Bilateral Temporomandibular Joint Dislocation Research Articles

Conservative management of a 3 months long standing bilateral temporomandibular joint dislocation: A case report

Temporomandibular joint (TMJ) dislocation is a type of condition where the condyle is anteriorly displaced beyond the articular eminence. Long standing cases with TMJ dislocation condition persisting for more than a month becomes challenging to treat. Its management includes closed reduction to complicated surgical procedures so as to reduce the dislocated condyles. Mandibular dislocation cases present with its own distinctive features. The aim of the report is to reduce the dislocated condyles through conservative management.This paper presents with non-invasive and conservative method for management of a long standing case (three months old) of TMJ dislocation in patient with acute renal failure and uncontrolled diabetes giving excellent outcome using elastic traction. Elastic traction with fulcrum on molars for reduction and inter-maxillary fixation was done in order to stabilize the mandibular condyles into the glenoid fossa. Here we stressed on the effectiveness of continuous traction using elastics and Inter-maxillary fixation (IMF) in achieving a complete repositioning of the mandibular condyles back into the fossaCondyles were reduced back in glenoid fossa with excellent outcome.Where manual reduction is not possible, elastic traction and IMF is the only method to reduce condyles. In long standing chronic TMJ dislocation case, only manual reduction was not sufficient. Since no standard rules for the ideal strategy are available till date, initial approach must be conservative so to preserve surgical treatment for later if needed.

A New Extraoral Closed Reduction Technique for Temporomandibular Joint Dislocation: A Preliminary Case Series


 
 
 
 ABSTRACTObjective: This study aims to describe a new extraoral technique for reducing bilateral temporomandibular joint (TMJ) dislocations.
 
 
 
 
 Methods: 
 Design: Retrospective Preliminary Case Series
 Setting: Tertiary Government Training Hospital
 Participants: Ten (10) adults with bilateral TMJ dislocation
 
 
 
 
 
 
 
 
 Results: Ten patients, 7 males and 3 females with median age of 35.50 (IQR:21.25 [23.50, 44.75]) years old were included in our series. Seven had more than one previous episode of TMJ dislocation, and the dislocation spontaneously occurred while yawning or eating in six patients. Our new technique resulted in complete bilateral reduction in three patients who had first-episode TMJ dislocations but only in four out of seven with previous dislocation. The three others (two partial, unilateral failure of reduction and one complete failure of reduction) needed conventional extraoral reduction (Hippocratic technique).
 
 
 
 
 Conclusion: This new extraoral technique may show promising preliminary results in the management of temporomandibular joint dislocation, but a larger trial in comparison with other techniques is needed.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Are There Cephalometric Measurements Associated With Recurrent Temporomandibular Joint Dislocation?

Several theories have been proposed for the etiology of recurrent temporomandibular joint (TMJ) dislocation. The purpose of the present study was to determine whether there are cephalometric measurements associated with this phenomenon. A retrospective case-control study was performed, which included individuals who suffered from recurrent TMJ dislocation and a control group composed of patients who suffered from unrelated odontogenic infections and did not have any TMJ disorder. All the patients were referred to the Department of Oral and Maxillofacial Surgery at the Hadassah Medical Center between 2010 and 2021 and underwent multidetector computed tomography of the jaws. The main predictor variable was a history of recurrent TMJ dislocations. Covariates included age and gender. The primary outcome variable was a set of 11 cephalometric measurements. A statistical analysis was performed with the Mann-Whitney U-test for continuous variables and the Chi-squared test or Fisher's exact test for categorical variables, followed by a logistic regression model. Multiple comparisons were made by using the Benjamini-Hochberg method. The total 32 subjects included in the analysis consisted of 16 patients presenting with bilateral recurrent TMJ dislocation and a control population of 16 patients. The mean age was 34.19±12.7years, 40.6% (n=13) were males, with no statistically significant differences between the groups. An increased overbite was detected in the TMJ dislocation group, whereas over-jet was greater among the control group, although not statistically significant. Skeletal ratio analysis showed that the TMJ dislocation group had a statistically significantly greater Articulare-Gonion length (46.96mm±5.2mm vs 43.01mm±5.3mm; P=.043) and a lower angle of occlusal plane to Frankfort horizontal (4.56o±5.7o vs 9.60o ± 3.9o; P=.007), Y-axis (58.01o±4.9o vs 61.72o ± 3.3o; P=.019), and Frankfurt mandibular plane (24.10o±6.1o vs 30.14o ± 4.7o; P=.004). Specific cephalometric measurements are associated with recurrent TMJ dislocation. The high Articulare-Gonion length and the low rates of occlusal plane to Frankfort horizontal angle, Y-axis, and Frankfurt mandibular plane found in the study population suggest that the resultant vertically oriented elevator muscles may be considered a predisposing factor for this phenomenon.

Temporomandibular joint dislocation: A 7-year retrospective study in Two Nigerian Teaching Hospitals

Context: Temporomandibular joint (TMJ) dislocation constitutes about 3% of all reported joint dislocations worldwide. The study presents our experience with TMJ dislocation and its management at two tertiary healthcare centers in Nigeria. Materials and Methods: A retrospective study of patients managed for TMJ dislocation at two healthcare facilities over a period of 7 years was conducted. The diagnosis was clinical with confirmation by radiographic findings. Bio-data, predisposing conditions, duration of onset of presenting complaints, and treatment techniques were documented. Cases were classified as unilateral (right or left) or bilateral and they were further sub-classified as acute (less than or equal to 2 weeks of presentation to the clinic), chronic (greater than 2 weeks of presentation to the clinic), or recurrent (more than one episode of dislocation before presentation). Results: A total of 25 cases were analyzed. There was a slight male preponderance 13 (52%) observed with a male/female ratio of 1.1: 1. The mean age is 35.52 ± 17.36 years and a range of 15-80 years. Majority 18 (72%) of the patients were diagnosed with acute TMJ dislocation. The principal predisposing factor was yawning 12 (48%) and most of the patients had bilateral TMJ dislocation 19 (76%). Hippocratic maneuver was the treatment main method of choice in 14 (56%) of the patients. Conclusion: Bilateral TMJ dislocation was the most common pattern seen in our environment.

Evaluation of Intermaxillary Fixation (IMF) Screw Therapy with Craniomandibular Index Analysis for Chronic Recurrent Dislocation in the Temporomandibular Joint.

Temporomandibular joint (TMJ) hypermobility is classified as a subluxation, complete (luxation), unilateral, or bilateral, acute, chronic protracted, or chronic recurrent dislocation. This controlled randomized clinical study aims to evaluate the effectiveness of intermaxillary fixation (IMF) screw application and autologous blood injections in the treatment of chronic recurrent dislocation of TMJ in comparison with the placebo group. The patients who were admitted to the Faculty of Dentistry of the Atatürk University between October 2018 and January 2020 were evaluated. Three hundred patients diagnosed with bilateral chronic recurrent dislocation of TMJ based on clinical findings and radiographs were included in the study. The patients were randomly divided into three groups according to the evaluation criteria. Group 1 received IMF, group 2 received autologous blood injection, and group 3 (placebo group) received an intraarticular saline injection. The results of the patients who received IMF, autologous blood injection, and saline injection were evaluated by the craniomandibular index. The IMF group showed significant improvement after 1 month and 6 months (P < 0.001), while the patients who received autologous blood injection and saline injection showed no significant improvement (P > 0.05). The data were analyzed with IBM SPSS V23. The significance level was P < 0.05. In our study, the IMF gave the best results among all the study groups. The IMF technique can be used in patients with protracted chronic recurrent dislocation in whom autologous blood injection has failed.

MUMS THE WORD: UNSPOKEN COMPLICATIONS OF INTUBATION

SESSION TITLE: Medical Student/Resident Procedures Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Intubation is one of the most common and basic procedures performed in intensive care units and other emergent settings. Some of the more well-known potential complications include direct airway injury, soft tissue injury, lacerations, bleeding, and vocal cord paralysis. Patients with intubation related injury can increase their hospital cost by 20% and lengthen their hospital stay by at least one day compared to those who did not have an intubation related injury (Pacheco-Lopez 1006). Here we will discuss a more rare potential complication of intubation. CASE PRESENTATION: The patient was a 79 year old male with a past medical history of multiple strokes, cardiomyopathy and tobacco use. He was admitted to the hospital after a mechanical fall. X-ray of his left hip showed a femoral neck fracture. Patient underwent successful left hip ORIF by orthopedic surgery. Following surgery, patient complained of dysarthria, facial droop and inability to eat. With concern for stroke, a stat CT head was obtained showing no acute findings. Three days later, an x-ray of the mandible showed bilateral anterior mandible dislocations. Patient was transferred to another facility for oral maxillary surgery for reduction of his mandible. DISCUSSION: Mandible dislocation during intubation is an unusual occurrence, but providers and even radiologists should be aware of this possible complication. It is often overlooked, and treatment can be delayed. Our patient’s hospital stay was increased by three days due to lack of prompt diagnosis clinically and on imaging. He required transfer to another facility for oral maxillary surgery. A conscious patient with temporomandibular joint (TMJ) dysfunction most often presents with an inability to close the mouth, salivation, impaired speech and a depression that is palpable in the preauricular area. Anterior and anteromedial dislocations are the most common types (Chung 75). The exact prevalence of mandibular dislocation after intubation is unknown, however several studies have shown TMJ dysfunction occurs in at least 5% of cases after intubation (Pillai 243). CONCLUSIONS: Prompt diagnosis and treatment of mandibular dislocation due to intubation is essential to prevent long term sequelae due to this complication. Providers should be aware and vigilant in diagnosing and treating this condition should it present post intubation. Reference #1: Paulette C Pacheco-Lopez, Lauren C Berkow, Alexander T Hillel and Lee M Akst. “Complications of Airway Management.” Respiratory Care (June 2014): 1006-1021. Reference #2: Sang-Bong Chung, Hyoungbae Jeon, and Taikwan Kim. “Unrecognized Bilateral Dislocation of Temporomandibular Joint during Orotracheal Intubation.” Journal of Trauma and Injury (2015): 75-78. Reference #3: Konia, Suri Pillai and Mojca Remskar. “ Unrecognized bilateral temporomandibular joint dislocation after general anesthesia with a delay in diagnosis and management: a.” Journal of Medical Case Reports (2013): 243. DISCLOSURES: No relevant relationships by Haytham Adada, source=Web Response no disclosure on file for Mahmoud Amarna; No relevant relationships by Camelia Chirculescu, source=Web Response No relevant relationships by Beverly Smith, source=Web Response No relevant relationships by Sana Yakoob, source=Web Response

Management of temporomandibular joint recurrent dislocation using Dautery’s procedure: report and review

&lt;p class="abstract"&gt;Temporomandibular joint (TMJ) dislocation is an involuntary forward movement of the mandible beyond the articular eminence with the condyle remaining stuck in the anterior-most position which leaves the patient unable to close his mouth. Various surgical methods have been described in literature for the management of TMJ dislocation in patients where conservative measures are not successful and need surgical intervention. This case report highlights outcome of Dautrey’s method of surgical correction in three cases of recurrent bilateral TMJ dislocation. All the patients had history of manual reduction of lock jaw in the past and none was medically compromised. TMJ tomograms open mouth confirmed anterior dislocation of condyles beyond articular eminence in all three patients. Total six Dautrey’s procedures were performed. All the patients showed marked improvement in pain and TMJ function with no relapse at two years follow up. Post-operative mouth opening became normal in all the patients at one year follow up. No episode of pain, clicking, deviation or TMJ dislocation was seen in follow up period of 1, 3, 6, 12, 24 months. Hence, Dautery’s procedure serves as an effective management option for recurrent temporomandibular joint dislocation.&lt;/p&gt;

Uzun Süreli Temporomandibular Eklem Dislokasyonunun Çift Taraflı Eminektomi ve Chin-Cap ile Tedavisi

Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence resulting in a condition that fixes the joint in the open position, preventing any translation. Acute dislocation of the TMJ may be reduced manually under local anesthesia, intravenous sedation or general anesthesia. However, chronic persistent or prolonged dislocations usually require surgical intervention. Various surgical interventions have been proposed for the management of prolonged dislocation. Some of these are more conservative, such as reduction with the aid of interosseous wire, modified intermaxillary fixation, eminectomy and myotomy, while others are more radical such as condylectomy, midline mandibulotomy, inverted L-shaped ramus osteotomy or sagittal split ramus osteotomy. This case report describes the clinical and radiological findings and comprehensive treatments with bilateral eminectomy and chin-cap support of a patient with long-term and prolonged bilateral TMJ dislocation resulting from misdiagnosis.

Unrecognized Bilateral Dislocation of Temporomandibular Joint during Orotracheal Intubation

Unrecognized Bilateral Dislocation of Temporomandibular Joint during Orotracheal Intubation

Bilateral temporomandibular joint dislocation in a 26-month-old child: A rare emergency

Bilateral temporomandibular joint (TMJ) dislocation is very rare in children with only three cases previously reported in the literature. We report a case of a 26-month-old female child who presented to the emergency department of a tertiary care hospital with complaints of inability to close her mouth and drooling of saliva for the last two hours. Clinical examination and X-ray of the TMJ revealed bilateral TMJ dislocation. Bilateral TMJ reduction was achieved with the Hippocratic method after giving analgesia and procedural sedation. The child was able to close her mouth post-reduction, and was discharged with post-TMJ reduction instructions given to the mother and with maxillofacial clinic follow up. Our report is the first case of a child presenting to the emergency department with bilateral TMJ dislocation.

A Missed Case of Occult Bilateral Temporomandibular Dislocation Mistaken for Dystonia.

A 24-year-old male with a history of psychiatric disorder and no prior significant temporomandibular joint (TMJ) pathology presented to the emergency department for “lockjaw.” Plain film X-rays of the mandible were read as unremarkable by an attending radiologist, leading to the initial diagnosis of medication-induced dystonic reaction. Following unsuccessful medical treatment a maxillofacial computed tomography (CT) was ordered. CT confirmed bilateral dislocation, illustrating the importance of clinical judgment, and limitations of certain radiographic images. The authors believe this case to be the first reported case in the medical literature of bilateral anterior TMJ dislocation with a false negative X-ray.

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

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.

Risperidone-Induced Dislocation of the Temporomandibular Joint

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 2 sentences of the full text.We report a case of bilateral temporomandibular joint dislocation associated with antipsychotic-induced acute dystonia. Although this side effect of antipsychotics is rare, clinicians should still be aware of it.†‹J Clin Psychiatry 2012; 73(2):176

Anterior bilateral temporomandibular joint dislocation: an emergency presentation

Anterior dislocation of the temporomandibular joint (TMJ) though an infrequent presentation at the emergency department; often demands an immediate reduction to relieve discomfort and prevent adverse long-term sequelae. A simple and effective technique to reduce the dislocation is successfully demonstrated by putting the operator's thumbs over the molar teeth of the patient and pushing the dislocated jaw downward and backward. We report the case of a patient who presented at our accident and emergency department with bilateral anterior TMJ dislocation and was successfully reduced with this simple technique.Keywords: Temporomandibular joints (TMJ), dislocation

Temporomandibular joint dislocation in Nairobi

Despite the diverse conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology and management of TMJ dislocation. To audit the pattern of occurrence, demographics, aetiology and enumerate the treatment modalities of TMJ dislocation at the oral and maxillofacial surgery division (OMFS) of the University of Nairobi Dental Hospital. Descriptive cross-sectional study. University of Nairobi Dental Hospital (UNDH) from January 1995 to July 2005. Twenty nine patients had been diagnosed and managed for TMJ dislocation. Twenty (69%) were females and nine (31%) were males. Their ages ranged from 10-95 years with a mean of 42 years. The cases managed were primarily chronic in nature. The most common form being anterior TMJ dislocation, accounting for twenty-five (86.2%) cases. Trauma was implicated as an aetiology in only five (17%) of the cases while the remaining majority of twenty four (83%) cases were spontaneous. Amongst the causes of spontaneous TMJ dislocation, yawning was the most common accounting for fourteen cases (48.3%). Dislocations caused by trauma were found to be 12.6 times more likely to be associated with other injuries than spontaneous dislocations. Anterior TMJ dislocations were found to be 1.3 times more likely to be associated with absence of molars than posterior TMJ dislocations. Anatomical aberrations, as predisposing factors, were not a significant finding in this research. Eight (28%) of the cases were managed conservatively. Twenty one (72%) of the cases were managed surgically. The eminectomy was the most common technique with a 75% success rate. The highest incidence of TMJ dislocation occurs in the 3rd-5th decade with a female preponderance with bilateral anterior TMJ dislocation being the most common. Most of the cases were managed surgically with eminectomy being the preferred technique with the highest success rate. A study needs to be undertaken to determine reasons' why conservative modalities are least employed in the management of TMJ dislocation in our setup and what can be done about it.

Bilateral temporomandibular joint dislocation in a 29-year-old man: a case report

IntroductionA dislocation of the temporomandibular joint represents three percent of all reported dislocated joints.The treatment entails reduction of the deformity and this can often be achieved in a ward setting.Case presentationWe present the case of a 29-year-old Caucasian man with a non-traumatic bilateral anterior temporomandibular joint dislocation. Following several unsuccessful attempts, due to both inadequate patient analgesia and sedation, joint reduction had to be performed in theatre with the patient under general anesthesia.ConclusionThis case highlights the importance of providing the patient with adequate analgesia and sedation when attempting the reduction of temporomandibular joint dislocations.

Temporomandibular joint dislocation due to acute propranolol intoxication

Temporomandibular joint (TMJ) dislocation has not previously been reported as a complication of beta-blocker toxicity. We are reporting two cases of TMJ dislocation resulted from acute severe intoxication with pure propranolol (PPL) for the first time. Bilateral TMJ dislocation happened in two patients who were admitted to intensive care unit with diagnosis of severe acute PPL toxicity. Clinical diagnosis of TMJ dislocation was obtained by physical examination. Successful reduction was performed for both patients without subsequent recurrence in two weeks following hospital discharge. Both of our subjects had no previous history of lower jaw dislocation. There was not any risk factor for dislocation such as convulsion during admission period, recent face trauma, or oral manipulation by the medical team. This study showed that TMJ dislocation may occur after severe acute PPL toxicity probably due to spastic contraction of the lateral pterygoid muscle. This is against previously mentioned hypothesis that stated masseteric muscles contraction as the main cause of a bilateral dislocated TMJ.

Temporomandibular Joint Dislocation During Orotracheal Extubation

Temporomandibular joint (TMJ) dislocation can occur whenever the mouth is opened wide during upper airway manipulation, even without external force. In the perioperative period, the majority of TMJ dislocations occur during anesthetic induction. We report the occurrence and management of bilateral TMJ dislocation upon orotracheal extubation in a 35-year-old woman. At the end of an otherwise unremarkable uterine myomectomy under general anesthesia, with the patient having regained consciousness in the operating room, we asked the patient to open her mouth so we could extubate her. Immediately after orotracheal extubation, however, the patient was found to be unable to close her mouth. The diagnosis of bilateral TMJ dislocation was made. The bilateral TMJ dislocation was reduced with the traditional transoral approach under morphine analgesia/sedation. The dislocation possibly occurred in consequence of her compliance with our request to open her mouth excessively before she was fully awake. As TMJ dislocation is a possible complication of upper airway manipulation, anesthesiologists should be prepared for its occurrence and to manage it competently.

Temporo-mandibular joint dislocation: an unusual complication of transoesophageal echocardiography

Temporo-mandibular joint (TMJ) dislocation is an unusual complication of transoesophageal echocardiography (TEE). We report a rare case of bilateral TMJ dislocation in an 84-year-old man prior to DC cardioversion (DCCV) for atrial flutter. Shortly after TEE and DCCV, the patient complained of bilateral facial pain. An orthopantomogram revealed bilateral TMJ dislocation. A closed reduction was performed by maxillo-facial surgeons under intravenous anaesthesia. Although very uncommon, the physician should be aware of the complication and its management.

Bilateral Temporomandibular Joint Dislocation Following Upper GI Endoscopy

Purpose: Background: Gastrointestinal endoscopy is a safe modality for diagnosis and treatment of many digestive disorders. Complications are rare, occurring in about 1 in 1000 procedures. Perforation and bleeding are the most common complications, occurring with a frequency of 0.2 and 0.15%, respectively. We present the case of a woman who developed an unusual complication of bilateral temporomandibular joint dislocation following upper GI endoscopy. Case: A 64 year old woman with past history of diabetes mellitus and hypertension presented with acute complaints of passage of dark red blood per rectum associated with dizziness and lightheadedness of one day's duration. She was noted to be tachycardic and anemic. After adequate resuscitation, patient underwent a colonoscopy that showed colonic diverticula but no site of bleeding. Gastroscopy was done to rule out a possible upper GI cause of bleeding, but was completely normal. Intravenous propofol was used for sedation during endoscopy. The patient opened her mouth by herself to insert the bite-block before sedation, and the gastroscopy was completed uneventfully within 10 minutes. On the following day, the patient started complaining of jaw discomfort and difficulty in closing her mouth. Her speech was hindered and she was unable to chew properly. Clinically, TMJ dislocation was suspected. Plain radiograph of the jaw was obtained and showed bilateral anterior TMJ dislocation, confirmed by CT scan. An oromaxillofacial surgeon evaluated the patient and bimanual reduction of the dislocation was performed under anesthesia. After reduction of the dislocation, the patient's symptoms resolved and she was able to chew without difficulty. At follow-up a few days later, she was doing well. Discussion: TMJ dislocation after upper GI endoscopy has so far been described in five cases, not including our case. Most of the reported cases occurred with the use of intravenous midazolam as sedative during endoscopy, although two patients did not receive any i.v. sedation. The exact mechanism of this complication is not known. Laxity of jaw muscles after sedation is a likely underlying cause, however, hyperextension of the jaw during insertion of the bite-block or during esophageal intubation with the scope could be a contributing factor. A patient with TMJ dislocation may still be able to swallow liquids, thus we suggest that observed mastication, and not just tolerance of oral liquids, be included in the discharge process following upper GI endoscopy. The complication is readily correctable once identified, and increasing awareness about this complication would aid in its prompt detection and possibly reducing its incidence.