title: Treatment Algorithm for Intracranial Intrusion Injuries of the Mandibular Condyle.
abstract: OBJECTIVE
  Traumatic injuries of the mandible resulting in intrusion of the condyle into the middle cranial fossa are rare and treatment is often based on anecdotal experience. The objective of this study was to develop an algorithm for the management of condylar intrusion injuries by identifying factors that influenced the treatment decision of closed versus open reduction of the condyle.
  
  
  METHODS
  This study was a systematic review of the literature on intracranial intrusion injuries of the mandibular condyle. A thorough search of the PubMed and Cochrane databases and individual maxillofacial and craniofacial journal databases was conducted using the Medical Subject Heading terms condylar impaction, condylar dislocation, condylar intrusion, and middle cranial fossa and condyle without date and language restriction. Quantitative data on the patient's age, gender, etiology of injury, and time from injury to diagnosis were analyzed using descriptive statistics. The authors studied how the predictor variables of age, etiology, time from injury to diagnosis, and associated neurologic injuries influenced the outcome variable of closed versus open reduction of the condyle.
  
  
  RESULTS
  Forty-eight of the 62 retrieved case reports, case series, and review articles were published in the English-language literature from 1963 to 2015. Data on 51 patients with these injuries showed that 38 (75%) were female and younger than 30 years. The most common etiology of injury was motor vehicular accidents, occurring in 25 of 51 patients (49%). The mean time from injury to diagnosis was 31.2 days (0 to 106.4 days). Forty of the 51 patients (78%) were diagnosed within the first 2 weeks of injury. A good proportion of patients underwent open reduction (63%) and 18 of the 51 of patients (35%) underwent closed reduction.
  
  
  CONCLUSIONS
  Predictor variables that influenced the treatment decision of open versus closed reduction were age of the patient, etiology of injury, and time from injury to diagnosis. Based on the present results, younger patients (0 to 15 yr old), patients who sustain condylar intrusion injuries from bicycle accidents, and those diagnosed within the first 2 weeks of injury are more likely to benefit from closed reduction. The treatment algorithm emphasizes the importance of assessment of associated neurologic injuries and an interdisciplinary approach for the management of these injuries.
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Boston University, School of Dental Medicine and Boston Medical Center, Boston, MA. Electronic address: arya@bu.edu.
authors.forename: Varun
authors.initials: V
authors.lastname: Arya
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Boston University, School of Dental Medicine and Boston Medical Center, Boston, MA.
authors.forename: Radhika
authors.initials: R
authors.lastname: Chigurupati
mesh_terms: D000063:Accidents, Traffic; D000367:Age Factors; D000465:Algorithms; D001930:Brain Injuries / Q000175:diagnosis; D002985:Clinical Protocols; D035301:Cranial Fossa, Middle / Q000293:injuries* / Q000601:surgery; D003657:Decision Making; D042241:Early Diagnosis; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery / Q000628:therapy*; D008335:Mandibular Condyle / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000601:surgery / Q000628:therapy*