Intrusion of the Mandibular Condyle Into the Middle Cranial Fossa: A Meta-Analysis and Treatment Protocol

PURPOSE:The purpose of this study was to present a treatment protocol for management of rare mandibular injuries resulting in condylar intrusion into the middle cranial fossa. The treatment protocol is based on a systematic review of the literature, a meta-analysis of the reported cases and the author’s experience at an academic medical center.

METHODS: We conducted a thorough search of the PubMed and Cochrane databases and individual maxillofacial and craniofacial journal databases using the MeSH terms “condylar impaction”, “condylar intrusion”, “middle cranial fossa and condyle” without date and language restriction.  We included 48 case reports, case series and review articles from the English literature reported between 1963-2015, on condylar intrusion injuries into the middle cranial fossa, of the total 62 published articles that were retrieved. Articles that reported anterior, antero-medial, posterior or lateral condylar dislocation with respect to the glenoid fossa were excluded.  For the meta-analysis, we included 51 patients; 48 from the literature and, 3 treated by author that had available data on age, gender, etiology of injury, time lag from injury to diagnosis, and treatment were analyzed.

RESULTS: The data analysis revealed that these injuries were more common in females (74.5%) than males (26.5%). The vast majority of the patients (94%) were younger than 30 years of age.  In younger patients (<15 years) with these injuries, 90.9% were females. The most common cause of these injuries were motor vehicle accidents (49.0%), and bicycle accidents (25%).  The time lag from injury to diagnosis ranged from 0 days to 2 years and 40/51 patients (78.4%) were diagnosed within the first 2 weeks. We noted a trend of early diagnosis (< 2 weeks) since after 1990. About one third (35.3%) of the 51 of patients were treated by closed reduction and the remaining underwent open reduction. Despite the early diagnosis of injury within a period of two weeks, 22 patients (55%) had open reduction vs 18 patients (45%) had closed reduction.

CONCLUSIONS: The results of our meta-analysis revealed that time lag from injury to diagnosis and age of the patient were the most significant factors that dictated the treatment decisions for management of condylar intrusion injuries into middle cranial fossa. Neurosurgical and anesthesia consultations were a critical part of the treatment algorithm.

References:

1. Melugin MB, Indresano T, Clemens SP. Glenoid fossa fracture and condylar penetration into the middle cranial fossa. J Oral Maxillofac Surg, 55 (1997), p. 1342-7
2. Ohura N, Ichioka S, Sudo T, Nakagawa M, Kumaido K, Nakatsuka T. Dislocation of the bilateral mandibular condyle into the middle cranial fossa: review of the literature and clinical experience. J Oral Maxillofac Surg. 2006 Jul;64(7):1165-72.