Dislocation of a fractured mandibular condyle into the middle cranial fossa: a case treated by an extracranial approach.

INTRODUCTION: Penetration of the mandibular condyle into the middle cranial fossa is a rare complication usually due to blunt traumas to the chin. Particular anatomical and dynamic conditions can lead to the intracranial dislocation of the condyle in spite of the fracture of the condylar neck that usually prevents this event from dissipating the kinetic force of the impact. DISCUSSION: We report the case of a 10-year-old female patient suffering from symphyseal and bilateral condilar fracture with intrusion of the left condyle into the middle cranial fossa. The diagnosis of intracranial dislocation was initially missed because of the nonspecific symptomatology and insufficient radiologic data provided by conventional investigations (plain X-rays and panoramic views). The persistence of the limitation of the mouth opening and the worsening of the preauricular pain with irradiation to the temporal region led us to perform further radiological investigations (computed tomography scan and magnetic resonance imaging) that revealed the intracranial complication. A successful removal of the displaced condyle was carried out through an extracranial approach, and at a 3-year follow-up temporomandibular joint function is satisfactory. CONCLUSION: The case is reported to emphasize the need for careful radiological investigation in case of condylar fractures and the effectiveness of the extracranial route to surgically treat these rare complications.

The Elastic Internal Traction (EIT): an effective method to reduce the displaced facial fractures.

Open reduction and rigid fixation are commonly used to treat displaced fractures of the facial skeleton. Manual reduction can be performed by means of forceps or transosseus wires to close the bone fragments. In order to reduce facial fractures, we used a technique, called Elastic Internal Traction (EIT), based on the elastic action of rubber bands stretched between screws placed on both sides of the fracture line. We have used EIT in 104 patients suffering from mandibular fractures, and 40 cases of patients with orbito-maxillary complex fractures out of the 707 patients treated for trauma between July 2000 and August 2002 at our hospital. In our opinion, this technique provides an effective reduction and a stable primary fixation of the bone before the final fixation. It also has the advantage that the surgical field is clear of the assistant's hands and surgical instruments that are usually used to lock the reduction. The resulting operative time is shortened, and the plating of the bone is simplified.

New intraluminal bypass tube for management of acutely obstructed left colon.

PURPOSE: A surgical technique is described for a new intracolonic bypass procedure in patients who underwent colonic surgery with an unprepared colon. METHODS: Resection and primary anastomosis was performed. The intraluminal bypass tube used was a latex condom. RESULTS: No clinical anastomotic leakage was noted. CONCLUSIONS: This is a safe, low cost, and uncomplicated procedure that decreases the risk of dehiscence and permits the performance of a high number of primary anastomosis.