External Auditory Canal Fracture after Posterior Dislocation of an Intact Condylar Head

Abstract

Aims: The aim of this article is the kind of applied treatment for fracture of the external auditory canal, following traumatic facial injuries. Presentation of Case: The case report of the patient described in this article, is evaluated for the posterior dislocation of an intact mandibular condyle after facial injuries she had due to a car accident. The physical and x-ray examination of the External Auditory Canal (EAC) revealed facial fractures, TMJ dysfunctional symptoms with severe disk displacement, as well as fracture of the anterior wall of the EAC. Atraumatical reduction of the fracture was accomplished during the TMJ disc reduction and joint exploration, resulting in a satisfactory outcome with no complications and with improvement of hearing impairment. Discussion: The anterior osseous wall of the external auditory canal, which represents part of the tympanic portion of the temporal bone, defines the posterior limit of the glenoid fossa, and is situated close to the condyle of the mandible. Due to this intimate anatomical relationship, herniation of the TMJ apparatus into the external auditory canal (EAC) occurs spontaneously or secondary to neoplasia, inflammation, developmental problems and especially trauma. Direct high-energy impact into the chin displaces the condyle posteriorly and the result may be a fracture of the condyle or posterior dislocation of intact condyle without fracture, a dislocation of condyle into middle cranial fossa or temporal fossa, or a fracture on the anterior wall of the EAC. Conclusion: In summary, a direct blow to the mandible can result in a TMJ apparatus injury. Due to the close relationship between TMJ and EAC, an atypical injury, such as a fracture of the anterior wall of the EAC can occur. An oral & maxillofacial surgeon, when called to examine and diagnose TMJ injury disorders, has the challenging responsibility to take into account the potential concomitant temporal bone fractures or intracranial complications in cooperation with radiologists, ENT doctors and neurosurgeons.