Updated review of traumatic dislocation of the mandibular condyle into the middle cranial fossa

Publication date: Available online 20 September 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): João Luiz Gomes Carneiro Monteiro, José Alcides Almeida de Arruda, Amanda Regina Silva de Melo, Ricardo Jorge Vasconcelos Barbosa, Suzana Célia de Aguiar Soares Carneiro, Belmiro Cavalcante do Egito Vasconcelos

Abstract

Purpose

Traumatic dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) is a rare event following maxillofacial trauma. Treatment may be a closed or open reduction (with or without craniotomy) and arthroplasty procedures might be necessary for long-standing cases. The aim of the present study was to perform an integrative review of traumatic DMCCF cases reported in an electronic database, and to report a case in which cerebrospinal fluid (CSF) leakage occurred after open treatment.

Patients and Methods

The study was carried out in two phases. In the first part, an electronic search was undertaken in Medline (via PubMed) in April/2018, with 52 articles being included. In the second, we report a case in which CSF leakage occurred trough the external auditory canal following open reduction of the mandibular condyle into the middle cranial fossa in a 22-year-old male patient, with a follow-up of 5 months.

Results

A total of 59 cases were included. Most patients were females (69%), the right condyle was mostly affected, and traffic accidents (53%) were the main etiology. A closed treatment was ideally performed within 2 weeks of intrusion. An open treatment was required for cases with ≥2 weeks of impaction. Types of open treatment were: open reduction, condylectomy, condylotomy or temporomandibular joint reconstruction with alloplastic implants. The glenoid fossa was reconstructed in 28 cases, and a temporalis muscle flap with or without bone grafts was the main choice. Despite the treatment option used, mandibular deviation during opening occurred in 41% of cases. Rare complications include persistent facial paralysis, persistent hearing loss on the affected side, increased cerebral contusion after reduction, and postoperative pneumocephalus.

Conclusion

Cases of DMCCF require a multidisciplinary approach based on the expertise of both maxillofacial and neurological surgeons. Close monitoring is extremely important to mitigate complications.

https://ift.tt/2PU1FWl