A Missed Case of Occult Bilateral Temporomandibular Dislocation Mistaken for Dystonia.

Evelyn Lee,Jan Shoenberger,Jonathan Wagner

doi:10.1155/2015/753260

Abstract

A 24-year-old male with a history of psychiatric disorder and no prior significant temporomandibular joint (TMJ) pathology presented to the emergency department for “lockjaw.” Plain film X-rays of the mandible were read as unremarkable by an attending radiologist, leading to the initial diagnosis of medication-induced dystonic reaction. Following unsuccessful medical treatment a maxillofacial computed tomography (CT) was ordered. CT confirmed bilateral dislocation, illustrating the importance of clinical judgment, and limitations of certain radiographic images. The authors believe this case to be the first reported case in the medical literature of bilateral anterior TMJ dislocation with a false negative X-ray.

Highlights

Case PresentationThe patient was unable to close his mouth and complained of associated left jaw pain
A 24-year-old male with a history of psychiatric disorder and no prior significant temporomandibular joint (TMJ) pathology presented to the emergency department for “lockjaw.” Plain film X-rays of the mandible were read as unremarkable by an attending radiologist, leading to the initial diagnosis of medication-induced dystonic reaction
Upon consideration of the X-ray findings, the patient’s calm demeanor, his ability to communicate relatively with little discomfort, and his history of psychotropic medication use, the presentation was thought to be consistent with a medication-induced dystonic reaction, rather than a dislocation

Summary

Case Presentation

The patient was unable to close his mouth and complained of associated left jaw pain. He denied history of similar episodes, recent changes in his haloperidol dosing, history of trauma to the face, jaw clicking, dislocations, or other temporomandibular joint pathology. The patient was calm and able to communicate with mildly slurred speech. He was able to close his lips to form words and had minimal drooling, but the jaw remained open. An intraoral examination was not performed after the reduction, but the patient was able to open and close his jaw.

Discussion

Conclusion