Jaw Joint Dysfunction and Endotracheal Intubation

Abstract

To the Editor: We are concerned that the report entitled "Iatrogenic Disruptions of Right Temporomandibular Joints During Orotracheal Intubation Causing Permanent Closed Lock of the Jaw" [1] may be misinterpreted, particularly by the legal profession. Jaw joint dysfunction after anesthesia, laryngoscopy, and endotracheal intubation does not automatically imply faulty technique and may occur when appropriate care and skill have been exercised. It is important that the role of arthroscopy be properly appreciated. The condition of "closed lock" is not necessarily permanent as implied in the paper. Early arthroscopy with manipulation and lavage may correct the situation. In both the cases cited, there was a delay of several months between diagnosis and confirmatory imaging studies, and no mention was made of any arthroscopic intervention. Failure of the disk to retract normally on jaw closure may be due to causes other than "rupture of the superior retrodiscal ligament." The disk may adhere to the eminence in a "sticky joint," the so-called "suction cup effect," and this may be remedied by arthroscopy with lavage and manipulation. Furthermore, some patients have inherently lax ligaments and this leaves the joint prone to subluxation or dislocation without the use of excessive force. We are concerned that some readers unfamiliar with the complexities of the temporomandibular joint and its disorders might conclude that joint dysfunction after laryngoscopy or intubation necessarily implies defective technique. Such is emphatically not the case. We failed to obtain a response from Dr. Gould. Philip Worthington, MD, BSc, FDSRCS Department of Oral and Maxillofacial Surgery University of Washington School of Dentistry Seattle, WA 98195-7134 Frederick W. Cheney, MD Department of Anesthesiology University of Washington School of Medicine Seattle, WA 98195-6540