Bilateral subcondylar fracture with medial dislocation

A 19-year-old female patient presented at the Emergency Department due to cranioencephalic trauma with nausea, vomiting and facial pain. No loss of consciousness was reported.

In order to conduct a more detailed evaluation, a non-contrast CT was performed revealing bilateral subcondylar fracture of the mandible with medial dislocation of both condyles (Fig. 1, 2).

Pneumatisation of the temporal bone petrous apices as an anatomical variant was noticed.

No intraaxial or extra-axial haemorrhages were observed. No expansive lesions suggestive of malignancy were noticed.

Many classifications of mandibular fractures have been reported in the literature in order to label them according to anatomical location, type, involvement of dentition, displacement and favourability of treatment.

Lindah and Hollender classified mandibular condyle fracture according to anatomical location (condylar head, condylar neck and subcondylar region or extracapsular fracture) and conforming to the degree of fracture fragment displacement (non-displacement, deviation, displacement, deviation-dislocation, displacement-dislocation, lateral override or medial override) [1].

As in our case, when displacement and/or dislocation is present, it is typically medial due to the action of the lateral pterigoid muscle [2].

In the AO-analogue classification of mandibular fractures, subcondylar fracture with luxation belongs to group 1, subunit 3 of the vertical unit [3].

Subcondylar fractures have been historically treated with closed reduction in order to avoid some complications such as facial nerve damage, scarring and non-anatomical reduction. However, nowadays the endoscopic-assisted reduction with internal fixation is becoming increasingly popular among maxillofacial surgeons due to the minimal invasion and lower complications rate [4].

Written informed patient consent for publication has been obtained.