A Case Report on Unusual Severe Superolateral Dislocation of Right Condyle Associated with Sagittal Split of Articular Eminence in Pan-Facial Trauma Managed with Inverted L-Plate

Abstract

Head and neck trauma is a difficult case for a maxillofacial surgeon since not only must pre-injury anatomy be restored, but also the cosmetic aspect must be improved. The management of such patients is difficult and often necessitates the involvement of a multidisciplinary team. Unprotected driving or high-velocity collisions are one of the causes of severe trauma. Pan-facial trauma not only disrupts normal facial anatomy but also hinders normal functions like vision (dystopia, diplopia, enophthalmos), respiration (airway) and olfactory senses, mastication and natural occlusion and intercuspation, deglutition, and overall asthetic of the patient. Restoring and rehabilitation of preinjury contour of facial skeleton in such patient of trauma requires artistic work of the operating maxillofacial surgeon. The treatment modality in case of trauma is open reduction and internal fixation (ORIF) under general anesthesia (GA). Various approaches have been suggested to achieve near normal anatomy. Past research suggested “top to bottom” or “bottom to top” along with “outward to inward” or “inward to outward,” The main aim being restoring horizontal and vertical facial pillars. This case was unique in terms of persistent superolateral displacement of intact mandibular condyle even after fixation of the zygomatic arch; to keep condyle in its anatomic place, the inverted “L” plate was used. Results obtained were functionally satisfactory even in dynamic motion and we propose it as an adequate alternative for treatment of superolateral dislocation of intact mandibular condyle.