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Intermittent intracranial condylar dislocation with minimal functional sequelae.

A Zumbrunn Wojczyńska¹, B Schuknecht², D A Ettlin³

¹Orofacial Pain Unit, Centre of Dental Medicine, University of Zurich, Zurich, Switzerland.

International Journal of Oral and Maxillofacial Surgery

|October 21, 2020

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This case study shows that rare temporomandibular joint (TMJ) degeneration with intracranial condylar dislocation can be managed conservatively. Conservative treatment led to pain resolution and restored masticatory function in a 77-year-old patient.

Area of Science:

Orthopedics
Neurology
Radiology

Background:

Degenerative changes in the temporomandibular joint (TMJ) typically manifest as diverse morphological alterations.
Erosions causing glenoid fossa defects and condylar impingement on the temporal lobe are exceptionally rare TMJ findings.

Observation:

A 77-year-old female patient with a history of poliomyelitis, multiple cancers, and osteonecrosis presented with limited mouth opening and pre-auricular pain.
Computed tomography revealed advanced degeneration of both TMJs, with a glenoid fossa fragment elevated towards the left middle cranial fossa on the left side.
Real-time dynamic magnetic resonance imaging (MRI) demonstrated repetitive intracranial condylar dislocation during mouth closure, without neurological dysfunction.

Findings:

The patient opted for conservative self-management over surgery.

Keywords:

diphosphonates joint diseases middle cranial fossa skull base temporomandibular joint disorders

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At 12-month follow-up, the patient reported complete resolution of pain and normal masticatory function.

Follow-up MRI confirmed a stable radiographic appearance, indicating successful conservative management.

Implications:

This case highlights that intermittent intracranial condylar dislocation, a rare TMJ complication, can be effectively managed conservatively.
Therapeutic strategies for TMJ degenerative joint disease should consider the condition's self-limiting nature, patient preferences, and overall health status.
Conservative management may be a viable option for select patients with advanced TMJ degeneration and intracranial dislocation, avoiding surgical risks.