Abstract
Introduction
A 10-year-old girl presented to the Emergency Department with temporomandibular joint pain, malocclusion, and trismus after a bicycle accident.
Methods
CT of the temporal bones showed displacement of the right mandibular condyle into the middle cranial fossa with small intraparenchymal hemorrhage. The condyle was reduced using closed reduction technique and the patient was placed in maxillomandibular fixation.
Results
Complete reduction of the displaced condyle with resultant normal occlusion and persistent bony defect in the temporal bone.
Conclusion
In early follow-up assessments the patient has had complete resolution of symptoms with residual bony defect from the site of fracture in the temporal bone.
1
Introduction
It has been well established in the literature that mandibular condyle injuries after trauma tend to result in fracture at the condylar neck or dislocation of the temporomandibular joint . A rarer event is fracturing of the glenoid fossa with mandibular condyle dislocation into the middle cranial fossa. To date, review of the English language shows only 41 case reports of displacement of the intact mandibular condyle into the middle cranial fossa in the Oral and Maxillofacial Surgery literature and one case report in the Neurosurgical literature . The authors present a case of a 10-year-old girl who fell off a bicycle with subsequent impact on the chin causing dislocation of the right intact mandibular condyle into the middle cranial fossa.
2
Case reports
A previously healthy 10 year old girl sustained facial trauma during a bicycle ride. She was unhelmeted with a friend seated directly behind her on a single-person bicycle. The patient lost control of the bike and subsequently fell over the handlebars landing on concrete with her chin hitting the ground first. She was transferred to the Division of Otolaryngology at Penn State Hershey Medical Center for further care the day of the incident. She denied any loss of consciousness, amnesia, nausea, or vomiting. She complained of an initial rush of air in her right ear and questionable muffled hearing on the right side which had resolved by the time of initial examination. She complained of bilateral temporomandibular joint pain and premature contact of her teeth on the right without any contact of her teeth on the left. Neurosurgery was consulted and determined no neurosurgical intervention was indicated.
Significant physical findings were right greater than left tenderness at the temporomandibular joints. Her auricular exam showed a slight blue hue of the right tympanic membrane without frank hemotympanum. Oral exam showed trismus with 1.6 cm inter-incisor distance and posterior displacement of the mandible with deviation to the right, premature contact of the right molars, and otherwise intact dentition. There was a 0.6 cm overbite. Her neurological exam was without any focal deficits or signs of cerebrospinal fluid leak. A computed tomography (CT) scan was obtained ( Figs. 1 and 2 ).
The patient was taken to the operating room for closed reduction of the mandibular condyle. With downward traction, the posterior molars were depressed and the right mandibular condyle was reduced back into the glenoid fossa. Arch bars were placed using 24-gauge wire and the patient was put into maxillomandibular fixation (MMF). An immediate post-operative CT panorex and facial bones showed reduction of the condyle with about 7 mm gap between the right condyle and fossa joint surfaces ( Fig. 3 ).
Post-operatively the patient was able to maintain occlusion while in MMF. She was discharged from the hospital within 48 h after surgery. One week after the patient was placed in MMF the rubber bands were removed in clinic. CT imaging on post-op day 37 showed the right condyle was sitting appropriately in the fossa ( Fig. 4 ).
2
Case reports
A previously healthy 10 year old girl sustained facial trauma during a bicycle ride. She was unhelmeted with a friend seated directly behind her on a single-person bicycle. The patient lost control of the bike and subsequently fell over the handlebars landing on concrete with her chin hitting the ground first. She was transferred to the Division of Otolaryngology at Penn State Hershey Medical Center for further care the day of the incident. She denied any loss of consciousness, amnesia, nausea, or vomiting. She complained of an initial rush of air in her right ear and questionable muffled hearing on the right side which had resolved by the time of initial examination. She complained of bilateral temporomandibular joint pain and premature contact of her teeth on the right without any contact of her teeth on the left. Neurosurgery was consulted and determined no neurosurgical intervention was indicated.
Significant physical findings were right greater than left tenderness at the temporomandibular joints. Her auricular exam showed a slight blue hue of the right tympanic membrane without frank hemotympanum. Oral exam showed trismus with 1.6 cm inter-incisor distance and posterior displacement of the mandible with deviation to the right, premature contact of the right molars, and otherwise intact dentition. There was a 0.6 cm overbite. Her neurological exam was without any focal deficits or signs of cerebrospinal fluid leak. A computed tomography (CT) scan was obtained ( Figs. 1 and 2 ).
