Journal article

Publication year: 2019

Pages: 395-399

Journal: Rechtsmedizin

Volume number: 29

Issue number: 5

ISSN: 0937-9819

eISSN: 1434-5196

DOI Link: https://doi.org/10.1007/s00194-019-0326-2

Publisher: Springer

Abstract: 
Background The human skull is frequently injured due to blunt trauma in interpersonal violence and accident settings. In some cases, the presence of certain distinctive fracture patterns enables the forensic expert to derive a reconstructive interpretation concerning the underlying blunt trauma. Publications on this subject, however, focus more on fractures of the calvaria than on those of the skull base. Material and methods A recent case with a depressed fracture due to a perforating mandibular condyle initiated the present retrospective study of autopsy cases. A search of autopsy protocols from the years 2009-2018 was performed in the Institutes of Forensic Medicine in Frankfurt/Main, Giessen and Homburg (Saar). Related case documents were evaluated with respect to the circumstances of death and accompanying injuries. Furthermore, a literature search was carried out in the medical database PubMed. Results During this 10-year period, 10,733 judicial autopsies were included in the evaluation. Only two cases with depressed fractures of the skull base and mandibular condyles perforating the base of the skull into the central cranial cavity were found. In both cases, the fracture was caused by a fall and the isolated depressed fracture was not the cause of death. The literature search revealed several clinical case reports, systematically processed case series and reviews as well as a single forensic case report. Discussion Traffic accidents are described as the main cause of superior and central luxation of the temporomandibular joint. Typical symptoms evoked by these fractures described in the literature include malocclusions (with unilaterally open or contralateral crossbite) and fixation of the mandible, which may be camouflaged by postmortem changes, e.g. rigor mortis and swelling of the facial soft tissue and therefore might not be conspicuous during the external inspection of the corpse. Conclusion Depressed fractures of the base of the skull due to perforating mandibular condyles are rare phenomena. As an analogue of ring fractures of the foramen magnum, they can be regarded as a particular form of bending fractures of the skull base. They enable reconstructive interpretation as they are caused by blunt trauma directed against the chin from an anterocaudal direction.

Harvard Citation style: Holz, F., Verhoff, M., Kettner, M., Ramsthaler, F., Ohlwaerther, T. and Birngruber, C. (2019) Depressed fractures of the skull base due to dislocated mandibular condyles, Rechtsmedizin, 29(5), pp. 395-399. https://doi.org/10.1007/s00194-019-0326-2

APA Citation style: Holz, F., Verhoff, M., Kettner, M., Ramsthaler, F., Ohlwaerther, T., & Birngruber, C. (2019). Depressed fractures of the skull base due to dislocated mandibular condyles. Rechtsmedizin. 29(5), 395-399. https://doi.org/10.1007/s00194-019-0326-2