Dautrey's Procedure in Treatment of Recurrent Dislocation of the Mandible

Abstract

The temporomandibular joint (TMJ) is the most complex joint in the human body. This joint is in use even when no activity seems to be apparent. It is the most used, as well as the most abused, joint. This abuse brings with it a number of problems, one of which is hypermobility of the TMJ. Hypermobility of the joint can result in recurrent dislocation of the mandible which, although uncommon, is a distressing condition. Various methods have been tried for the treatment of this disorder. The treatment modalities have been either conservative or surgical. Although initially conservative treatment is preferred, when it fails, the only option remaining is surgical. In patients with chronic recurrent dislocation, conservative treatment such as maxillomandibular fixation (MMF) and injections of sclerosing solutions often result in failure. Thus, such cases require surgical management. The surgical procedures can be categorized under 2 main headings: 1) procedures that enhance the path of condylar movement; and 2) those that inhibit the path of condylar movement. The most common procedure in the first category is eminectomy, as described by Myrhaug 1 in 1951. It includes a reduction in the height of the articular eminence such that the condyle will readily slip back into the fossa if subluxation occurs. However, it has been found to encroach on the physiologic pattern of condylar movement. Mayer 2 was the first to report the displacement of the zygomatic arch (or a segment of it) to obstruct the condylar path. LeClerc and Girard 3 performed a vertical osteotomy of the zygomatic arch and lowered the proximal segment and placed a thicker part of the zygoma into the path of the condyle. The procedure was refined by Gosserez and Dautrey 4 in 1967. Currently, the procedure is known as “Dautrey’s procedure.” In this procedure, the zygomatic arch is osteotomized downward and forward just in front of the articular eminence to create a mechanical obstruction. This procedure gained popularity during its initial years but somehow was lost thereafter for quite some time. Recently, many investigators have been using this procedure, but few have reported their findings. Therefore, the aim of the present study was to understand the philosophy behind the procedure and to evaluate the efficacy of fixation in this procedure to achieve better outcomes.