cranial fossa

INTRODUCTION

A 10-year-old girl presented to the Emergency Department with temporomandibular joint pain, malocclusion, and trismus after a bicycle accident.

METHODS

CT of the temporal bones showed displacement of the right mandibular condyle into the middle cranial fossa with small intraparenchymal hemorrhage. The condyle was reduced using closed reduction technique and the patient was placed in maxillomandibular fixation.

RESULTS

Complete reduction of the displaced condyle with resultant normal occlusion and persistent bony defect in the temporal bone.

CONCLUSION

In early follow-up assessments the patient has had complete resolution of symptoms with residual bony defect from the site of fracture in the temporal bone.

Complications in pediatric facial fractures

Despite recent advances in the diagnosis, treatment, and prevention of pediatric facial fractures, little has been published on the complications of these fractures. The existing literature is highly variable regarding both the definition and the reporting of adverse events. Although the incidence of pediatric facial fractures is relative low, they are strongly associated with other serious injuries. Both the fractures and their treatment may have long-term consequence on growth and development of the immature face. This article is a selective review of the literature on facial fracture complications with special emphasis on the complications unique to pediatric patients. We also present our classification system to evaluate adverse outcomes associated with pediatric facial fractures. Prospective, long-term studies are needed to fully understand and appreciate the complexity of treating children with facial fractures and determining the true incidence, subsequent growth, and nature of their complications.

Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation

BACKGROUND

Virtually all the articles in literature addressed only a specific type of dislocation. The aim of this review was to project a comprehensive understanding of the pathologic processes and management of all types of dislodgement of the head of the mandibular condyle from its normal position in the glenoid fossa. In addition, a new classification of temporomandibular joint dislocation was also proposed.

METHOD AND MATERIALS

A thorough computer literature search was done using the Medline, Cochrane library and Embase database. Key words like temporo-mandibular joint dislocation were used for the search. Additional manual search was done by going through published home-based and foreign articles. Case reports/series, and original articles that documented the type of dislocation, number of cases treated in the series and original articles. Treatment done and outcome of treatment were included in the study.

RESULT

A total of 128 articles were reviewed out which 79 were found relevant. Of these, 26 were case reports, 17 were case series and 36 were original articles. 79 cases were acute dislocations, 35 cases were chronic protracted TMJ dislocations and 311 cases were chronic recurrent TMJ dislocations. Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation. Various treatment modalities are outlined in this report as indicated for each type of dislocation.

CONCLUSION

The more complex and invasive method of treatment may not necessarily offer the best option and outcome of treatment, therefore conservative approaches should be exhausted and utilized appropriately before adopting the more invasive surgical techniques.

Dislocation of a fractured mandibular condyle into the middle cranial fossa: a case treated by an extracranial approach

INTRODUCTION

Penetration of the mandibular condyle into the middle cranial fossa is a rare complication usually due to blunt traumas to the chin. Particular anatomical and dynamic conditions can lead to the intracranial dislocation of the condyle in spite of the fracture of the condylar neck that usually prevents this event from dissipating the kinetic force of the impact.

DISCUSSION

We report the case of a 10-year-old female patient suffering from symphyseal and bilateral condilar fracture with intrusion of the left condyle into the middle cranial fossa. The diagnosis of intracranial dislocation was initially missed because of the nonspecific symptomatology and insufficient radiologic data provided by conventional investigations (plain X-rays and panoramic views). The persistence of the limitation of the mouth opening and the worsening of the preauricular pain with irradiation to the temporal region led us to perform further radiological investigations (computed tomography scan and magnetic resonance imaging) that revealed the intracranial complication. A successful removal of the displaced condyle was carried out through an extracranial approach, and at a 3-year follow-up temporomandibular joint function is satisfactory.

CONCLUSION

The case is reported to emphasize the need for careful radiological investigation in case of condylar fractures and the effectiveness of the extracranial route to surgically treat these rare complications.

Dislocation of the mandible into the middle cranial fossa. Case report

Dislocation of the mandibular condyle into the middle cranial fossa is a rare event due to anatomical and biomechanical factors. The authors report the case of a 12-year-old girl who presented with this condition after colliding with a classmate. One day after her injury, the patient demonstrated an inability to close her mouth completely, and she had minor tenderness to palpation anterior to the tragus, without neurological deficits. Imaging studies demonstrated a fractured glenoid fossa with intrusion of the mandible into the cranial cavity. Open reduction of the mandibular condyle was performed, and the glenoid fossa was reconstructed with a split-thickness bone graft and titanium screws. Several dural tears noted at the time of surgery were repaired primarily. Mandibular condyle dislocation into the middle cranial fossa is often misdiagnosed initially because of its low incidence and nonspecific symptoms. Computed tomography scanning is the most sensitive diagnostic study for detecting this injury. Closed reduction after induction of general anesthesia has been recommended in recently suffered injuries without neurological deficits, but this approach may overlook damage to intracranial structures. Surgical repair is recommended if neurological injury is suspected. Treatment options should be tailored to the individual factors of each case.