title: Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma.
abstract: Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma due to anatomical and biomechanical factors. Owing to the proximity of the temporal glenoid fossa to the middle meningeal artery, there is the risk of serious sequelae in case of trauma. The authors report the case of a 36-year-old male patient, who was beaten up in a family dispute and presented with complex mandibular and maxillofacial fractures, including mandibular condyle intrusion into the middle cranial fossa causing extensive meningeal bleeding. The patient underwent immediate surgery, with evacuation of the epidural haematoma via a temporal approach. In addition open reduction and reconstruction of the temporal glenoid fossa via anatomic reduction of the fragments was performed. A functional occlusion was re-established via miniplate reconstruction of the complex mandibular body and ramus fractures. Prompt diagnosis and a multidisciplinary approach are essential to minimize the complications. Advanced imaging modalities of computed tomography are indicated. Treatment options should be individualized in particular in case of suspected neurological injury.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße, 35043 Marburg, Germany. struewer@med.uni-marburg.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Struewer
authors.forename: Ilias
authors.initials: I
authors.lastname: Kiriazidis
authors.forename: Jens
authors.initials: J
authors.lastname: Figiel
authors.forename: Thomas
authors.initials: T
authors.lastname: Dukatz
authors.forename: Thomas
authors.initials: T
authors.lastname: Frangen
authors.forename: Ewgeni
authors.initials: E
authors.lastname: Ziring
mesh_terms: D000328:Adult; D001860:Bone Plates; D035301:Cranial Fossa, Middle / Q000293:injuries*; D005147:Facial Bones / Q000293:injuries; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006407:Hematoma, Epidural, Cranial / Q000209:etiology* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D004204:Joint Dislocations / Q000150:complications* / Q000601:surgery; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000150:complications* / Q000601:surgery; D008576:Meningeal Arteries / Q000293:injuries; D019651:Plastic Surgery Procedures / Q000379:methods; D012887:Skull Fractures / Q000150:complications; D013701:Temporal Bone / Q000293:injuries / Q000601:surgery; D013704:Temporomandibular Joint / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods; D014754:Violence