Unrecognized bilateral temporomandibular joint dislocation after general anesthesia with a delay in diagnosis and management: a case report

Suri Pillai,Mojca Remskar Konia

doi:10.1186/1752-1947-7-243

Abstract

IntroductionAnterior bilateral temporomandibular joint dislocation is not an uncommon occurrence and has been reported before. However, its diagnosis can easily be overlooked, especially by clinicians who are unfamiliar with this pathology. Continuous discussion of the pathology is required to prevent delays in diagnosis, which can lead to long-term sequelae for the patient.Case presentationWe present the case of a 66-year-old Somali woman who experienced a bilateral anterior temporomandibular joint dislocation after a general anesthetic for an exploratory laparotomy for excision of a pelvic sarcoma. She first presented in the intensive care unit with preauricular pain and an inability to close her mouth, and was initially misdiagnosed and treated for a muscle spasm. The cause of her misdiagnosis was multifactorial - opioid-related sedation, language and cultural barrier, and unfamiliarity with the pathology. Her diagnosis was proven 18 hours after the completion of surgery with a plain X-ray. A manual closed reduction was performed with minimal sedation by oral surgery.ConclusionWe provided an in-depth discussion of temporomandibular joint dislocation and suggest a simple test that would prevent delayed diagnosis of temporomandibular joint dislocation in any patient undergoing general anesthesia. A normal mandibular excursion should be tested in every patient after surgery in the postoperative care unit, by asking the patient to open and close their mouth during the immediate postoperative recovery period or passively performing the range of motion test.

Highlights

Anterior bilateral temporomandibular joint dislocation is not an uncommon occurrence and has been reported before
We provided an in-depth discussion of temporomandibular joint dislocation and suggest a simple test that would prevent delayed diagnosis of temporomandibular joint dislocation in any patient undergoing general anesthesia
Temporomandibular joint (TMJ) evaluation is a component of the preoperative airway physical examination as suggested by The American Society of Anesthesiologist practice guidelines for the management of the difficult airway [1]

Summary

Conclusion

A conscious patient with TMJ most often presents with an inability to close the mouth, salivation, impaired speech and a depression that is palpable in the preauricular area. History of previous injury to the jaw, any periauricular pain, with or without headache, and any clicking or grating sounds during mandibular motion should be noted Any of these signs and symptoms may indicate existing TMJ dysfunction and significantly increase the likelihood of increased severity of postoperative symptoms. To exclude TMJ dislocation or dysfunction, we suggest a simple test of normal mandibular excursion by asking every patient undergoing a general anesthetic to open and close their mouth during the immediate postoperative recovery period or by checking the passive range of motion of the TMJ joint. MRK critically revised the article for relevant intellectual content and contributed to intellectual references Both authors read and approved the final manuscript

Introduction

Discussion

Findings

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