Dislocation of the condyle into the middle cranial fossa.

Surgical intervention by a preauricular approach appears to be the preferred treatment in this rare injury. It does not appear necessary or wise to disimpact the condyle as it presents more of a surgical risk and its presence in the cranial fossa seems to pose no neurological problems. The use of an interposing medium, placed after the teeth are secured in occlusion, appears to be definitely indicated to prevent ankylosis and, hopefully, to eliminate deviation of the mandible. A carved piece of Silastic, designed to conform to the recontoured roof of the glenoid fossa, has produced excellent results in cases of ankylosis; it served well in this case. Silastic has the advantages of being easy to carve, it may be attached to the rim of the fossa, and it is extremely nonirritating; it eventually becomes encased in a fibrous capsule.