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

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.