Chronic Recurrent Temporomandibular Joint Dislocation: A Comparison of Various Surgical Treatment Options, and Demonstration of the Versatility and Efficacy of the Dautrey's Procedure.

Abstract

There has been a changing trend of treating temporomandibular joint subluxation, which range from conservative non-surgical measures to various soft and hard tissue surgical procedures aimed at either augmenting or restricting the condylar path. This study was aimed at comparing the efficacy of three major surgical treatment modalities: condylar obstruction creation, obstruction removal and anti-translatory procedures. Also, the location, anatomy and morphology of the TMJs pre- and post-surgery were evaluated and compared using radiographs, sagittal and 3-D Computed Tomographic scans. A 6-year study was carried out on seventy-five patients of various age groups. Twenty-five were operated by the Dautrey's procedure, 25 by articular eminectomy alone and the remaining 25 by eminectomy followed by meniscal plication and tethering. The distribution of patients in the three groups was random. Effectiveness of the surgical procedure and incidence of complications including recurrence were carefully compiled and compared between the three groups. Dautrey's procedure yielded more gratifying and stable results, leading to a successful and permanent correction of chronic recurrent dislocation of the TMJs, with practically nil complications, thus demonstrating it to be an extremely safe, effective and versatile technique, making the joints function normally and securing sufficient volume of mouth opening. There was observed an average increase in articular tubercle height by 3.65mm and a mean anterior shift of its lowest point by 4.5mm following the Dautrey's procedure, which were statistically significant findings. The upper age limit to carry out the Dautrey's procedure can be safely taken up to 45years.