Intermittent intracranial condylar dislocation with minimal functional sequelae

Abstract

Degenerative changes of the temporomandibular joint (TMJ) present with a broad spectrum of morphological alterations. However, erosions leading to a glenoid fossa defect and condylar impingement of the temporal lobe are a rare finding. A 77-year-old female patient presented with limited mouth opening and pre-auricular pain during mastication on the left side. She denied any neurological dysfunction. Her medical history included poliomyelitis, multiple cancers, and osteonecrosis of the left tibial plateau. Computed tomography revealed advanced degeneration of both TMJs. On the left side, a glenoid fossa fragment was elevated towards the left middle cranial fossa. Real-time dynamic magnetic resonance imaging (MRI) showed repetitive intracranial condylar dislocation during mouth closure. She declined surgery and received instructions for self-management. At the 12-month follow-up, she reported resolution of the pain and normal masticatory function. A control MRI showed a stable radiographic appearance. This report illustrates that intermittent dislocation of the mandibular condyle into the middle cranial fossa can be successfully managed conservatively. The self-limiting nature of the TMJ degenerative joint disease, patient preference, and the patient's general health status require consideration when advising patients on the therapeutic strategy.

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

“…The etiologies were motor vehicle accidents (MVA; 50%, n = 58), falls (20.7%, n = 24), bicycle accidents (16.4%, n = 19), assault (3.4%, n = 4), collision (1.7%, n = 2), osteomyelitis (1.7%, n = 2), and others (3.4%, n = 4). Other etiologies included industrial accidents [14], accidents [80], degenerative changes of TMJ [107], and orthognathic surgery [108]. The etiology was not reported in three cases (2.6%).…”

“…Nine of the patients required a TMJ surgery (Table 4). This condition was conservatively observed in four cases [14,94,107,108]. New dentures were inserted in two cases [12,15].…”

“…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].…”

“…Treatment modalities vary widely, from no treatment with close observation to closed reduction under general anesthesia or a craniotomy with intracranial condylectomy. Four patients included in this study were not provided treatment and were closely observed instead [14,94,107,108]. Elastic splint traction was successful in two cases [6,36].…”