A Case of Acute Epidural Hematoma Caused by Mandibular Fossa Fracture

Acute epidural hematoma is one of the most serious traumatic conditions in neurosurgery, for which emergency surgery may be indicated. Injury to the middle meningeal artery (MMA) is generally the cause of hemorrhage, often accompanied by convexity fractures resulting from head trauma. However, an epidural hematoma by a contusion of the jaw is very rare. A 27-year-old male fell after drinking alcohol and was brought to our hospital. The patient's Glasgow Coma Scale (GCS) score was 6 (E1V1M4), and the right pupil was 5 mm with no response to light. A computed tomography (CT) scan of the head showed an acute epidural hematoma in the right middle skull base to the temporal region and no fracture lines of the vault of the skull. An emergency right frontotemporal craniotomy was performed to remove the hematoma. A postoperative recheck of the preoperative images revealed a right mandibular fossa fracture. The postoperative course was uneventful, with clear consciousness and resolution of motor paralysis the day after surgery. On the 11th postoperative day, the patient could walk independently and was discharged. As there was no injury to the MMA in the convexity area, which is generally the cause of acute epidural hematoma, damage to a branch of the MMA resulting from a mandibular fossa fracture was considered a possible mechanism for developing acute epidural hematoma. A case of mandibular fossa fracture resulting in acute epidural hematoma is extremely rare, and the etiology remains unknown, so we reported here with a review of the literature.