Updated Review of Traumatic Dislocation of the Mandibular Condyle Into the Middle Cranial Fossa

• Published in: Journal of oral and maxillofacial surgery Vol. 77; no. 1; pp. 132.e1 - 132.e16
• Main Authors: Monteiro, João Luiz Gomes Carneiro, de Arruda, José Alcides Almeida, de Melo, Amanda Regina Silva, Barbosa, Ricardo Jorge Vasconcelos, Carneiro, Suzana Célia de Aguiar Soares, Vasconcelos, Belmiro Cavalcanti do Egito
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2019
• Subjects: Cranial Fossa, Middle; Dentistry; Humans; Joint Dislocations; Mandibular Condyle; Mandibular Prosthesis; Reconstructive Surgical Procedures; Temporomandibular Joint
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2018.09.011

Traumatic dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) is a rare event after maxillofacial trauma. Treatment may be performed with closed or open reduction (with or without craniotomy), and arthroplasty procedures might be necessary for long-standing cases. The aims of this study were to perform an integrative review of traumatic DMCCF cases reported in an electronic database and to report a case in which cerebrospinal fluid leakage occurred after open treatment.
The study was carried out in 2 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 cerebrospinal fluid leakage occurred through the external auditory canal after 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.
A total of 59 cases were included. Most patients were female patients (69%), the right condyle was mostly affected, and traffic accidents (53%) were the main etiology. Closed treatment was ideally performed within 2 weeks of intrusion. Open treatment was required for cases with 2 or more weeks of impaction. The types of open treatment were open reduction, condylectomy, condylotomy, and 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 included persistent facial paralysis, persistent hearing loss on the affected side, increased cerebral contusion after reduction, and postoperative pneumocephalus.
Cases of DMCCF require a multidisciplinary approach based on the expertise of both maxillofacial and neurologic surgeons. Close monitoring is extremely important to mitigate complications.