Michael Zhang1, Allyson L Alexander1, Sam P Most2, Gordon Li1, Odette A Harris3. 1. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA. 2. Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA. 3. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA. Electronic address: odette@stanford.edu.
Abstract
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.
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.
Authors: Mark A Dobish; David A Wyler; Christopher J Farrell; Hermandeep S Dhami; Victor M Romo; Daniel D Choi; Travis Reed; Michael E Mahla Journal: Case Rep Crit Care Date: 2018-09-27