Traumatic dislocation of the mandibular condyle into the middle cranial fossa treated by an intraoral approach.

Dislocation of the mandibular condyle is one of several consequences of facial trauma that can be anticipated. The condylar neck is inherently weak and likely to fracture at the time of impact before dislocating into the middle cranial fossa. A review of the literature revealed that most cases of dislocation of the mandibular condyle into the middle cranial fossa are treated by open reduction and internal fixation via an extraoral approach or are treated conservatively with closed reduction. An intraoral approach is rare. Here we present a patient with traumatic dislocation of the mandibular condyle into the middle cranial fossa who was treated successfully by condylectomy and coronoidectomy through an intraoral approach and intermaxillary fixation followed by mouth-opening exercises and rehabilitation. Stable occlusion and movement of the mandible was achieved and the long-term results have been good. The intraoral approach may be an option in patients with traumatic dislocation of the mandibular condyle into the middle cranial fossa.

Endoscopically Assisted Middle Cranial Fossa Reconstruction Following Traumatic Intracranial Intrusion of the Mandibular Condyle.

Traumatic intracranial intrusions of the mandibular condyle are a rare injury pattern that carries significant morbid outcomes due to potential for neurological, otological, temporomandibular joint damage, or joint ankylosis. Treatment modalities involve either closed reduction, open approaches via transcranial or subtemporal approaches, or delayed total joint replacement. This paper presents a clinical report of a traumatic intracranial intrusion of the mandibular condyle treated with an endoscopically assisted preauricular approach to reconstruct the middle cranial fossa and temporomandibular articular disc. Endoscopically assisted techniques allow for minimally invasive and less morbid surgical interventions to this pathology, with greater precision than closed reduction techniques.

Superolateral dislocation of an intact mandibular condyle into the temporal fossa: case report and literature review.

Temporomandibular joint dislocation refers to the dislodgement of mandibular condyle from the glenoid fossa. Anterior and anteromedial dislocations of the mandibular condyle are frequently reported in the literature, but superolateral dislocation is a rare presentation. This report outlines a case of superolateral dislocation of an intact mandibular condyle that occurred in conjunction with an ipsilateral mandibular parasymphysis fracture. A review of the clinical features of superolateral dislocation of the mandibular condyle and the possible techniques of its reduction ranging from the most conservative means to extensive surgical interventions is presented.

Treatment Algorithm for Intracranial Intrusion Injuries of the Mandibular Condyle.

PURPOSE: Traumatic injuries of the mandible resulting in intrusion of the condyle into the middle cranial fossa are rare and treatment is often based on anecdotal experience. The objective of this study was to develop an algorithm for the management of condylar intrusion injuries by identifying factors that influenced the treatment decision of closed versus open reduction of the condyle. MATERIALS AND METHODS: This study was a systematic review of the literature on intracranial intrusion injuries of the mandibular condyle. A thorough search of the PubMed and Cochrane databases and individual maxillofacial and craniofacial journal databases was conducted using the Medical Subject Heading terms condylar impaction, condylar dislocation, condylar intrusion, and middle cranial fossa and condyle without date and language restriction. Quantitative data on the patient's age, gender, etiology of injury, and time from injury to diagnosis were analyzed using descriptive statistics. The authors studied how the predictor variables of age, etiology, time from injury to diagnosis, and associated neurologic injuries influenced the outcome variable of closed versus open reduction of the condyle. RESULTS: Forty-eight of the 62 retrieved case reports, case series, and review articles were published in the English-language literature from 1963 to 2015. Data on 51 patients with these injuries showed that 38 (75%) were female and younger than 30 years. The most common etiology of injury was motor vehicular accidents, occurring in 25 of 51 patients (49%). The mean time from injury to diagnosis was 31.2 days (0 to 106.4 days). Forty of the 51 patients (78%) were diagnosed within the first 2 weeks of injury. A good proportion of patients underwent open reduction (63%) and 18 of the 51 of patients (35%) underwent closed reduction. CONCLUSIONS: Predictor variables that influenced the treatment decision of open versus closed reduction were age of the patient, etiology of injury, and time from injury to diagnosis. Based on the present results, younger patients (0 to 15 yr old), patients who sustain condylar intrusion injuries from bicycle accidents, and those diagnosed within the first 2 weeks of injury are more likely to benefit from closed reduction. The treatment algorithm emphasizes the importance of assessment of associated neurologic injuries and an interdisciplinary approach for the management of these injuries.

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.

Removal of infratemporal fossa foreign body under C-arm.

A 12-year-old boy presented to our emergency department after being shot in the face. A computed tomographic scan revealed a bullet through the posterolateral wall of the maxillary sinus into the right infratemporal area, just adjacent to the skull base. We elected transantral approach with the help of endoscopy and C-arm. The bullet was successfully removed. Little is known on the best strategy for removing the infratemporal foreign body. Our experience in this case provides a safe and effective way for such injury.

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.

[Fracture of the glenoid fossa without mandibular condylar dislocation or fracture: two case reports]. / Mandibüler kondil çikigi ve kirigi olmaksizin glenoid fossa kirigi: Iki olgu sunumu.

The mandibular condyle region which protects the middle cranial fossa from facial and jaw traumas has an excellent osteomuscular structure. Condylar structures reduce or limit the force of trauma. Most importantly, the condylar neck is the weakest part of the mandible and is easily fractured without dislocation. Generally, this mechanism prevents condylar penetration into the middle cranial fossa; however, there are condylar penetration into the middle cranial fossa can be rarely. Glenoid fossa fractures without mandibular condylar fracture and dislocation can be made. In this article, we present two cases to assess the isolated glenoid fossa fractures of the temporal bone.

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.

Trauma to the intracranial internal carotid artery.

BACKGROUND: : A 4-year retrospective review of injury to the intracranial internal carotid artery at the skull base was undertaken to assess the impact of the injuries and their consequence in both the adult and the pediatric population. METHODS: : The trauma registry followed by confirmatory chart reviews provided the total number of admissions, the mode of injury, demographics, and subdivided the trauma patients into the different groupings used in this study. RESULTS: : In our series, traumatic damage to the intracranial internal carotid artery represented 1.495% of all facial trauma seen during a 4-year period at a Level I Trauma Center. Of the 10 patients seen with injury to the intracranial internal carotid artery at the siphon, 3 were pediatric patents, and all of these ended with permanent neurologic deficits. Adults fared better, exhibiting either no neurologic symptoms or transient neurologic symptoms that resolved over time. The exception was a patient who expired in the Emergency Center from a clival fracture involving transaction of both intracranial internal carotid arteries. CONCLUSIONS: : Traumatic damage to the intracranial internal carotid artery is a rare event fraught with the difficulty of early diagnosis in the midst of major life-threatening multiorgan trauma. Within the different age groups, adults fared better than children.

Transzygomatic extended middle fossa approach for upper petroclival skull base lesions.

Central skull base lesions in the upper retroclival and petroclival regions can be challenging to access because of their location anterior to the brainstem. Several transpetrosal approaches have been developed to access the petroclival junction, including anterior petrosal (anterior petrosectomy), posterior petrosal (retrolabyrinthine, translabyrinthine, transcochlear), and combined petrosal approaches. The anterior petrosal approach is best suited for upper petroclival lesions located anterior and superior to the internal auditory canal and superior to the inferior petrosal sinus. This approach provides direct access to the anteromedial cerebellopontine angle, petrous apex, Meckel cave, and ventrolateral brainstem between the trigeminal root and the facial nerve. The authors describe their modification of an anterior petrosal approach, the so-called transzygomatic extended middle fossa approach, which incorporates a zygomatic osteotomy, anterior mobilization of the V3, and extensive middle fossa drilling. This exposure provides a wider surgical corridor for direct view of the clivus and ventral brainstem.

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.

Arachnoid cysts: spontaneous resolution distinct from traumatic rupture. Case report.

Although many arachnoid cysts are discovered incidentally and require no intervention, a small subset has been known to rupture. Note that rupture can occur either spontaneously or in association with trauma. Based on a review of the literature on ruptured arachnoid cysts, it appears that patients with middle fossa cysts are more likely to experience symptomatic traumatic rupture than those with cysts in other locations. Middle fossa cysts are more commonly associated with hemispheric subdural collections and hematomas than are any other cysts. The authors report on two representative cases illustrating the distinct presentation, imaging characteristics, and management of these cysts.

Treatment of traumatic dislocation of the mandibular condyle into the cranial fossa: development of a probable treatment algorithm.

This study summarizes our experience of treating three rare cases of traumatic superior dislocation of the mandibular condyle into the cranial fossa and provides a potential treatment algorithm. Between the years 2002 and 2012, three patients with traumatic superior dislocation of the mandibular condyle into the cranial fossa were admitted to our department. After evaluating the interval from injury to treatment, the associated facial injuries including neurological complications, and the computed tomography imaging findings, an individualized treatment plan was developed for each patient. One patient underwent closed reduction under general anaesthesia. Two patients underwent open reduction with craniotomy and glenoid fossa reconstruction. All three patients were followed up for 1 year. Mouth opening and occlusal function recovered well, but all patients had mandibular deviation during mouth opening. Closed reduction under general anaesthesia, open surgical reduction with craniotomy, and mandibular condylotomy are the three main treatment methods for traumatic superior dislocation of the mandibular condyle into the cranial fossa. The treatment method should be selected on the basis of the interval from injury to treatment, associated facial injuries including neurological complications, and computed tomography imaging findings.

Management of traumatic dislocation of the mandibular condyle into the middle cranial fossa.

Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of facial trauma that can have neurological and life-threatening implications. This article discusses the anatomic features that predispose patients to this type of injury, as well as the clinical features and mechanism of injury for this rare type of condylar deformity, to help practitioners recognize this easily overlooked injury and avoid disastrous complications. The article summarizes previously published case reports of this rare complication of condylar trauma and presents a case for which initial diagnosis and a management protocol are described.

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.

A bullet in the maxillary antrum and infratemporal fossa.

A young male patient was shot from a revolver on his left temple from a close range, but surprisingly he survived. On imaging, a complete bullet was found occupying his left maxillary sinus and infratemporal fossa. The bullet, after hitting and breaking the neck of the mandible on the left side, ricocheted and entered the left maxillary sinus through its posterior wall. It was removed safely by a combination of sublabial antrotomy and endoscopic approach.

Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma.

Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma due to anatomical and biomechanical factors. Owing to the proximity of the temporal glenoid fossa to the middle meningeal artery, there is the risk of serious sequelae in case of trauma. The authors report the case of a 36-year-old male patient, who was beaten up in a family dispute and presented with complex mandibular and maxillofacial fractures, including mandibular condyle intrusion into the middle cranial fossa causing extensive meningeal bleeding. The patient underwent immediate surgery, with evacuation of the epidural haematoma via a temporal approach. In addition open reduction and reconstruction of the temporal glenoid fossa via anatomic reduction of the fragments was performed. A functional occlusion was re-established via miniplate reconstruction of the complex mandibular body and ramus fractures. Prompt diagnosis and a multidisciplinary approach are essential to minimize the complications. Advanced imaging modalities of computed tomography are indicated. Treatment options should be individualized in particular in case of suspected neurological injury.