Bilateral Superolateral Fracture Dislocation of the Temporomandibular Joint (TMJ) Following Trauma: A Report of a Unique Case.

Traumatic temporomandibular joint (TMJ) dislocation is well described; however, superolateral displacement of the mandibular condyle relative to the zygomatic arch is rare, particularly when occurring bilaterally in the setting of panfacial trauma.  A 17-year-old male sustained high-energy trauma in a road traffic collision and was intubated at the scene (Glasgow Coma Scale (GCS) score of 5). Trauma CT demonstrated multisystem injuries and complex maxillofacial fractures, including Le Fort II fractures, comminuted symphyseal mandibular fracture, bilateral high condylar head fractures, and bilateral superolateral TMJ fracture-dislocation. Conventional dental impressions were not feasible due to the endotracheal tube; a digital intraoral scan (3Shape TRIOS) was used to capture occlusion for 3D planning and fabrication of patient-specific occlusal splints. Following medical stabilization, the patient underwent submental intubation, open reduction of both TMJs via preauricular approaches, and open reduction and internal fixation of midface and mandibular fractures. Bilateral superolateral TMJ fracture-dislocation can present a mechanical block to closed reduction. Digital occlusal capture combined with CT-based 3D planning may assist in restoring mandibular width and achieving accurate maxillomandibular reduction in complex panfacial trauma.