Traumatic Intracranial Displacement of an Intact Temporomandibular Joint Condyle: A Case Report and Literature Review

Traumatic intrusion of the mandibular condyle into the middle cranial fossa is an extremely rare and life-threatening condition. It often lacks specific clinical manifestations, particularly in patients with polytrauma, which typically leads to oversight or misdiagnosis. Although many individuals present without obvious neurological deficits, associated craniofacial injuries such as concussion, intracranial hemorrhage, cerebrospinal fluid leakage, otorrhagia, hearing impairment, and facial nerve dysfunction are commonly observed. Most published cases have involved condylar fractures; however, intracranial penetration by an intact condyle is extremely rare. While guidelines for condylar fractures suggest prompt condylar removal and skull base repair, the feasibility of skull base reconstruction depends on the complexity of the trauma. Treatment decisions, including the choice of surgical approach and reconstruction, were individualized for each case. In the present case, skull base repair was not performed because of a comminuted fracture during emergency surgery. Despite severe craniocerebral injuries, emergency surgery could not resolve the issue, and the patient refused secondary surgery and opted for conservative treatment, which ultimately resulted in a favorable outcome. This case highlights that conservative treatment can be a prudent choice when surgical conditions are limited. This report describes a rare case of intact intracranial penetration of the mandibular condyle, discusses its clinical and imaging characteristics, and reviews therapeutic strategies, providing insights into early diagnosis and personalized management.