Central condylar displacement with brain abscess from chronic mandibular osteomyelitis

Abstract

In this case report, we describe a unique long-term complication from undiagnosed mandibular osteomyelitis. A 53-year-old female who underwent a dental extraction complicated by chronic postoperative odontogenic infection and cutaneous parotid fistula formation 2 years earlier presented with acute mental status change, gradual unilateral facial nerve palsy (House-Brackmann score V), and nontraumatic dislocation of the condylar head into the middle cranial fossa. The patient's chronic mandibular osteomyelitis led to glenoid fossa erosion, middle cranial fossa penetration, and temporal lobe abscess formation. A combined middle cranial fossa approach through a burr hole placed in the squamous temporal bone near the zygomatic root and intraoral mandibular approach to ipsilateral condylar head was performed to complete partial mandibulectomy, including condylectomy. The patient was treated with 6 weeks of meropenem perioperatively. Four months after the surgery, the patient had complete resolution of skull base osteomyelitis, parotid fistula, and neurologic deficits and full recovery of facial nerve function (House-Brackmann score of I).

Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction

“…According to the authors, the dissemination of the infection was through the blood circulation ( 5 ). Lee T et al ( 6 ) reported a case of central condylar displacement with brain abscess from chronic mandibular osteomyelitis. In this study, the authors hypothesize that the patient’s chronic mandibular osteomyelitis led to glenoid fossa erosion with penetration of the germs in the middle cranial fossa and temporal lobe abscess formation.…”

Superior Dislocation of the Mandibular Condyle into the Middle Cranial Fossa: A Comprehensive Review of the Literature

“…Previously, the reported cases were those associated with trauma; however, cases linked to causes other than trauma have recently been reported. These include chronic osteomyelitis [77,109], degenerative changes in the TMJ [107], and asymptomatic intracranial intrusion after orthognathic surgery [108]. A chronic mandibular and/or middle skull base osteomyelitis with a concurrent brain abscess can result in a non-traumatic intracranial condylar head displacement [109].…”