CT of intact but nonfunctioning temporomandibular joints following temporal bone fracture

Abstract

Six patients were examined by CT following head trauma, with bleeding from the ear and trismus. The mandibular condyles were normal and MRI in two patients demonstrated a normally located meniscus. An unilateral comminuted temporal bone fracture (TBF) with multiple fracture lines and one or more fragments detached from the petrous bone was demonstrated by CT in every patient. On physical examination there was trismus, inability to chew and local pain in the temporomandibular joint (TMJ) without tenderness and swelling. Measurements of vertical and horizontal mandibular movement unequivocally demonstrated TMJ malfunction in comparison with 10 controls. The malfunction was presumably due to instability of the fractured petrous bone, base of the TMJ. Immobilising one TMJ results in blocking of both joints. Clinical improvement in 6–8 months and absence of symptoms of joint derangement on repeated physical examination were thought to be explained by restored petrous bone stability following healing of the fractures. The phenomenon of trismus following TBF with normal TMJ is rare and not yet reported.