Functional Evaluation of the Use of Total TMJ Custom Prothesis in the Treatment of Fracture of the Middle Cranial Fossa by Condylar Impaction

Hayashi, Gerson

Fracture of the middle cranial fossa by dislocation of mandibular condyle is a rare type of trauma, and only a few cases are reported in literature. This injury is more common among children and young adults than among the elderly. Most of these fracture have been treated in a open reduction, and variable outcomes have been reported, primarily the functional recovery of these patients. The aim of this paper is to present a follow-up of 2 years of a fracture of the cranial fossa by impaction of mandibular condyle treated with TMJ custom prothesis, where we perform the functional assessment preoperative and postoperative, analyzing the maximum incisal opening (MIO), protrusive (P), lateral excursive movements right and left (LR/LL) and deviation (D). Measurements of mandibular movements were made by the same professional using a caliper, the evaluation of the facial asymmetry and occlusion was performed by clinical and radiographic evaluation and pain assessment was performed using a specific questionnaire. The data were subjected to direct analysis of data and measures of central tendency. The patient evaluated had 19 year-old, female, victim of a motorcycle accident. The patient presented with pain, limited jaw movements, facial asymmetry and malocclusion. We did not observe neurological and ENT injuries. Evolved in right subcondilar fracture and middle cranial fossa by dislocation of the left condyle. Surgery was performed through open reduction with IRF on the right side and on the left a total TMJ custom prosthesis. There were no local or neurological complications during surgery and the patient underwent rehabilitation physiotherapy for 6 months and accompanied by two years. In functional evaluation pre and postoperative respectively had the following results: MIO increase 2mm to 40mm (38mm) LR increase 0mm to 3mm (3mm), LL increase 0mm to 5mm (5mm) and P increase 2mm to 5mm (5mm). The patient after clinical and radiographic evaluation showed no facial asymmetry and had good occlusion. The pain questionnaire answered by it showed that the patient did not have significant pain. The use of Total TMJ custom prosthesis for treatment of cases of fracture of the middle cranial fossa by impaction of the mandibular condyle, without neurological complications, seems an excellent choice, especially in functional recovery.

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