Temporomandibular joint dislocation in an epileptic and mentally retarded patient: a case report.

Abstract

Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of articular surfaces and fixation in that position.' Theories regarding the pathogenesis of TMJ dislocation propose laxity of TMJ ligaments or capsule, excessive activity of the lateral pterygoid muscle (LPM)and erosion of the eminence'. TMJ dislocation can occur in an anterior, posterior, lateral and superior direction'. Clinical presentation of dislocated TMJ includes inability to close the mouth, deviation of the mandible away from the affected side in unilateral cases, hollowing in front of the tragus, spasm of muscles of mastication and severe pain of the TMt Radiographs show an empty condylar fossa with the condylar head located anterior to the articular eminence. Anterior TMJ dislocation usually follows excessive mouth opening during yawning, laughing, eclamptic fit and motor vehicle accident (MVA)'. Iatrogenic causes of TMJ dislocation are excessive mouth opening during dental treatment, intubation, and otorhinolaryngological procedures Some drugs are associated with TMJ dislocation, these include antiemetics such as metoclopramide and compazine which produce extrapyramidal effects' and neuroleptic drugs. Systemic connective diseases like Ehlers-Danlos and Marfan syndromes have also been implicated in TMJ dislocations The purpose of this article is to report management challenges of an epileptic and mentally retarded patient with recurrent TMJ dislocation.