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Degenerative changes of the temporomandibular joint (TMJ) present with a broad spectrum of morphological alterations. However, erosions leading to a glenoid fossa defect and condylar impingement of the temporal lobe are a rare finding. A 77-year-old female patient presented with limited mouth opening and pre-auricular pain during mastication on the left side. She denied any neurological dysfunction. Her medical history included poliomyelitis, multiple cancers, and osteonecrosis of the left tibial plateau. Computed tomography revealed advanced degeneration of both TMJs. On the left side, a glenoid fossa fragment was elevated towards the left middle cranial fossa. Real-time dynamic magnetic resonance imaging (MRI) showed repetitive intracranial condylar dislocation during mouth closure. She declined surgery and received instructions for self-management. At the 12-month follow-up, she reported resolution of the pain and normal masticatory function. A control MRI showed a stable radiographic appearance. This report illustrates that intermittent dislocation of the mandibular condyle into the middle cranial fossa can be successfully managed conservatively. The self-limiting nature of the TMJ degenerative joint disease, patient preference, and the patient's general health status require consideration when advising patients on the therapeutic strategy.

This report presents a case of extensive tophaceous pseudogout involving the temporomandibular joint (TMJ), causing erosion into the middle cranial fossa. Pseudogout is a benign metabolic arthropathy caused by calcium pyrophosphate dihydrate crystal deposition within joints and peri-articular tissue. Pseudogout more frequently occurs in large joints such as the knee, wrist, symphysis pubis, and shoulder. Tophaceous pseudogout involving the TMJ is rare, with only seven cases involving erosion into the middle cranial fossa reported previously. Despite skull base erosion being a rare consequence of this erosive disease, this case highlights the importance of appropriate investigation and multidisciplinary team management.

This study summarizes our experience of treating three rare cases of traumatic superior dislocation of the mandibular condyle into the cranial fossa and provides a potential treatment algorithm. Between the years 2002 and 2012, three patients with traumatic superior dislocation of the mandibular condyle into the cranial fossa were admitted to our department. After evaluating the interval from injury to treatment, the associated facial injuries including neurological complications, and the computed tomography imaging findings, an individualized treatment plan was developed for each patient. One patient underwent closed reduction under general anaesthesia. Two patients underwent open reduction with craniotomy and glenoid fossa reconstruction. All three patients were followed up for 1 year. Mouth opening and occlusal function recovered well, but all patients had mandibular deviation during mouth opening. Closed reduction under general anaesthesia, open surgical reduction with craniotomy, and mandibular condylotomy are the three main treatment methods for traumatic superior dislocation of the mandibular condyle into the cranial fossa. The treatment method should be selected on the basis of the interval from injury to treatment, associated facial injuries including neurological complications, and computed tomography imaging findings.

This report presents the case of an extensive synovial chondromatosis of the temporomandibular joint (TMJ), with extension into the middle cranial fossa, middle ear, and carotid canal. Synovial chondromatosis of the TMJ is rare, particularly when associated with intracranial involvement. This case is unique owing to its size and the involvement with the internal carotid artery. The importance of a multidisciplinary approach in the surgical management of such a rare and complex form of this condition is highlighted.

Gap arthroplasty, used in the treatment of temporomandibular joint (TMJ) ankylosis, is challenging, requiring resecting of massive abnormal bone formation at the skull base with complex and distorted anatomy. This study evaluated the application of image-guided navigation to gap arthroplasty. Four gap arthroplasties were performed on patients with unilateral TMJ ankylosis under computer-assisted navigation guidance. After preoperative planning and 3-dimensional simulation, the normal anatomic structures of the TMJ were created by superimposing and comparing the unaffected and affected sides. The amount and range of ankylotic bone to be resected was determined and displayed. Registration achieved an accurate match between the intra-operative anatomy and the CT virtual images. Anatomic structures and the position of surgical instruments were shown real time on the screen. In all cases the accuracy of the system measured by the computer did not exceed 1 mm. No complications occurred and the mean minimal thickness of the skull base between middle cranial fossa and reconstructed glenoid fossa was 1.97 mm. Using image-guided navigation resulted in safe surgical excision of the bony ankylosis from the skull base. Navigation-guided resection of the ankylotic bone in the TMJ gap arthroplasty was a valuable and safe technique in this potentially complicated procedure.

The variety of temporomandibular joint (TMJ) prostheses and condylar reconstruction plates available is in contradiction to their rare application. This emphasizes that alloplastic TMJ reconstruction is still evolving. This article reviews the history of TMJ reconstruction. Medline as well as public and private libraries have been searched. Current systems are reviewed. Prosthetic devices can be differentiated into fossa-eminence prostheses, ramus prostheses and condylar reconstruction plates, and total joint prostheses. Fossa and total joint prostheses are recommended when the glenoid fossa is exposed due to excessive stress (degenerative disorders, arthritis, ankylosis, multiply operated pain patients). Singular replacement of the condyle is preferred as a temporary solution in ablative surgery. The use of prosthetic devices for long-term replacement should be restricted to selected cases, taking care to retain the disk, in order to prevent penetration into the middle cranial fossa. The term 'condylar reconstruction plate' reflects this more clearly than 'ramus prosthesis' which suggests permanent reconstruction. Long-term studies comparing the functional and aesthetic results of the various prostheses and condylar reconstruction plates are not available, which leaves the choice to personal experience.

Multiple reports document that a foreign-body giant cell reaction forms around Proplast-Teflon temporomandibular joint (TMJ) implants. This results in destruction of surrounding bone and instability of the implants. This case presents a patient whose Proplast-Teflon TMJ implants became displaced into her middle cranial fossa. The staged reconstruction of this patient is described, including removal of the TMJ implants, reconstruction of the defect, concomitant orthodontic treatment and final reconstruction with TMJ Concepts. This process involved a multidisciplinary approach between several medical and dental specialties. At her 3-year follow up, the patient had a stable postoperative result.

The skull base is uniquely placed to absorb anteriorly directed forces imparted either via the midfacial skeleton or cranial vault. A variety of skull base fracture classifications exist. Less well understood, however, is fracture extension beyond the anterior cranial fossa (ACF) into the middle and posterior cranial fossae. The cases of 81 patients from two UK major trauma centres were studied to examine the distribution of fractures across the skull base and any relationship between the vector of force and extent of skull base injury. It was found that predominantly lateral force to the craniofacial skeleton produced a fracture that propagated beyond the ACF into the middle cranial fossa in 77.4% of cases, significantly more (P

In hemifacial microsomia, patients with severely hypoplastic mandibles (Pruzansky type III) require replacement of the ramus and condyle unit. Common complications of this procedure include graft fracture and overgrowth of the graft. An uncommon case of osteolysis of the costochondral graft with osteitis of the middle cranial fossa is reported herein. To our knowledge, no such case has been reported in the literature previously. The aim of this report is to present the only known case and to discuss the contributing factors.

Dislocation of the mandibular condyle into the middle cranial fossa is extremely rare. The authors present a case of superior dislocation of left condyle into the middle cranial fossa. The dislocated condyle was reduced successfully and then a flap of temporal muscle and a thin titanium network were used to repair the defect in the middle cranial fossa.

Synovial chondromatosis of the temporomandibular joint (TMJ) is relatively rare. An unusual case with extension through the glenoid fossa and into the middle cranial fossa is reported. Invasion of the infratemporal fossa and the middle cranial fossa was seen on both computed tomography and magnetic resonance imaging. Complete removal of the loose bodies with excision of the affected synovium is the accepted treatment of synovial chondromatosis. A conservative approach should be followed while trying to eliminate any remaining lesion in the infratemporal fossa and the middle cranial fossa. An overview of previously reported cases of synovial chondromatosis with cranial extensions is also presented.

An unusual case of massive osteolysis affecting the left side of the mandible, the maxilla, the zygoma, and the orbit is reported. The disease extended over a period of 25 years. The special feature of this case is that there were, before the osteolysis appeared, enlargement and sclerosis of the maxillofacial bones reaching up to the middle cranial fossa. Histopathologic examination of the affected mandible revealed that the bone was replaced by fibrous tissue.

A 17-year-old patient suffered a dislocation of the right mandibular condyle into the middle cranial fossa following a motorcycle accident. Reduction was delayed because of serious orthopaedic injuries. The condyle was relocated into the glenoid fossa through a combined neurosurgical and preauricular approach. Five years later the patient presented for removal of wisdom teeth and a CT-scan was done to determine the effects of the trauma and management to the condyle. A fibro-osseous ankylosis had occurred in the right temporomandibular joint. The radiological changes confirm that early management appears to improve the prognosis for these injuries.

A variety of osteoplastic flaps have been devised for transoral or extraoral access to the base of skull and the upper anterior cervical spine. Part I of this two-part review describes access to the clivus and upper anterior cervical spine. Part II will describe access to the middle cranial fossa, the infratemporal fossa and the pterygoid (retromaxillary) "space".

A case of superior dislocation of the mandibular condyle into the middle cranial fossa is presented. A modified method of reducing the mandibular condyle was used, and restitution of the perforated glenoid fossa was achieved by a combination of titanium plate and repair of the articular disk.

The authors reported 46 patients with maxillofacial malignancies involving the anterior and middle cranial fossae treated over a 20-year period in the Department of Oral and Maxillofacial Surgery, Shanghai Second Medical University. The primary sites of the malignancies were: maxilla (25), infra-temporal fossa (6), peri-orbital region (7), cheek (4) and temporomandibular joint (2). The pathological diagnoses included: squamous cell carcinoma (19), adenoid cystic carcinoma (4), adenocarcinoma (4), fibrosarcoma (3), malignant fibrohistocytoma (3), osteosarcoma (2) and others (11). All the patients underwent craniomaxillofacial resection: en bloc resection included anterior cranial fossa in 20 patients, middle cranial fossa in 16 patients, and combined anterior and middle cranial fossae in 10 patients. 18 patients underwent simultaneous orbital exenteration. All the defects were reconstructed with a variety of flaps including free or pedicled pectoralis major flap, free latissimus dorsi flap, forehead flap, temporalis flap, etc. 41 patients were followed up for more than 3 years. The result showed that the 3- and 5-year survival rates were 48.8% (20/41) and 35.1% (13/37), respectively, while the 10-year survival rate was 20% (4/20). The authors concluded that craniomaxillofacial resection played an increasingly important role in improving the survival of patients suffering from advanced malignancy of the oral and maxillofacial region. Steve G. F. Shen