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A method of conservative management of dislocated mandible condyle into the middle cranial fossa: Report of a case
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 25 (2013) 35–38
Contents lists available at SciVerse ScienceDirect
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology journal homepage: www.elsevier.com/locate/jomsmp
Case report
A method of conservative management of dislocated mandible condyle into the middle cranial fossa: Report of a case夽 Jianjun Jiao a,1 , Yuxing Guo b,1 , Shubin Jin a , Xueqiang Zhang a , Gendong Yao a , Hongxiang Chen a , Chuanbin Guo b,∗ a b
Department of Oral and Maxillofacilal Surgery, Handan Center Hospital of Hebei, No. 15 Zhonghua South Avenue in Handan 056001, PR China Department of Oral and Maxillofacilal Surgery, Peking University School of Stomatology, 22 Zhongguancun Nandajie, Haidian District, Beijing 100081, PR China
a r t i c l e
i n f o
Article history: Received 14 August 2011 Received in revised form 27 September 2011 Accepted 12 October 2011 Available online 10 November 2011 Keywords: Mandibular condyle dislocation Middle cranial fossa Temporomandibular joint
a b s t r a c t Acute traumatic mandibular condyle dislocations into the middle cranial fossa are rare. The diagnosis of intracranial condylar dislocation is difficult, and CT is the most effective screening tool to get early correct diagnosis. A patient with an acute traumatic dislocated condyle into the middle cranial fossa, which was treated conservatively, is presented here. After conservative treatment, the patient restored to normal function of jaw movement, and the fractures of the middle cranial fossa completely healed and the condyle was in the reconstruction stage. The anatomic features, clinical features, and mechanism of injury for this rare type of condylar dislocation were discussed to help recognize this easily overlooked injury and avoid disastrous complications. © 2011 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.
1. Introduction Acute traumatic dislocation of mandibular condyle is defined as the condylar head displacement out of the glenoid fossa as a result of a sudden stroke. The dislocation occurred more to the anterior or lateral side [1]. Though a limited portion of the temporal-mandibular joint fossa is formed by a translucent bony lamina, the condylar head is far bigger than this less resistant area, thus upward dislocation of the condyle is very rare in clinical situation [2]. In 2009, one case of acute dislocation of condyle into the middle cranial fossa was treated by elastic intermaxillary traction and fixation, which was reported as follows. 2. Case report A 36-year-old man fell down from bicycle on his chin and lost consciousness for a few minutes. He was sent to local hospital and his vital signs were stable. He complained of left pre-auricular pain, limitation of jaw mobility, anterior open bite and deviation of the chin to the injured side. The result of CT scan showed the
夽 Asian AOMS: Asian Association of Oral and Maxillofacial Surgeons; ASOMP: Asian Society of Oral and Maxillofacial Pathology; JSOP: Japanese Society of Oral Pathology; JSOMS: Japanese Society of Oral and Maxillofacial Surgeons; JSOM: Japanese Society of Oral Medicine; JAMI: Japanese Academy of Maxillofacial Implants. ∗ Corresponding author. Tel.: +86 10 62179977; fax: +86 10 62173402. E-mail address: [email protected] (C. Guo). 1 Both are first authors.
left mandibular condyle dislocated into the middle cranial fossa with the temporal bone fragment and contusion of left temporal lobe. The patient was transferred into our hospital for thorough examination and treatment. On physical examination the patient was fully conscious with normal vital signs. He did not have any past history of neurological and cardiovascular diseases. There were no signs of any neurological deficit and the examination of the external auditory meatus showed intact tympanic membranes, with no evidence of cerebrospinal fluid (CSF) otorrhea or hemorrhage. The left pre-auricular area was swollen obviously. No steps or crepitation could be appreciated at the inferior border of the mandible. Intra-oral examination showed a significant malocclusion with deviation of the mandible midline to the left, a premature contact of left posterior dentition, and an anterior open bite of 15 mm. The occlusion was locked in this position, and the patient was unable to open or close his mouth. A computed tomography (CT) with a 3-dimensional reconstruction was obtained. It showed that the left condyle penetrated through the roof of the glenoid fossa and into the middle caranial fossa with external and internal side fragment of the condyle displacement (Fig. 1). The patient also had a left temporal lobe contusion. A diagnosis of acute dislocation of the mandible condyle into the floor of the middle cranial fossa was made. Neurosurgical consultation was immediately obtained, and no additional clinical or radiographic signs of neurologic injury were found. Three days after accident, swelling and pain were
0915-6992/$ – see front matter © 2011 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ajoms.2011.10.004
36
J. Jiao et al. / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 25 (2013) 35–38
significantly relieved. Maxillary and mandibular teeth were aligned by dental splint ligation with elasticity, and a rubber pad was placed on the molar area (Fig. 2A). For alleviation of the pain, the implementation of traction force was done gradually. Two days later, the left mandbilbular condylar was completely guided out of the middle cranial fossa and automatically reset in its normal position, so the occlusion recovered. We removed the rubber pad between the molars, and re-fixed intermaxillary traction (Fig. 2B). A CT scan was immediately obtained, which showed the condyle returned into the glenoid fossa, and the intracranial bony fragments from skull base automatically reset and closed the perforation from inside because of the intracranial compression (Fig. 3). The traction was after 1 week of intermaxillary fixation, and he started functional training of open-close mouth and lateral jaw movement. He returned to normal function of jaw movement with a little difficulty in left protrusive movement on the 1 month, 11 months and 2 years reviews (Fig. 2C). The CT scan showed the top plate of the temporalmandibular joint fossa healed well (Fig. 4).
3. Discussion
Fig. 1. Preoperative CT shows fracture and perforation of glenoid fossa and dislocation of condyle into the middle cranial fossa.
Dislocation of the mandible condyle into the middle cranial fossa is a rare event due to anatomical and biomechanical factors. This kind injury is often associated with extensive skull fracture, dural tear, severe brain injury, and prolonged coma. It is often classified into acute and chronic wounds [1]. More of these patients were first
Fig. 2. Patient’ pictures with elastic intermaxillary traction and fixation: (A) place a rubber pad on the molar area (black arrow); (B) remove the rubber pad, and re-fix intermaxillary traction; (C) on the 2 years review, the mouth opening is normal.
J. Jiao et al. / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 25 (2013) 35–38
Fig. 3. Postoperative CT shows reset of condyle in the glenoid fossa and reduction of fragments in the middle cranial fossa.
sent to neurosurgery, and become chronic injuries when they were transferred into oral and maxillofacial surgery department. Magge et al. reviewed 42 cases published in all the English literatures from 1960 to 2007. More than half (54.8%) of the patients were young (<18 years). The incidence of female patients was 2 times as the male. Proportion of motor vehicle injuries was 52.4%, and 26.2% of bike [1]. The possible mechanism of the injury is a sudden forceful injury to the bottom of the chin, while the patient was in open mouth state. The condyle did not get fracture, and the force had no relief halfway.
Fig. 4. Eleven months later, CT shows fractures of the middle cranial fossa completely healed and the condyle was in the reconstruction stage.
37
Thus all the energy concentrated on the top of temporal-mandible fossa, which fractured the glenoid into fragments, and the condyle displaced superiorly into the middle cranial fossa meanwhile [3]. De Fonseca demonstrated that although it is difficult to fracture the roof the glenoid, because of its morphology, a small round condyle could penetrate this structure more readily than the normal scroll-shaped condyle [4]. Thus the blocking effects of muscle weakening accompanying with more pneumatization of the temporal bone and lack of posterior dentition, increase the possibility of such damage [5]. The typical clinical presentation is the deviation of mandible midline to the injured side, half-open mouth jaw in a passive state (could not open or close mouth), limitation of chewing, and speech disorder. Neurological symptoms such as loss of consciousness, nausea, cerebrospinal fluid leak, facial paralysis, and hearing loss, suggests the possibility of intracranial hematoma, or injury [6,7]. Lack of specific clinical features increases the difficulty of accurate diagnosis. CT is the most effective screening tool to help early diagnosis, and three-dimensional reconstruction can determine the extent of injury. MRI diagnosis of intracranial injury has more advantages [8–10]. In dealing with patients of upward dislocation of the condyle, comprehensive examination should be conducted to avoid any missing injury. If any change in the conscious levels, patients should be immediately referred to the neurosurgical treatment capacity, and any delay could cause serious consequences [5]. After reviewing of literature and careful planning, we determined to use conservative methods as the first treatment choice. We tried to use forceps-shaped mouth gag and extra-oral traction and manual reduction, but failed. Then we switched to use intermaxillary elastic traction, and placed rubber pad between the left molars as the fulcrum. The force in intermaxillary traction increased gradually, which pulled down the condylar head slowly. Two days later, the force had accumulated enough to pull the condylar head through the lock of the skull base perforation, and automatically reset in the glenoid fossa. The patient had a sudden feeling of relaxation and heard a snap sound. The rescan of CT showed the condylar head had set under the temporal-mandibular fossa completely. The treatment protocol of superior dislocation of the mandible condyle is to reset condyle as soon as possible, to restore chewing function. A variety of surgical treatments have been considered, from closed-reduction techniques with manual manipulation to open reduction combined with intracranial bone grafting. Closed reduction has been accomplished by means of manual traction applied to the condyle in a direction dorsal-inferior to the mandible. This technique is most useful in young children, whose treatment occurred within 4 weeks of injury. Most patients have subsequently undergone maxilla-mandible fixation either with wires or with light occlusion-guiding elasticity [7,11,12]. The case was treated shortly after the acute dislocation of condyle. The intermaxillary traction began 3 days after injury, and satisfactory result was achieved. When closed reduction failed for patients with neurological symptoms, or facial fractures and established injury (>4 months), open reduction should be considered. Open reduction involves either condylectomy under direct vision via an intracranial approach combined with craniotomy or condylectomy via a pre-auricular incision [7,12]. CT scan should be applied immediately after condyle reset, and reviewed 24 h later. In the process of removing fractured bone fragments, brain tissue tearing or middle meningeal artery injury may result in intracranial hemorrhage. And a recurrence of condylar dislocation may occur after manipulation. CT examination can identify the complications as soon as possible [6,12–14]. During the restoration of chewing, the exercise of opening up must be limited to avoid affecting the healing of the skull base
38
J. Jiao et al. / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 25 (2013) 35–38
fracture. While any abruptly and strong force on the mandible should be avoided to prevent the recurrence of condyle dislocation. Although intermaxillary traction can early reset the position of the condyle in the glenoid fossa, restore the normal function of occlusion and mouth open, but may not be able to re-attach the avulsed lateral pterygoid muscles to the condylar neck. This may explain the deviation of the mandible to the injured side after treatment for this patient. The conservative method of treatment of dislocation of condyle is simple, which helps the patient satisfactorily recover the function of the occlusion and mouth opening and also avoid secondary trauma due to surgery and further complications. Meanwhile it also enriches the treatment methods of condyle dislocation. Conflict of interest There is no conflict of interest. Acknowledgements The article written process was supported by the National High Technology Research and Development Program of China(SQ2009AA04ZX1485930). References [1] 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.
[2] 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. [3] Yi Z, Yong GS. Rigid internal fixation of maxillary and mandibular. Beijing: Peking University Medical Press; 2003. [4] Da FG. Experimental study on fractures of the mandibular condylar process (mandibular condylar process fractures). Int J Oral Surg 1974;3:89– 101. [5] Barron RP, Kainulainen VT, Gusenbauer AW, Hollenberg R, Sandor GK. Management of traumatic dislocation of the mandibular condyle into the middle cranial fossa. J Can Dent Assoc 2002;68:676–80. [6] 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. [7] Baldwin AJ. Superior dislocation of the intact mandibular condyle into the middle cranial fossa. J Oral Maxillofac Surg 1990;48:623–8. [8] Long X, Hu C, Zhao J, Li J, Zhang G. Superior dislocation of mandibular condyle into the middle cranial fossa. A case report. Int J Oral Maxillofac Surg 1997;26:29–30. [9] Taglialatela SC, Aliberti F, Scotto DCS, Taglialatela SS, 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. [10] Ohura N, Ichioka S, Sudo T, Nakagawa M, Kumaido K, Nakatsuka T. Dislocation of the bilateral mandibular condyle into the middle cranial fossa: review of the literature and clinical experience. J Oral Maxillofac Surg 2006;64: 1165–72. [11] Chuong R. Management of mandibular condyle penetration into the middle cranial fossa: case report. J Oral Maxillofac Surg 1994;52:880–4. [12] Melugin MB, Indresano AT, Clemens SP. Glenoid fossa fracture and condylar penetration into the middle cranial fossa: report of a case and review of the literature. J Oral Maxillofac Surg 1997;55:1342–7. [13] Christiansen RL. Condylar penetration into the middle cranial fossa. J Craniomandib Disord 1989;3:100–4. [14] Koretsch LJ, Brook AL, Kader A, Eisig SB. Traumatic dislocation of the mandibular condyle into the middle cranial fossa: report of a case, review of the literature, and a proposal management protocol. J Oral Maxillofac Surg 2001;59: 88–94.
Contents lists available at SciVerse ScienceDirect
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology journal homepage: www.elsevier.com/locate/jomsmp
Case report
A method of conservative management of dislocated mandible condyle into the middle cranial fossa: Report of a case夽 Jianjun Jiao a,1 , Yuxing Guo b,1 , Shubin Jin a , Xueqiang Zhang a , Gendong Yao a , Hongxiang Chen a , Chuanbin Guo b,∗ a b
Department of Oral and Maxillofacilal Surgery, Handan Center Hospital of Hebei, No. 15 Zhonghua South Avenue in Handan 056001, PR China Department of Oral and Maxillofacilal Surgery, Peking University School of Stomatology, 22 Zhongguancun Nandajie, Haidian District, Beijing 100081, PR China
a r t i c l e
i n f o
Article history: Received 14 August 2011 Received in revised form 27 September 2011 Accepted 12 October 2011 Available online 10 November 2011 Keywords: Mandibular condyle dislocation Middle cranial fossa Temporomandibular joint
a b s t r a c t Acute traumatic mandibular condyle dislocations into the middle cranial fossa are rare. The diagnosis of intracranial condylar dislocation is difficult, and CT is the most effective screening tool to get early correct diagnosis. A patient with an acute traumatic dislocated condyle into the middle cranial fossa, which was treated conservatively, is presented here. After conservative treatment, the patient restored to normal function of jaw movement, and the fractures of the middle cranial fossa completely healed and the condyle was in the reconstruction stage. The anatomic features, clinical features, and mechanism of injury for this rare type of condylar dislocation were discussed to help recognize this easily overlooked injury and avoid disastrous complications. © 2011 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.
1. Introduction Acute traumatic dislocation of mandibular condyle is defined as the condylar head displacement out of the glenoid fossa as a result of a sudden stroke. The dislocation occurred more to the anterior or lateral side [1]. Though a limited portion of the temporal-mandibular joint fossa is formed by a translucent bony lamina, the condylar head is far bigger than this less resistant area, thus upward dislocation of the condyle is very rare in clinical situation [2]. In 2009, one case of acute dislocation of condyle into the middle cranial fossa was treated by elastic intermaxillary traction and fixation, which was reported as follows. 2. Case report A 36-year-old man fell down from bicycle on his chin and lost consciousness for a few minutes. He was sent to local hospital and his vital signs were stable. He complained of left pre-auricular pain, limitation of jaw mobility, anterior open bite and deviation of the chin to the injured side. The result of CT scan showed the
夽 Asian AOMS: Asian Association of Oral and Maxillofacial Surgeons; ASOMP: Asian Society of Oral and Maxillofacial Pathology; JSOP: Japanese Society of Oral Pathology; JSOMS: Japanese Society of Oral and Maxillofacial Surgeons; JSOM: Japanese Society of Oral Medicine; JAMI: Japanese Academy of Maxillofacial Implants. ∗ Corresponding author. Tel.: +86 10 62179977; fax: +86 10 62173402. E-mail address: [email protected] (C. Guo). 1 Both are first authors.
left mandibular condyle dislocated into the middle cranial fossa with the temporal bone fragment and contusion of left temporal lobe. The patient was transferred into our hospital for thorough examination and treatment. On physical examination the patient was fully conscious with normal vital signs. He did not have any past history of neurological and cardiovascular diseases. There were no signs of any neurological deficit and the examination of the external auditory meatus showed intact tympanic membranes, with no evidence of cerebrospinal fluid (CSF) otorrhea or hemorrhage. The left pre-auricular area was swollen obviously. No steps or crepitation could be appreciated at the inferior border of the mandible. Intra-oral examination showed a significant malocclusion with deviation of the mandible midline to the left, a premature contact of left posterior dentition, and an anterior open bite of 15 mm. The occlusion was locked in this position, and the patient was unable to open or close his mouth. A computed tomography (CT) with a 3-dimensional reconstruction was obtained. It showed that the left condyle penetrated through the roof of the glenoid fossa and into the middle caranial fossa with external and internal side fragment of the condyle displacement (Fig. 1). The patient also had a left temporal lobe contusion. A diagnosis of acute dislocation of the mandible condyle into the floor of the middle cranial fossa was made. Neurosurgical consultation was immediately obtained, and no additional clinical or radiographic signs of neurologic injury were found. Three days after accident, swelling and pain were
0915-6992/$ – see front matter © 2011 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ajoms.2011.10.004
36
J. Jiao et al. / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 25 (2013) 35–38
significantly relieved. Maxillary and mandibular teeth were aligned by dental splint ligation with elasticity, and a rubber pad was placed on the molar area (Fig. 2A). For alleviation of the pain, the implementation of traction force was done gradually. Two days later, the left mandbilbular condylar was completely guided out of the middle cranial fossa and automatically reset in its normal position, so the occlusion recovered. We removed the rubber pad between the molars, and re-fixed intermaxillary traction (Fig. 2B). A CT scan was immediately obtained, which showed the condyle returned into the glenoid fossa, and the intracranial bony fragments from skull base automatically reset and closed the perforation from inside because of the intracranial compression (Fig. 3). The traction was after 1 week of intermaxillary fixation, and he started functional training of open-close mouth and lateral jaw movement. He returned to normal function of jaw movement with a little difficulty in left protrusive movement on the 1 month, 11 months and 2 years reviews (Fig. 2C). The CT scan showed the top plate of the temporalmandibular joint fossa healed well (Fig. 4).
3. Discussion
Fig. 1. Preoperative CT shows fracture and perforation of glenoid fossa and dislocation of condyle into the middle cranial fossa.
Dislocation of the mandible condyle into the middle cranial fossa is a rare event due to anatomical and biomechanical factors. This kind injury is often associated with extensive skull fracture, dural tear, severe brain injury, and prolonged coma. It is often classified into acute and chronic wounds [1]. More of these patients were first
Fig. 2. Patient’ pictures with elastic intermaxillary traction and fixation: (A) place a rubber pad on the molar area (black arrow); (B) remove the rubber pad, and re-fix intermaxillary traction; (C) on the 2 years review, the mouth opening is normal.
J. Jiao et al. / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 25 (2013) 35–38
Fig. 3. Postoperative CT shows reset of condyle in the glenoid fossa and reduction of fragments in the middle cranial fossa.
sent to neurosurgery, and become chronic injuries when they were transferred into oral and maxillofacial surgery department. Magge et al. reviewed 42 cases published in all the English literatures from 1960 to 2007. More than half (54.8%) of the patients were young (<18 years). The incidence of female patients was 2 times as the male. Proportion of motor vehicle injuries was 52.4%, and 26.2% of bike [1]. The possible mechanism of the injury is a sudden forceful injury to the bottom of the chin, while the patient was in open mouth state. The condyle did not get fracture, and the force had no relief halfway.
Fig. 4. Eleven months later, CT shows fractures of the middle cranial fossa completely healed and the condyle was in the reconstruction stage.
37
Thus all the energy concentrated on the top of temporal-mandible fossa, which fractured the glenoid into fragments, and the condyle displaced superiorly into the middle cranial fossa meanwhile [3]. De Fonseca demonstrated that although it is difficult to fracture the roof the glenoid, because of its morphology, a small round condyle could penetrate this structure more readily than the normal scroll-shaped condyle [4]. Thus the blocking effects of muscle weakening accompanying with more pneumatization of the temporal bone and lack of posterior dentition, increase the possibility of such damage [5]. The typical clinical presentation is the deviation of mandible midline to the injured side, half-open mouth jaw in a passive state (could not open or close mouth), limitation of chewing, and speech disorder. Neurological symptoms such as loss of consciousness, nausea, cerebrospinal fluid leak, facial paralysis, and hearing loss, suggests the possibility of intracranial hematoma, or injury [6,7]. Lack of specific clinical features increases the difficulty of accurate diagnosis. CT is the most effective screening tool to help early diagnosis, and three-dimensional reconstruction can determine the extent of injury. MRI diagnosis of intracranial injury has more advantages [8–10]. In dealing with patients of upward dislocation of the condyle, comprehensive examination should be conducted to avoid any missing injury. If any change in the conscious levels, patients should be immediately referred to the neurosurgical treatment capacity, and any delay could cause serious consequences [5]. After reviewing of literature and careful planning, we determined to use conservative methods as the first treatment choice. We tried to use forceps-shaped mouth gag and extra-oral traction and manual reduction, but failed. Then we switched to use intermaxillary elastic traction, and placed rubber pad between the left molars as the fulcrum. The force in intermaxillary traction increased gradually, which pulled down the condylar head slowly. Two days later, the force had accumulated enough to pull the condylar head through the lock of the skull base perforation, and automatically reset in the glenoid fossa. The patient had a sudden feeling of relaxation and heard a snap sound. The rescan of CT showed the condylar head had set under the temporal-mandibular fossa completely. The treatment protocol of superior dislocation of the mandible condyle is to reset condyle as soon as possible, to restore chewing function. A variety of surgical treatments have been considered, from closed-reduction techniques with manual manipulation to open reduction combined with intracranial bone grafting. Closed reduction has been accomplished by means of manual traction applied to the condyle in a direction dorsal-inferior to the mandible. This technique is most useful in young children, whose treatment occurred within 4 weeks of injury. Most patients have subsequently undergone maxilla-mandible fixation either with wires or with light occlusion-guiding elasticity [7,11,12]. The case was treated shortly after the acute dislocation of condyle. The intermaxillary traction began 3 days after injury, and satisfactory result was achieved. When closed reduction failed for patients with neurological symptoms, or facial fractures and established injury (>4 months), open reduction should be considered. Open reduction involves either condylectomy under direct vision via an intracranial approach combined with craniotomy or condylectomy via a pre-auricular incision [7,12]. CT scan should be applied immediately after condyle reset, and reviewed 24 h later. In the process of removing fractured bone fragments, brain tissue tearing or middle meningeal artery injury may result in intracranial hemorrhage. And a recurrence of condylar dislocation may occur after manipulation. CT examination can identify the complications as soon as possible [6,12–14]. During the restoration of chewing, the exercise of opening up must be limited to avoid affecting the healing of the skull base
38
J. Jiao et al. / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 25 (2013) 35–38
fracture. While any abruptly and strong force on the mandible should be avoided to prevent the recurrence of condyle dislocation. Although intermaxillary traction can early reset the position of the condyle in the glenoid fossa, restore the normal function of occlusion and mouth open, but may not be able to re-attach the avulsed lateral pterygoid muscles to the condylar neck. This may explain the deviation of the mandible to the injured side after treatment for this patient. The conservative method of treatment of dislocation of condyle is simple, which helps the patient satisfactorily recover the function of the occlusion and mouth opening and also avoid secondary trauma due to surgery and further complications. Meanwhile it also enriches the treatment methods of condyle dislocation. Conflict of interest There is no conflict of interest. Acknowledgements The article written process was supported by the National High Technology Research and Development Program of China(SQ2009AA04ZX1485930). References [1] 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.
[2] 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. [3] Yi Z, Yong GS. Rigid internal fixation of maxillary and mandibular. Beijing: Peking University Medical Press; 2003. [4] Da FG. Experimental study on fractures of the mandibular condylar process (mandibular condylar process fractures). Int J Oral Surg 1974;3:89– 101. [5] Barron RP, Kainulainen VT, Gusenbauer AW, Hollenberg R, Sandor GK. Management of traumatic dislocation of the mandibular condyle into the middle cranial fossa. J Can Dent Assoc 2002;68:676–80. [6] 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. [7] Baldwin AJ. Superior dislocation of the intact mandibular condyle into the middle cranial fossa. J Oral Maxillofac Surg 1990;48:623–8. [8] Long X, Hu C, Zhao J, Li J, Zhang G. Superior dislocation of mandibular condyle into the middle cranial fossa. A case report. Int J Oral Maxillofac Surg 1997;26:29–30. [9] Taglialatela SC, Aliberti F, Scotto DCS, Taglialatela SS, 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. [10] Ohura N, Ichioka S, Sudo T, Nakagawa M, Kumaido K, Nakatsuka T. Dislocation of the bilateral mandibular condyle into the middle cranial fossa: review of the literature and clinical experience. J Oral Maxillofac Surg 2006;64: 1165–72. [11] Chuong R. Management of mandibular condyle penetration into the middle cranial fossa: case report. J Oral Maxillofac Surg 1994;52:880–4. [12] Melugin MB, Indresano AT, Clemens SP. Glenoid fossa fracture and condylar penetration into the middle cranial fossa: report of a case and review of the literature. J Oral Maxillofac Surg 1997;55:1342–7. [13] Christiansen RL. Condylar penetration into the middle cranial fossa. J Craniomandib Disord 1989;3:100–4. [14] Koretsch LJ, Brook AL, Kader A, Eisig SB. Traumatic dislocation of the mandibular condyle into the middle cranial fossa: report of a case, review of the literature, and a proposal management protocol. J Oral Maxillofac Surg 2001;59: 88–94.