Intraoperative Recognition of Middle Cranial Fossa Perforation During Temporomandibular Joint Arthroscopy

Intracranial complications of temporomandibular joint (TMJ) arthroscopy, such as middle cranial fossa perforation, are rare but potentially severe.

The authors present the case of a 31-year-old female patient with internal derangement of the right TMJ (Wilkes II) in whom a perforation of ∼2.29 mm was identified intraoperatively during level II arthroscopy in the roof of the glenoid fossa, with apparent integrity of the dura mater and no cerebrospinal fluid (CSF) leak. The procedure was suspended immediately, and multidisciplinary conservative management was carried out with the neurosurgery department, with a satisfactory clinical course.

The authors review the available literature on this complication, the surgical anatomy of the skull base, and strategies for prevention, diagnosis, and management.

Early intraoperative recognition and individualized conservative management, in the absence of dural injury or CSF leak, allow a favorable outcome without the need for neurosurgical intervention.