Case Report
Features and management of intracranial mandibular condyle dislocation after trauma Shilei Zhang, Jinyang Wu, Bing Xu, Jun Shi, Steve G. F. Shen, Haijun Gui Department of Oral and Cranio-maxillofacial Science, Ninth People’s Hospital, College of Stomatology, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, China Background: Dislocation of the mandibular condyle into the middle cranial fossa is rare in clinics. It often occurs when the mouth is open wide during the injury. It causes restriction of mandibular motion, lower facial asymmetry, pain in the temporomandibular joint (TMJ), etc. Objective: To introduce the features of intracranial mandibular condyle dislocation and discuss the management to this kind of trauma. Major findings: In this paper, the authors present two cases, describing the diagnosis, surgical management, and 1-year follow-up evaluation. The results of the authors’ treatment to intracranial mandibular condyle dislocation were satisfactory and stable, and no surgical complications were detected. Conculsion: Advanced imaging studies are mandatory for exact diagnosis and successful treatment of intracranial mandibular condyle dislocation, and individualized management is recommended. Keywords: Mandibular condyle dislocation, Middle cranial fossa, Glenoid fossa
Introduction Anterior dislocation of the mandibular condyle, which results from chronic dislocation of temporomandibular joints and condylar fractures caused by trauma are commonly seen,1–4 but it is rare to find dislocation of the mandibular condyle into the middle cranial fossa. Since 1960, only 49 cases of patients with intracranial dislocation of the mandibular condyle, including the cases in this study, have been reported in English literature.5–7 In this paper, the authors present two cases with discussion of etiology, clinical features, and surgical treatments.
(TMJ) tenderness, maximal mouth opening of 10 mm, premature occlusal of right posterior teeth, slight open bite of left posterior teeth, and fixation with arch bars. Coronal computed tomography (CT) scans (Fig. 1) and three-dimensional reconstructions illustrated that the right condyle penetrated into the middle cranial fossa through the glenoid fossa without condylar fractures. An open reduction of the dislocated condyle was attempted through a semicoronal approach. Intraoperatively, the articular disc was ruptured and displaced, the condyle was reduced successfully without any injuries to the brain, and
Clinical Reports Case 1 A 23-year-old woman, who was involved in a traffic accident and suffered the impact on her chin, complained of the restriction of mandibular motion and pain in the preauricular region, without loss of consciousness, nausea, or vomiting. She was referred to the authors’ department after an unsatisfactory treatment of intermaxillary fixation in the local hospital. Clinical examinations revealed a deviation of the chin to the right, right temporomandibular joint Correspondence to: B Xu, Department of Oral and Cranio-maxillofacial Science, Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Road, Shanghai 200011, China. Email: [email protected] ß W. S. Maney & Son Ltd 2014 DOI 10.1179/0886963413Z.0000000007
Figure 1 Coronal CT scan illustrates the dislocation of the right mandibular condyle and the relationship between the right mandibular condyle and middle cranial fossa.
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2014
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Features and management of intracranial mandibular condyle dislocation
Figure 2 Exposure of the right TMJ. The photograph illustrates the superiorly dislocated condyle (long white arrow) and the lateral rim of glenoid fossa (short white arrow).
the defect in the middle cranial fossa was repaired with calvarial bone. The disc was repositioned and repaired with a calvarial periosteum (Figs. 2–4). A postoperative coronal CT scan indicated that the right condyle was corrected successfully (Fig. 5). Satisfactory profile and stable occlusion were achieved postoperatively.
Figure 3 Fixation of the calvarial bone. The photograph illustrates the zygomatic arch (short black arrow), the ruptured articular disc (long black arrow), the condyle (long white arrow), and the calvarial bone (short white arrow) fixed to reconstruct the fossa. The small photograph shows the size of bone graft.
Case 2 A 39-year-old man suffered impact on his chin by accident and had no signs of neurological deficit. The patient was referred to the authors’ department after
Figure 4 Suturing the calvarial periosteum. The photograph illustrates the zygomatic arch (short white arrow) and the calvarial periosteum (long white arrow).
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Features and management of intracranial mandibular condyle dislocation
In both cases, close consultations with neurosurgery were made during the surgery to avoid additional brain damage. In the 1-year follow-up, clinical and radiographic examinations demonstrated that both patients had favorable profiles, stable occlusions, normal position of dislocated condyles, and good shapes of fractured glenoid fossa. The maximal mouth opening had stabilized at 41 mm in case 1 and 38 mm in case 2. No surgical complications were detected, including headaches or ipsilateral ankylosis. Figure 5 CT scan illustrates reduction of the right condyle and reconstruction of the middle cranial fossa, and the relationship between the right mandibular condyle and middle cranial fossa.
regular debridement in the local hospital, because he complained of difficulty opening his mouth. Clinical examinations revealed deviation of the chin to the left, preauricular pain and scars in the mental region. Intraorally, maximal interincisial distance was 12 mm. Edge-to-edge occlusion between the left posterior teeth and buccal cross-bite between the right posterior teeth were observed. Arch bars were fixed on the maxillary and mandibular teeth. Coronal CT scans illustrated intracranial dislocation of the left mandibular condyle through glenoid fossa and lateral dislocation of the right condyle, and no fracture of the condyle was found (Fig. 6). Through a standard preauricular approach, the left condyle was successfully reduced, and titanium mesh was fixed to reconstruct the glenoid fossa. The articular disc was ruptured totally and a temporal musculofascial flap was placed between the condyle and titanium mesh. The right condyle was replaced by a closed manipulation. Postoperative occlusion was satisfied.
Figure 6 Coronal CT scans illustrate intracranial dislocation of the left mandibular condyle through glenoid fossa and lateral dislocation of the right condyle.
Discussion Dislocation of the mandibular condyle into the middle cranial fossa is extremely rare. This infrequency could be explained by the safety mechanism.8,9 Typically, fractures of unilateral or bilateral condylar neck dissipate the impact energy to the mandible, preventing the intracranial injuries through the glenoid fossa. The exact etiology of these cases remains unknown. In previous literature, the factors were closely related to the anatomical characteristics of the TMJ, including a small and ovoid condyle,10 weakness of the glenoid fossa,11 increased pneumatization of the temporal bone,12 or a lack of posterior occlusion.13 Direct impact on the chin when the mouth is in the open position was another significant factor for these dislocations.5 The most possible etiology of the patients in this study was direct impact on the chin, because both of them suffered impingement on their chins in the accidents. Missed or delayed diagnosis of the dislocations were reported in the cases, due to the lack of peculiar clinical symptoms and neurological signs,14 and sometimes, the insufficient evidence of radiography. Clinical features may contain restriction of mandibular motion, preauricular pain, deviation of the chin to the affected side, ipsilateral open bite with a contralateral cross-bite, or an ipsilateral loss of the lower facial height.5,13,15 If the penetrations accompany these neurological signs, such as epidural hematoma, loss of consciousness, nausea, facial nerve paralysis or paresis, ipsilateral hearing loss, and cerebrospinal fluid leakage, it may indicate injuries in the brain.5,16–18 In the cases in this study, the patients’ only complaint was restriction of mandibular motion with malocclusion, which could lead to missed or delayed diagnosis. Conventional radiography was insufficient for diagnosis, though it could reveal the fractures initially. However, CT is mandatory to locate the fracture fragments, investigate possible intracranial lesions, and confirm the clinical suspicion.14 For diagnosis and assessing treatment,
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Features and management of intracranial mandibular condyle dislocation
three-dimensional reconstructions are more advisable. Magnetic resonance imaging could be used to confirm the intracranial dislocation of the mandibular condyle,19 observe possible brain complications,12 even locate the disc of the TMJ in order to find and reposition it successfully during the operation. The treatment of these intracranial dislocations should be individualized.13 Various therapeutic methods have been described, including closed reduction and open reduction. Closed reduction could be accomplished by different means of manual traction. If the patients have no condylar fracture, closed reduction is the primary consideration since it is the simplest and least-traumatic method.20 Most authors proposed that treatment in growing individuals should be conservative because of the possible growth implications for the mandible, even in those cases of condylar fractures.21,22 Intermaxillary fixation and functional exercise with elastic traction were warranted after closed reduction. If condylar fracture occurs, closed reduction of the condyle is not applicable, or interventions are delayed, as in the two cases in this study, or dislocation is associated with cerebral injuries, open reduction is necessary5,7,23. Open reduction includes craniotomy, condylectomy, condylotomy, subcondylar osteotomy, and repositioning without osteotomy, combining with intracranial bone grafting and glenoid fossa reconstruction. The glenoid fossa could be reconstructed by autologous or synthetic implants, for example, iliac crest, calvarial bone, temporal bone, fascia temporalis, titanium mesh, silastic implants, etc. In the authors’ cases, the glenoid fossa was reconstructed by calvarial bone in case 1, and by titanium mesh in case 2, and the articular disc was restored with a calvarial periosteum in case 1, and in case 2, the temporal musculofascial flap was placed between the implants and the condylar heads. Moreover, the semi-coronal approach has its advantage in harvesting the calvarial bone and periosteum, compared with the standard preauricular approach. The outcomes of both patients were satisfactory. In conclusion, individualized management is recommended for these cases. Considering the various traumatic characteristics and the potential serious neurological complications, close consultations with the neurosurgeon are essential. Advanced imaging studies are mandatory for exact diagnosis and successful treatment, preventing related complications like epidural hematoma, ankylosis of TMJ, etc. Application of a surgical navigation system may make the surgery more accurate and promote surgical safety. 66
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2014
Acknowledgements This work was supported by Shanghai Science and Technology Committee (11441902200 and 11495810800), and Shanghai Jiao Tong University (YG2011MS06).
References 1 Papadopoulos H, Edwards RS. Superolateral dislocation of the condyle: report of a rare case. Int J Oral Maxillofac Surg. 2010;39:508–10. 2 Ellis E 3rd, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol. 1985;59:120–9. 3 Silvennoinen U, Iizuka T, Lindqvist C, Oikarinen K. Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period. J Oral Maxillofac Surg. 1992;50:1032–7. 4 Iida S, Matsuya T. Paediatric maxillofacial fractures: their aetiological characters and fracture patterns. J Craniomaxillofac Surg. 2002;30:237–41. 5 Struewer J, Kiriazidis I, Figiel J, Dukatz T, Frangen T, Ziring E. Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma. J Craniomaxillofac Surg. 2012;40:396–9. 6 Lloyd TE, Sivarajasingam V. An unusual cranial dislocation of the mandibular condyle. Br J Oral Maxillofac Surg. 2010;48:176–7. 7 Man C, Zhu SS, Chen S, Jiang L, Hu J. Dislocation of the intact mandibular condyle into the middle cranial fossa: a case report. Int J Oral Maxillofac Surg. 2011;40:118–20. 8 Chuong R. Management of mandibular condyle penetration into the middle cranial fossa: case report. J Oral Maxillofac Surg. 1994;52:880–4. 9 Barron RP, Kainulain VT, Gusenbauer AW, Hollenberg R, Sa`ndor GK. Management of the traumatic dislocation of the mandibular condyle into the middle cranial fossa. J Can Dent Assoc. 2002;68:676–80. 10 Whitacre WB. Dislocation of the mandibular condyle into the middle cranial fossa: review of the literature and report of a case. Plast Reconstr Surg. 1966;38:23–6. 11 Tsunoda A, Sumi T, Shirakura S, Kishimoto S, Akita K. Bony eminence on the middle cranial fossa corresponding to the temporomandibular joint. Clin Anat. 2007;20:512–5. 12 Rosa VL, Guimaraes AS, Marie SK. Intrusion of the mandibular condyle into the middle cranial fossa: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:E4–7. 13 Melugin MB, Indresano T, Clemens SP. Glenoid fossa fracture and condylar penetration into the middle cranial fossa. J Oral Maxillofac Surg. 1997;55:1342–7. 14 Spanio S, Baciliero U, Fornezza U, Pinna V, Toffanin A, Padula E. Intracranial dislocation of the mandibular condyle: report of two cases and review of the literature. Br J Oral Maxillofac Surg. 2002;40:253–5. 15 Magge SN, Chen HI, Heuer GG, Carrasco LR, Storm PB. Dislocation of the mandible into the middle cranial fossa. Case report. J Neurosurg. 2007;107:75–8. 16 Sandler NA, Ozaki WH, Ochs MW, Marion DW. Intracranial reduction of an intact mandibular condyle displaced into the middle cranial fossa. J Oral Maxillofac Surg. 1996;54: 506–10. 17 Harstall R, Gratz KW, Zwahlen RA. Mandibular condyle dislocation into the middle cranial fossa: a case report and review of literature. J Trauma. 2005;59:1495–503. 18 Clauser L, Tieghi R, Polito J, Galie` M. Dislocation of the mandibular condyle into the middle cranial fossa. J Craniofac Surg. 2006;17:590–4. 19 Taglialatela Scafati C, Aliberti F, Scotto di Clemente S, Taglialatela Scafati S, Facciuto E, Cinalli G. Dislocation of a fractured mandibular condyle into the middle cranial fossa: a case treated by an extracranial approach. Childs Nerv Syst. 2008;24:1067–70.
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20 Kallal RH, Gans BJ, Lagrottria LB. Cranial dislocation of mandibular condyle. Oral Surg Oral Med Oral Pathol. 1977;43:2–10. 21 Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg. 2006;34:421–2.
Features and management of intracranial mandibular condyle dislocation
22 Iatrou I, Theologie-Lygidakis N. Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years’ experience. J Craniomaxillofac Surg. 2010;38:511–6. 23 van der Linden WJ. Dislocation of the mandible into the middle cranial fossa: report of a case with 5 year CT follow-up. Int J Oral Maxillofac Surg. 2003;32:215–8.
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Features and management of intracranial mandibular condyle dislocation after trauma Shilei Zhang, Jinyang Wu, Bing Xu, Jun Shi, Steve G. F. Shen, Haijun Gui Department of Oral and Cranio-maxillofacial Science, Ninth People’s Hospital, College of Stomatology, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, China Background: Dislocation of the mandibular condyle into the middle cranial fossa is rare in clinics. It often occurs when the mouth is open wide during the injury. It causes restriction of mandibular motion, lower facial asymmetry, pain in the temporomandibular joint (TMJ), etc. Objective: To introduce the features of intracranial mandibular condyle dislocation and discuss the management to this kind of trauma. Major findings: In this paper, the authors present two cases, describing the diagnosis, surgical management, and 1-year follow-up evaluation. The results of the authors’ treatment to intracranial mandibular condyle dislocation were satisfactory and stable, and no surgical complications were detected. Conculsion: Advanced imaging studies are mandatory for exact diagnosis and successful treatment of intracranial mandibular condyle dislocation, and individualized management is recommended. Keywords: Mandibular condyle dislocation, Middle cranial fossa, Glenoid fossa
Introduction Anterior dislocation of the mandibular condyle, which results from chronic dislocation of temporomandibular joints and condylar fractures caused by trauma are commonly seen,1–4 but it is rare to find dislocation of the mandibular condyle into the middle cranial fossa. Since 1960, only 49 cases of patients with intracranial dislocation of the mandibular condyle, including the cases in this study, have been reported in English literature.5–7 In this paper, the authors present two cases with discussion of etiology, clinical features, and surgical treatments.
(TMJ) tenderness, maximal mouth opening of 10 mm, premature occlusal of right posterior teeth, slight open bite of left posterior teeth, and fixation with arch bars. Coronal computed tomography (CT) scans (Fig. 1) and three-dimensional reconstructions illustrated that the right condyle penetrated into the middle cranial fossa through the glenoid fossa without condylar fractures. An open reduction of the dislocated condyle was attempted through a semicoronal approach. Intraoperatively, the articular disc was ruptured and displaced, the condyle was reduced successfully without any injuries to the brain, and
Clinical Reports Case 1 A 23-year-old woman, who was involved in a traffic accident and suffered the impact on her chin, complained of the restriction of mandibular motion and pain in the preauricular region, without loss of consciousness, nausea, or vomiting. She was referred to the authors’ department after an unsatisfactory treatment of intermaxillary fixation in the local hospital. Clinical examinations revealed a deviation of the chin to the right, right temporomandibular joint Correspondence to: B Xu, Department of Oral and Cranio-maxillofacial Science, Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Road, Shanghai 200011, China. Email: [email protected] ß W. S. Maney & Son Ltd 2014 DOI 10.1179/0886963413Z.0000000007
Figure 1 Coronal CT scan illustrates the dislocation of the right mandibular condyle and the relationship between the right mandibular condyle and middle cranial fossa.
CRANIOH: The Journal of Craniomandibular & Sleep Practice
2014
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NO.
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Zhang et al.
Features and management of intracranial mandibular condyle dislocation
Figure 2 Exposure of the right TMJ. The photograph illustrates the superiorly dislocated condyle (long white arrow) and the lateral rim of glenoid fossa (short white arrow).
the defect in the middle cranial fossa was repaired with calvarial bone. The disc was repositioned and repaired with a calvarial periosteum (Figs. 2–4). A postoperative coronal CT scan indicated that the right condyle was corrected successfully (Fig. 5). Satisfactory profile and stable occlusion were achieved postoperatively.
Figure 3 Fixation of the calvarial bone. The photograph illustrates the zygomatic arch (short black arrow), the ruptured articular disc (long black arrow), the condyle (long white arrow), and the calvarial bone (short white arrow) fixed to reconstruct the fossa. The small photograph shows the size of bone graft.
Case 2 A 39-year-old man suffered impact on his chin by accident and had no signs of neurological deficit. The patient was referred to the authors’ department after
Figure 4 Suturing the calvarial periosteum. The photograph illustrates the zygomatic arch (short white arrow) and the calvarial periosteum (long white arrow).
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Features and management of intracranial mandibular condyle dislocation
In both cases, close consultations with neurosurgery were made during the surgery to avoid additional brain damage. In the 1-year follow-up, clinical and radiographic examinations demonstrated that both patients had favorable profiles, stable occlusions, normal position of dislocated condyles, and good shapes of fractured glenoid fossa. The maximal mouth opening had stabilized at 41 mm in case 1 and 38 mm in case 2. No surgical complications were detected, including headaches or ipsilateral ankylosis. Figure 5 CT scan illustrates reduction of the right condyle and reconstruction of the middle cranial fossa, and the relationship between the right mandibular condyle and middle cranial fossa.
regular debridement in the local hospital, because he complained of difficulty opening his mouth. Clinical examinations revealed deviation of the chin to the left, preauricular pain and scars in the mental region. Intraorally, maximal interincisial distance was 12 mm. Edge-to-edge occlusion between the left posterior teeth and buccal cross-bite between the right posterior teeth were observed. Arch bars were fixed on the maxillary and mandibular teeth. Coronal CT scans illustrated intracranial dislocation of the left mandibular condyle through glenoid fossa and lateral dislocation of the right condyle, and no fracture of the condyle was found (Fig. 6). Through a standard preauricular approach, the left condyle was successfully reduced, and titanium mesh was fixed to reconstruct the glenoid fossa. The articular disc was ruptured totally and a temporal musculofascial flap was placed between the condyle and titanium mesh. The right condyle was replaced by a closed manipulation. Postoperative occlusion was satisfied.
Figure 6 Coronal CT scans illustrate intracranial dislocation of the left mandibular condyle through glenoid fossa and lateral dislocation of the right condyle.
Discussion Dislocation of the mandibular condyle into the middle cranial fossa is extremely rare. This infrequency could be explained by the safety mechanism.8,9 Typically, fractures of unilateral or bilateral condylar neck dissipate the impact energy to the mandible, preventing the intracranial injuries through the glenoid fossa. The exact etiology of these cases remains unknown. In previous literature, the factors were closely related to the anatomical characteristics of the TMJ, including a small and ovoid condyle,10 weakness of the glenoid fossa,11 increased pneumatization of the temporal bone,12 or a lack of posterior occlusion.13 Direct impact on the chin when the mouth is in the open position was another significant factor for these dislocations.5 The most possible etiology of the patients in this study was direct impact on the chin, because both of them suffered impingement on their chins in the accidents. Missed or delayed diagnosis of the dislocations were reported in the cases, due to the lack of peculiar clinical symptoms and neurological signs,14 and sometimes, the insufficient evidence of radiography. Clinical features may contain restriction of mandibular motion, preauricular pain, deviation of the chin to the affected side, ipsilateral open bite with a contralateral cross-bite, or an ipsilateral loss of the lower facial height.5,13,15 If the penetrations accompany these neurological signs, such as epidural hematoma, loss of consciousness, nausea, facial nerve paralysis or paresis, ipsilateral hearing loss, and cerebrospinal fluid leakage, it may indicate injuries in the brain.5,16–18 In the cases in this study, the patients’ only complaint was restriction of mandibular motion with malocclusion, which could lead to missed or delayed diagnosis. Conventional radiography was insufficient for diagnosis, though it could reveal the fractures initially. However, CT is mandatory to locate the fracture fragments, investigate possible intracranial lesions, and confirm the clinical suspicion.14 For diagnosis and assessing treatment,
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Features and management of intracranial mandibular condyle dislocation
three-dimensional reconstructions are more advisable. Magnetic resonance imaging could be used to confirm the intracranial dislocation of the mandibular condyle,19 observe possible brain complications,12 even locate the disc of the TMJ in order to find and reposition it successfully during the operation. The treatment of these intracranial dislocations should be individualized.13 Various therapeutic methods have been described, including closed reduction and open reduction. Closed reduction could be accomplished by different means of manual traction. If the patients have no condylar fracture, closed reduction is the primary consideration since it is the simplest and least-traumatic method.20 Most authors proposed that treatment in growing individuals should be conservative because of the possible growth implications for the mandible, even in those cases of condylar fractures.21,22 Intermaxillary fixation and functional exercise with elastic traction were warranted after closed reduction. If condylar fracture occurs, closed reduction of the condyle is not applicable, or interventions are delayed, as in the two cases in this study, or dislocation is associated with cerebral injuries, open reduction is necessary5,7,23. Open reduction includes craniotomy, condylectomy, condylotomy, subcondylar osteotomy, and repositioning without osteotomy, combining with intracranial bone grafting and glenoid fossa reconstruction. The glenoid fossa could be reconstructed by autologous or synthetic implants, for example, iliac crest, calvarial bone, temporal bone, fascia temporalis, titanium mesh, silastic implants, etc. In the authors’ cases, the glenoid fossa was reconstructed by calvarial bone in case 1, and by titanium mesh in case 2, and the articular disc was restored with a calvarial periosteum in case 1, and in case 2, the temporal musculofascial flap was placed between the implants and the condylar heads. Moreover, the semi-coronal approach has its advantage in harvesting the calvarial bone and periosteum, compared with the standard preauricular approach. The outcomes of both patients were satisfactory. In conclusion, individualized management is recommended for these cases. Considering the various traumatic characteristics and the potential serious neurological complications, close consultations with the neurosurgeon are essential. Advanced imaging studies are mandatory for exact diagnosis and successful treatment, preventing related complications like epidural hematoma, ankylosis of TMJ, etc. Application of a surgical navigation system may make the surgery more accurate and promote surgical safety. 66
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2014
Acknowledgements This work was supported by Shanghai Science and Technology Committee (11441902200 and 11495810800), and Shanghai Jiao Tong University (YG2011MS06).
References 1 Papadopoulos H, Edwards RS. Superolateral dislocation of the condyle: report of a rare case. Int J Oral Maxillofac Surg. 2010;39:508–10. 2 Ellis E 3rd, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol. 1985;59:120–9. 3 Silvennoinen U, Iizuka T, Lindqvist C, Oikarinen K. Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period. J Oral Maxillofac Surg. 1992;50:1032–7. 4 Iida S, Matsuya T. Paediatric maxillofacial fractures: their aetiological characters and fracture patterns. J Craniomaxillofac Surg. 2002;30:237–41. 5 Struewer J, Kiriazidis I, Figiel J, Dukatz T, Frangen T, Ziring E. Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma. J Craniomaxillofac Surg. 2012;40:396–9. 6 Lloyd TE, Sivarajasingam V. An unusual cranial dislocation of the mandibular condyle. Br J Oral Maxillofac Surg. 2010;48:176–7. 7 Man C, Zhu SS, Chen S, Jiang L, Hu J. Dislocation of the intact mandibular condyle into the middle cranial fossa: a case report. Int J Oral Maxillofac Surg. 2011;40:118–20. 8 Chuong R. Management of mandibular condyle penetration into the middle cranial fossa: case report. J Oral Maxillofac Surg. 1994;52:880–4. 9 Barron RP, Kainulain VT, Gusenbauer AW, Hollenberg R, Sa`ndor GK. Management of the traumatic dislocation of the mandibular condyle into the middle cranial fossa. J Can Dent Assoc. 2002;68:676–80. 10 Whitacre WB. Dislocation of the mandibular condyle into the middle cranial fossa: review of the literature and report of a case. Plast Reconstr Surg. 1966;38:23–6. 11 Tsunoda A, Sumi T, Shirakura S, Kishimoto S, Akita K. Bony eminence on the middle cranial fossa corresponding to the temporomandibular joint. Clin Anat. 2007;20:512–5. 12 Rosa VL, Guimaraes AS, Marie SK. Intrusion of the mandibular condyle into the middle cranial fossa: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:E4–7. 13 Melugin MB, Indresano T, Clemens SP. Glenoid fossa fracture and condylar penetration into the middle cranial fossa. J Oral Maxillofac Surg. 1997;55:1342–7. 14 Spanio S, Baciliero U, Fornezza U, Pinna V, Toffanin A, Padula E. Intracranial dislocation of the mandibular condyle: report of two cases and review of the literature. Br J Oral Maxillofac Surg. 2002;40:253–5. 15 Magge SN, Chen HI, Heuer GG, Carrasco LR, Storm PB. Dislocation of the mandible into the middle cranial fossa. Case report. J Neurosurg. 2007;107:75–8. 16 Sandler NA, Ozaki WH, Ochs MW, Marion DW. Intracranial reduction of an intact mandibular condyle displaced into the middle cranial fossa. J Oral Maxillofac Surg. 1996;54: 506–10. 17 Harstall R, Gratz KW, Zwahlen RA. Mandibular condyle dislocation into the middle cranial fossa: a case report and review of literature. J Trauma. 2005;59:1495–503. 18 Clauser L, Tieghi R, Polito J, Galie` M. Dislocation of the mandibular condyle into the middle cranial fossa. J Craniofac Surg. 2006;17:590–4. 19 Taglialatela Scafati C, Aliberti F, Scotto di Clemente S, Taglialatela Scafati S, Facciuto E, Cinalli G. Dislocation of a fractured mandibular condyle into the middle cranial fossa: a case treated by an extracranial approach. Childs Nerv Syst. 2008;24:1067–70.
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20 Kallal RH, Gans BJ, Lagrottria LB. Cranial dislocation of mandibular condyle. Oral Surg Oral Med Oral Pathol. 1977;43:2–10. 21 Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg. 2006;34:421–2.
Features and management of intracranial mandibular condyle dislocation
22 Iatrou I, Theologie-Lygidakis N. Surgical protocols and outcome for the treatment of maxillofacial fractures in children: 9 years’ experience. J Craniomaxillofac Surg. 2010;38:511–6. 23 van der Linden WJ. Dislocation of the mandible into the middle cranial fossa: report of a case with 5 year CT follow-up. Int J Oral Maxillofac Surg. 2003;32:215–8.
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