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World Neurosurg. 2016 Feb;86:514.e1-11. doi: 10.1016/j.wneu.2015.09.007. Epub 2015 Sep 11.

Intracranial Dislocation of the Mandibular Condyle: A Case Report and Literature Review.

Author information

1
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
2
Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA.
3
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA. Electronic address: odette@stanford.edu.

Abstract

BACKGROUND:

Intracranial dislocation of the mandibular condyle is an infrequent injury that can follow traumatic upward force at the chin. A limited number of cases have been reported, and an individualized approach for patients is often recommended. Nevertheless, several consistent strategies for reduction have emerged.

METHODS:

We present the case of a 20-year-old pregnant woman with multiple facial and skeletal injuries who required open reduction after a motor vehicle accident. We also reviewed the English literature for all reported cases of traumatic mandibular dislocation into the middle cranial fossa. The demographics, presentation, surgical approach, and follow-up were examined.

RESULTS:

A total of 52 cases were identified, with most events occurring in the younger and female population, usually after motor vehicle (54%) or bicycle trauma (25%). At least one neurological finding was reported in 60% of initial presentations. Most reductions required an open procedure (73%), for which either a preauricular or temporal approach was used at comparatively similar rates. Additional condylotomy or condylectomy was sometimes incorporated, but most open reductions were achieved by traction (62%). At follow-up, half of reporting patients noted persistent mandibular deviation and mean maximal opening was 37.7 mm.

CONCLUSIONS:

Appropriate surgical and nonsurgical approaches for addressing mandibular dislocation have emerged during the past several decades. When deciding on an optimal strategy, variables including patient age, time-to-diagnosis, accompanying injuries, prior failed maneuvers, and risk of resubluxation should be considered. Coordinated care between neurosurgery and otolaryngology teams can minimize complications and achieve successful reductions.

KEYWORDS:

Dislocation; Intracranial; Mandibular condyle; Middle fossa; Reduction

PMID:
26365884
DOI:
10.1016/j.wneu.2015.09.007
[Indexed for MEDLINE]

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