Traumatic dislocation of the mandibular condyle into the middle cranial fossa in an elderly patient.

Dislocation of the mandibular condyle into the middle cranial fossa is a rare traumatic injury caused by transmission of upward force through the condyle onto the glenoid fossa resulting in fracture of the fossa and superior displacement of the condylar head. This type of injury occurs when the "safety mechanisms" of the mandible fail or are absent. The authors present the case of a 72-year-old female patient with multiple comorbidities who suffered a subcondylar fracture of the left mandible and dislocation of the right mandibular condyle into the middle cranial fossa after a fall. Bilateral external fixation of the mandible to the zygomatic arch was utilized to minimize operative time and provide definitive treatment. Many factors must be taken into account when determining the treatment modality for this type of injury, and the final decision should be tailored to each individual case based on several factors including the length of time between injury and presentation, concomitant neurologic deficit, age, and stability of the patient. The goals of treatment are reduction of the dislocation, avoidance of neurologic injury, and restoration of mandibular function. A multidisciplinary effort is necessary to optimize patient care.

CASE REPORT Removal of Exposed Titanium Reconstruction Plate After Mandibular Reconstruction With a Free Fibula Osteocutaneous Flap With Large Surgical Pin Cutters: A Case Report and Literature Review.

Locking reconstruction plates have led to significant improvement in osteosynthesis and graft anchorage in mandibular reconstruction following the free fibula osteocutaneous flap. Plate extrusion is the most common complication associated with mandibular reconstruction, occurring in approximately 20% to 48% of cases; often necessitating plate removal once the bone flap has united to the mandible. Radiation therapy is a known risk factor to the development of such a complication and it presents further challenges to the successful removal of the reconstruction plate. Several reports have been published regarding plate removal in the setting of orthopedics that describe the management of jammed or stripped locking screws, but few in the setting of mandibular reconstruction. In this case, we report the successful removal of an exposed titanium mandibular reconstruction plate from a 41-year-old woman 12 months after her initial reconstruction with a free fibula osteocutaneous flap and radiation therapy. The approach was selected because the chin and neck skin could not be expected to be raised for full plate exposure secondary to radiation-induced skin changes (thinning and friability). We also discuss the use of previously employed methods of plate removal in various settings as well as their inherent strengths and weaknesses.

CASE REPORT Simultaneous Latissimus Dorsi Myocutaneous Flap Transfer and Revision Total Knee Arthroplasty With Allograft Extensor Mechanism Reconstruction: A Case Report.

INTRODUCTION: We present the case of a patient undergoing simultaneous reconstruction of a massive soft tissue deficit of the right knee along with total knee arthroplasty and allograft reconstruction of the extensor mechanism after multiple failed attempts to repair and revise the affected joint. METHODS: A latissimus dorsi myocutaneous flap was transferred to fill the soft-tissue deficit of the right knee. During the same procedure, a previously placed antibiotic-cement spacer was removed and a new total knee prosthesis was implanted. What remained of the damaged extensor mechanism was excised and replaced with a cadaveric allograft. RESULTS: The latissimus dorsi flap provided the necessary soft-tissue coverage of the revision. The new knee components and allograft extensor mechanism were satisfactorily implanted. One year after simultaneous reconstruction, the knee remains functional and free of infection. DISCUSSION: Although current literature may have indicated conversion to arthrodesis or prophylactic soft-tissue repair prior to revision, simultaneous soft-tissue and extensor mechanism repair along with revision total knee arthroplasty have yielded promising results in this patient.