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 Table of Contents  
CASE REPORTS
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 33-35

Superolateral dislocation of mandibular condyle associated with parasymphysis fracture


1 Department of Oral and Maxillofacial Surgery, Paras HMRI Hospital, Patna, Bihar, India
2 Department of Conservative Dentistry and Endodontics, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
3 Department of Oral Medicine and Radiology, Patna, Bihar, India

Date of Submission12-Jun-2021
Date of Acceptance19-Jul-2021
Date of Web Publication19-Sep-2022

Correspondence Address:
Amber Ali Faraz
Department of Oral and Maxillofacial Surgery, Paras HMRI Hospital, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/DYPJ.DYPJ_32_21

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  Abstract 

Superolateral dislocation of intact mandibular condyle is a rare clinical condition due to trauma of the mandible. We report the case of a 31-year-old male patient presenting with superolateral dislocation of the mandibular condyle and an associated parasymphyseal fracture following traumatic insult to the mandible in a road traffic accident.

Keywords: Condyle, fracture dislocation, mandibular fracture, superolateral dislocation, trauma, zygomatic arch


How to cite this article:
Faraz AA, Fatima A, Faraz SA. Superolateral dislocation of mandibular condyle associated with parasymphysis fracture. D Y Patil J Health Sci 2022;10:33-5

How to cite this URL:
Faraz AA, Fatima A, Faraz SA. Superolateral dislocation of mandibular condyle associated with parasymphysis fracture. D Y Patil J Health Sci [serial online] 2022 [cited 2022 Oct 6];10:33-5. Available from: http://www.dypatiljhs.com/text.asp?2022/10/1/33/356512




  Introduction Top


Temporomandibular joint (TMJ) dislocation is a challenging pathophysiological joint condition to manage for oral and maxillofacial surgeons. TMJ dislocation involves a nonself-limiting condylar displacement, outside of its functional position within the glenoid fossa and posterior slope of the articular eminence.[1] Dislocation of the TMJ can be classified as anterior, posterior, superior, or lateral depending on the direction of dislocation, while based on the symmetry, it can be unilateral or bilateral.[2]

Superolateral dislocation of the mandibular condyle is an infrequent complication of trauma to the mandible. It is usually associated with the fracture of the mandible but rarely with other facial fractures.[3],[4] Critical factors for such rarity can be disparate anatomy of the condyle, direction of muscle pull, and ligaments attached to condyle and capsule.[3],[5]

This case report attempts to describe a rare case of superolateral dislocation of the mandibular condyle associated with parasymphysis fracture.


  Case Report Top


A 31-year-old male patient with a noncontributory medical history reported to our hospital with the chief complaint of pain, reduced mouth opening, and difficulty in lower jaw movement for 2 days. A detailed history revealed that the patient had met a road traffic accident 2 days prior to the presentation. There was no significant history of loss of consciousness, nausea, or vomiting. Clinical examination revealed facial asymmetry where the chin was deviated to the right along with deranged occlusion, tenderness in the right TMJ and parasymphysis region, and restricted mouth opening. The right condyle was palpable above the zygomatic arch. A computed tomography scan was done which revealed that the right mandibular condyle was dislodged from the glenoid fossa and hooked above the zygomatic arch along with the fracture of right parasymphysis [Figure 1] and [Figure 2]. A diagnosis of superolateral dislocation of the right condyle was made and it was decided to reduce the condyle under general anesthesia. Manual reduction of the right condyle was attempted by placing the thumb over the retromolar region and other fingers over the lower border of the mandible, and a pull was given in downward and lateral direction to dislodge the condyle from the zygomatic arch and rotated clockwise to reduce the condyle back into its normal position. The parasymphyseal fracture was reduced and fixed using 2.5 mm × 8 mm and 2 mm × 8 mm four-hole titanium miniplates [Figure 3]. Mandibular movements and occlusion were verified and the patient was extubated. Intermaxillary fixation was done for 2 weeks to keep the condyle in a reduced position. Antibiotics were prescribed to the patient for 7 days. After the given time period, inter-maxillary fixation was released and the patient was advised physiotherapy and mouth opening exercises using ice-cream sticks. Two months following trauma, the patient had a mouth opening of 31 mm and normal mandibular movements were seen.
Figure 1: Preoperative computed tomography scan showing superolateral dislocation of right mandibular condyle with associated parasymphysis fracture

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Figure 2: Preoperative computed tomography scan showing superolateral dislocation of right mandibular condyle above the zygomatic arch

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Figure 3: Intraoperative view of right parasymphysis reduced with 2.5 mm × 8 mm and 2 mm × 8 mm four hole titanium miniplates

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  Discussion Top


Allen and young proposed a classification for the lateral dislocation of the mandibular condyle and categorized them into Type I (lateral subluxation) where the condyle has been laterally displaced out of the fossa and Type II (complete dislocation), where the condyle is forced laterally and superiorly to enter the temporal fossa. They further described that an additional associated fracture of the mandible near the symphysis region is a requisite for Type II dislocation.[6] Type II dislocation was later classified by Satohet al. into three categories, i.e., Type II A, in which condyle is not hooked above the zygomatic arch; Type II B, in which the condyle is hooked above the zygomatic arch; and Type II C, in which the condyle is lodged inside the zygomatic arch, which is fractured.[7]

A new addition to the classification was proposed by Tauro et al. as Type III, in which complete dislocation without any associated fracture of the anterior mandible is seen. Further Type III was subclassified as Type III A – condyle not hooked above the zygomatic arch; Type III B – condyle hooked above the zygomatic arch; Type III C – condyle lodged within the zygomatic arch which is fractured.[8]

Worthington described the distinctive features of superolateral dislocation which includes a malocclusion persistence after the reduction of fractured jaw, the persistence of an open bite, restrictions of mandibular movement, facial asymmetry, and apparent loss of fragments of the ramus.[9]

Our case presented with the dislocation of the right mandibular condyle which was hooked above the zygomatic arch along with the fracture of right mandibular parasymphysis having a peculiar presentation of Type II B dislocation.

The goal of treatment of superolateral dislocation of the mandibular condyle is repositioning of the condyle back to its physiological position. Manual/closed reduction of the condyle which is the least traumatic, safest, and simplest method seems to be the first choice for treatment of superolateral dislocation of intact mandibular condyle. Cases not responding to closed reduction will require open reduction.[2] We opted for the closed reduction method in our case as a dislocation that has lasted for a few days can be corrected by closed or manual reduction.[10] Postoperatively, the patient was put on inter-maxillary fixation for 2 weeks to prevent the condyle from reverting back to its preoperative position and possibly to heal the damaged ligaments.

Early reduction of the condyle is a critical factor affecting the prognosis of treatment as delayed reduction causes fibrosis of glenoid fossa which results in an imperfect reduction resulting in fibro-osseous ankylosis of TMJ.[8] Long-term follow-up is also critical to keep an eye on the developing fibrous adhesion or ankylosis as sometimes, the initial follow-up may not show such signs.


  Conclusion Top


Superolateral dislocation of mandibular condyle usually goes unnoticed; therefore, thorough clinical and radiographic examination is a requisite. Early diagnosis and prompt management is required for a good prognosis. The more the delay in reduction of the condyle, the more reduction becomes difficult and prognosis worsens. In our case, satisfactory results can be attributed to early management. However, such type of cases should be kept on a routine follow-up to ascertain any TMJ problems.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Liddell A, Perez DE Temporomandibular joint dislocation. Oral Maxillofac Surg Clin North Am 2015;27:125-36.  Back to cited text no. 1
    
2.
Bhutia DP, Mehrotra D, Mahajan N, Howlader D, Gamit J Post-traumatic superolateral dislocation of condyle: A case series of 18 condyles with review of literature and a proposed classification. J Oral Biol Craniofac Res 2017;7:127-33.  Back to cited text no. 2
    
3.
Hira PG, Rikhotso RE Superolateral extracapsular dislocation of the mandibular condyle: Review of the literature and report of two cases. Oral Maxillofac Surg Cases 2019;5:100082.  Back to cited text no. 3
    
4.
Amaral MB, Bueno SC, Silva AA, Mesquita RA Superolateral dislocation of the intact mandibular condyle associated with panfacial fracture: A case report and literature review. Dent Traumatol 2011;27:235-40.  Back to cited text no. 4
    
5.
Patil SG, Patil BS, Joshi U, Rudagi BM, Aftab A Superolateral dislocation of bilateral intact mandibular condyles: A rare case series. J Maxillofac Oral Surg 2017;16:212-8.  Back to cited text no. 5
    
6.
Allen FJ, Young AH Lateral displacement of the intact mandibular condyle. A report of five cases. Br J Oral Surg 1969;7:24-30.  Back to cited text no. 6
    
7.
Satoh K, Suzuki H, Matsuzaki S A type II lateral dislocation of bilateral intact mandibular condyles with a proposed new classification. Plast Reconstr Surg 1994;93:598-602.  Back to cited text no. 7
    
8.
Tauro D, Lakshmi S, Mishra M Superolateral dislocation of the mandibular condyle: report of a case with review of literature and a proposed modification in the classification. Craniomaxillofac Trauma Reconstr 2010;3:119-23.  Back to cited text no. 8
    
9.
Worthington P Dislocation of the mandibular condyle into the temporal fossa. J Maxillofac Surg 1982;10:24-7.  Back to cited text no. 9
    
10.
Rahman T, Hashmi GS, Ansari MK Traumatic superolateral dislocation of the mandibular condyle: Case report and review. Br J Oral Maxillofac Surg 2016;54:457-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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