Bilaterally Superolateral Dislocation of Intact Mandibular Condyle Treated with Unilateral Open Reduction and Tmj Capsulorrhaphy

Rare occurrence and often misdiagnosed clinically ,we report a case of 42 year old male patient with very unusual diagnosis of superolateral dislocation of intact mandibular condyle bilaterally following traumatic insult to the mandible. Diffuse edema in the chin area and a left lateral deflection of the mandible, including an open bite and a crepitation in the Right parasymphyseal region. Three-dimensional computed tomography scans were taken, which presented a superior dislocation of both condyles hooked above the zygomatic arch laterally. Both condyles were reduced manually under general anaesthesia, right condyle was reduced but left condyle was repeatedly slipping into dislocated position. To prevent repeated early dislocation of condyle (dislocated superolaterally) the method of capsulorrhaphy by suturing split thickness temporalis Myofascial flap on lateral aspect of capsule was done followed by maxillomandibular fixation for 3 weeks and further active mouth opening exercise in order to prevent fibrosis. No case has been published in literature so far presented the method to prevent repeated slipping of condyle into superolateral dislocated position, ours is the first case with successful postoperative outcomes without any complication. 1 2 3 4 Kotak Rajkumar K, Sunil Sharma, Vikas Singh, Vishal Saini 1 2 3 4 Postgraduate Student, Professor and Head, Reader, Vishal Saini, Postgraduate Student, Department of Oral and Maxillofacial Surgery, Mahatma Gandhi Dental College and Hospital, Jaipur INTRODUCTION : Mandibular condyle fractures are common following maxillofacial trauma and dislocation of condyles as result of trauma out from the glenoid fossa is often associated with it. Displacement occurs anteriorly rather than posterior, laterally or superiorly. Superolateral Dislocation with intact mandibular condyle have often been misdiagnosed because of its rare occurrence. Yoshi et al1 suggested the possibility of unusual dislocation whenever signs and symptoms did not match any usual condylar fractures. Allen and Young2 first published in his series of case reports and gave classification of dislocation of condyle into type I (lateral subluxation),where the condyle is laterally displaced out of the glenoid fossa, and typeII (complete dislocation) where the condyle is displaced laterally as well as superiorly entering the temporal fossa Satoh et al3 also proposed a classification with modification an added subdivisions in it. dislocation into type IIA, in which the condyle is not hooked above the zygomatic arch; type IIB in which the condyle is hooked above the zygomatic arch; and type IIC in which the condyle is lodged inside the zygomatic arch, which is fractured. We present a case of Superolateral dislocation of intact mandibular condyle bilaterally associated with Right side parasymphysis fracture of mandible. Unilateral Open reduction for lateral Capsule repair of Temporomandibular joint was executed to prevent recurrence and hypermobilty of TMJ postoperatively with the help of conventional procedure of inferiorly based split thickness Temporalis myofascial Flap. CASE REPORT : A 42 years old male patient reported to emergency unit with the history of fall from height. Patient was conscious and was under the influence of alcohol all vital signs were normal with no history of loss of Consciousness. Patient was complaining of pain and inability to open mouth with presence of intraoral bleeding. No Positive history of vomiting and bleeding from ear or nose evaluated. On extraoral examination swelling and presence of laceration over the chin region with gross facial assymetry and left lateral deflection of the mandible was observed.(Figure 1) On palpation slight preauricular depression and condyles were palpated above the zygomatic arch. Marked Elevation at both the region above the zygomatic arch which was tender indicating the fracture displacement of condyle. On intraoral Examination classical anterior open bite with BILATERALLY SUPEROLATERAL DISLOCATION OF INTACT MANDIBULAR CONDYLE TREATED WITH UNILATERAL OPEN REDUCTION AND TMJ CAPSULORRHAPHY : A RARE CASE REPORT AND REVIEW OF LITERATURE. Journal of Dental Sciences University