Temporomandibular Joint Dislocation Research Articles

Autologous blood versus Platelet rich plasma (PRP), pericapsular injection in the treatment of chronic recurrent temporomandibular joint dislocation

Autologous blood versus Platelet rich plasma (PRP), pericapsular injection in the treatment of chronic recurrent temporomandibular joint dislocation

Trends in Medicare Reimbursement for the Top 20 Surgical Procedures in Craniofacial Trauma.

Research regarding financial trends in craniofacial trauma surgery is limited. Understanding these trends is important to the evolvement of suitable reimbursement models in craniofacial plastic surgery. The purpose of this study was to evaluate the trends in Medicare reimbursement rates for the top 20 most utilized surgical procedures for facial trauma. The 20 most commonly utilized Current Procedural Terminology (CPT) codes for facial trauma repairs in 2018 were queried from The National Summary Data File from the Centers for Medicare & Medicaid Services (CMS). Reimbursement data for each procedure was then extracted from The Physician Fee Schedule Lookup Tool. Changes to the United States consumer price index (CPI) were used to adjust all gathered data for inflation to 2021 US dollars (USD). The average annual and the total percent change in reimbursement were calculated for the included procedures based on the adjusted trends from the years 2000 to 2021. From 2000 to 2021, the average reimbursement for all procedures decreased by 16.6% after adjusting for inflation. Closed treatment of temporomandibular joint dislocation and closed treatment of nasal bone fractures without manipulation demonstrated the greatest decrease in mean adjusted reimbursement at -48.7% and -48.3%, respectively, while closed treatment of nasal bone fractures without stabilization demonstrated the smallest mean decrease at -1.4% during the study period. Open treatment of nasal septal fractures with or without stabilization demonstrated the greatest increase in mean adjusted reimbursement at 18.9%, while closed treatment of nasal septal fractures with or without stabilization demonstrated the smallest increase at 1.2%. The average reimbursement for all closed procedures in the top 20 decreased by 19.3%, while that for all open procedures decreased by 15.5%. The adjusted reimbursement rate for all top 20 procedures decreased by an average of 0.8% each year. To the best of our knowledge, this is the first study to comprehensively evaluate trends in Medicare reimbursement for facial trauma surgical repairs. Adjusting for inflation, Medicare reimbursement for the top 20 most commonly utilized procedures has largely decreased from 2000 to 2021. Consideration of these trends by surgeons, hospital systems, and policymakers will be important to assure continued access to meaningful surgical facial trauma care in the United States.

Treatment of Recurrent Dislocation of the Temporomandibular Joint with the Injection of Autologous Blood in Superior Joint Space with and without Pericapsular Tissue: An Experience at Tertiary Care Hospital of Peshawar

Background: Recurrent TMJ (temporomandibular joint) dislocation is a condition characterized by frequent dislocation events. Recurrent TMJ dislocation may be treated using a variety of techniques, including conservative therapy and surgical treatments. Objective: The objective of the study was to assess the effectiveness of treatment of recurrent dislocation of the temporomandibular joint with injection of autologous blood in superior joint space with and without pericapsular tissue Methodology: The current study was prospective was carried out at the Kabir Medical College, Gandhara University, Peshawar for duration of one year from June 2021 to July 2022. The patients were categorized into group A and B, each having 50 patients. In group A patients the autologous blood was injected in superior joint space while in group B, autologous blood was injected in pericapsular tissue. The average reduction in mouth opening was recorded in both the groups. All the data analysis was performed by using IBM SPSS version 23. Results: In group A patients, a mean (±sd) decrease in mouth opening of 3.30 (0.77) mm was observed (p=0.001) while a mean (±sd) decrease in mouth opening of 4.56 (0.72) mm was observed in group B patients (p=0.001). Dislocation recurrence was observed in 4 (57.14%) patients in group A while in group B, dislocation recurrence was observed in 3 (42.86%) patients (p=0.001). Conclusion: Our study concludes that management of recurrent dislocation of TMJ with injection of autologous blood was safe, efficient, simple and economic procedure. Patients with recurrent TMJ dislocation should be encouraged to use autologous blood injection for their treatment. Keywords: Recurrent; Temporomandibular joint dislocation; Autologous blood injection

Long-standing temporomandibular joint dislocation treated by intraoral condylectomy: a case report and review of the literature

BackgroundNoninvasive management by closed reduction is a desirable treatment for temporomandibular joint dislocation. However, reduction of long-standing temporomandibular joint dislocation is often difficult. Various conservative treatments have been attempted, but these often render poor outcomes. This article reports the case of long-standing temporomandibular joint dislocation that was successfully closed using intraoral condylectomy.Case presentationA 69-year-old Japanese man who sustained an injury in a car collision was unable to close his mouth. Owing to the diagnosis of long-standing temporomandibular joint dislocation, intraoral condylectomy was performed. In the case of temporomandibular joint dislocation, it is convenient to reach the condyle from the oral cavity because sufficient opening is maintained. The condyle can be clearly visualized using an approach similar to sagittal split ramus osteotomy, and the operation using surgical instruments can be facilitated by resecting the coronoid process. By separating the surrounding soft tissue and pulling the cut condyle with sufficient visual field, the condyle can be resected while addressing the hemostasis. During the 12-month postoperative follow-up period, no temporomandibular joint dislocation recurred and the occlusion remained stable.ConclusionsThe limited intraoral incision of this surgical technique provides sufficient access for condylectomy. The results of this case report suggest that condylectomy by intraoral approach could become the treatment of choice for long-standing temporomandibular joint dislocation.

Recurrent Temporomandibular Joint Dislocation Due to Antiemetic Induced Acute Dystonia: A Case Report

Introduction: Drug-induced acute dystonic reaction is a common presentation to emergency department. Oromandibular dystonia is one of the focal dystonias, which can be presented as jaw clenching, jaw opening or jaw deviation and leads to impaired speech and swallowing. In this paper, we presented an adult patient with recurrent temporomandibular joint dislocation due to metoclopramide use.
 Case Report: A 21-year-old female patient came to the emergency department with the complaints of inability chew and swallow, difficulty in speaking, pain at right temporomandibular region that started a few hours ago. On physical examination, she was having dystonia of the right mandibular region and left posterior servikal region and no dystonia at other parts of the body. The patient was diagnosed with metoclopramide-induced acute dystonia. She was treated with intravenous anticholinergic.
 Conclusion: Metoclopramide is an antiemetic drug that can cause serious adverse events such as acute dystonic reaction. Among these side effects are oromandibular dystonias, which may lead to TMJ dislocation. Physicians and other healthcare professionals working in the emergency department should be familiar with such side effects.

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.

Assessment of Maximal Incisal opening using autogenous Inlay Assessment of Maximal Incisal opening using autogenous Inlay Eminoplasty Technique For Treatment Of chronic recurrent Eminoplasty Technique For Treatment Of chronic recurrent temporo mandibular joint Dislocation

Purpose: Different surgical protocols have been introduced for eminence augmentation for treatment of recurrent temporomandibular joint dislocation, The aim of this study is to assess maximal incisal opening (MIO) using inlay (sandwich osteotomy) autogenous block augmentation harvested from patient’s symphesis for more stable condylar movements . Methods: five patients were treated in this study (10 joints) with bilateral autogenous inlay block bone grafting technique, each autogenous cortico-cancellous bone block was harvested from chin and wedged at the created defect of the eminence through a green stick fracture to increase its height . Results: The follow up period ranged from six months to two years to access the maximal incisal opening (MIO). the mean preoperative maximal incisal opening was 45.8mm and that of the postoperative was 32.3 mm . One patient reported postoperative slight unilateral edema and pain that gradually diminishes after one month postoperative.another patient showed intraoperative condylar dislocation that was treated with masseter scarification. Conclusion: autogenous block interpositional eminoplasty technique is a reliable procedure for management of antero-medial recurrent condylar dislocation.

Ultrasound-guided lateral pterygoid muscle botulinum toxin: an injection for recurrent temporomandibular joint dislocation in a brain injury patient.

Botulinum toxin type A (BTX-A) injection using nerve stimulation or electromyography for recurrent temporomandibular joint (TMJ) dislocation has been reported for several years. However, using the available equipment like a nerve stimulator or an electromyograph is uncommon, and ultrasound guidance is convenient and requires no additional resources. In this report, we used ultrasound as a tool to achieve BTX-A injections in a patient with a traumatic brain injury to treat her TMJ dislocation. One week after the injections, she had no more dislocation. She remained symptom free during the 3months of follow-up, and her clinical symptoms improved without significant complications. This is the first report using ultrasound guidance for BTX-A injections to treat recurrent TMJ dislocation. This treatment is an effective and safe technique that could be performed timely and locally without referral to a center with electromyography facilities.

Evaluation of Articular Eminence Morphology in Patients with Spontaneous Temporomandibular Joint Dislocation Using Cone Beam Computed Tomography

Evaluation of Articular Eminence Morphology in Patients with Spontaneous Temporomandibular Joint Dislocation Using Cone Beam Computed Tomography

Glenotemporal osteotomy with bone grafting versus Dautrey's procedure for the management of chronic recurrent temporomandibular joint dislocation and hypermobility: A retrospective study

AbstractAimThe aim of the current study was to retrospectively compare Dautery's procedure and glenotemporal osteotomy in the treatment of chronic recurrent temporomandibular joint dislocation and hypermobility.Materials and Methods28 patients presented with chronic recurrent dislocation of the TMJ during the period of the study. Three cases were omitted as they were operated using surgical techniques other than Dautrey's procedure or glenotemporal osteotomy. Another two cases were excluded because of incomplete data.Results23 patients, 18 females and 5 males were included in this study. Group I included nine patients who had Dautrey's procedure and group II included 14 patients for whom glenotemporal osteotomy and bone grafting was performed. The mean age was 26.2 years (ranging from 14.5 to 54 years). The mean postoperative mouth opening in group I was 29 mm (ranging from 23 to 36 mm). The mean postoperative mouth opening in group II was 28.5 mm (ranging from 21 to 41 mm). Statistical analysis failed to reveal a significant difference in complications between both groups.ConclusionsDautrey's procedure and glenotemporal osteotomy are valuable surgical options in the treatment of chronic TMJ dislocation. The choice of the procedure may be left to the operator's preference.

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.

Comparison of autologous blood prolotherapy and 25% dextrose prolotherapy for the treatment of chronic recurrent temporomandibular joint dislocation on the basis of clinical parameters: A retrospective study.

Prolotherapy is a nonsurgical regenerative injection technique and effective treatment method for the treatment of temporomandibular joint (TMJ) dislocation. Autologous blood and dextrose are commonly used agents for prolotherapy and the aim of this study is to compare the autologous blood injection prolotherapy and 25% dextrose prolotherapy for the treatment of chronic recurrent TMJ dislocation. This is a retrospective cohort study of 20 patients with chronic recurrent TMJ dislocation who were treated by either autologous blood (Group A) or 25% dextrose Prolotherapy (Group B). After prolotherapy, the patients were kept on follow-up and evaluated for maximum mouth opening (MMO), pain at visual analog scale (VAS), mandibular movements, frequency of dislocation, and TMJ sound. The collected data were then statistically analyzed. Group A showed better results in terms of reduction in MMO, mandibular movements as compared to Group B, and a statistically significant difference was found starting from 2 weeks post prolotherapy till 6 months follow-up. Whereas group B showed better results regarding reduction in pain intensity on VAS Scale at all follow-up visits. No statistically significant difference was found between both groups regarding reduction in the frequency of dislocation and TMJ sounds. Both autologous and dextrose prolotherapy gives promising results for the treatment of recurrent TMJ dislocation, however, regarding reduction in MMO and improvement in lateral and protrusive mandibular movements, autologous blood gave better results whereas 25% Dextrose was found to be more effective in terms of reduction of pain in recurrent TMJ dislocation cases.

MANAGEMENT OF AN UNRECOGNIZED AND DELAYED DIAGNOSED CASE OF BILATERAL CONDYLAR DISLOCATION FOLLOWING ORAL CANCER SURGERY - A CASE REPORT

Temporomandibular joint (TMJ) dislocation is characterized by displacement of the mandibular condyle from the glenoid fossa. There are various reasons for the dislocation of TMJ, among which iatrogenic dislocation is one of the cause which is generally overlooked. Acute dislocations can be corrected by various conservative methods like manual reduction, but long standing chronic dislocation requires surgical management. Here we present a case report of an unrecognized and delayed diagnosed case of bilateral condylar dislocation following oral cancer surgery under general anaesthesia with iatrogenic fracture of ramus of mandible which was managed surgically by vertical ramus osteotomy and ORIF.

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.

A technique to verify adequacy of eminectomy for recurrent temporomandibular joint dislocation

Recurrent dislocation of the temporomandibular joint (TMJ) can be highly debilitating, especially if the dislocation cannot be reduced by the patient. Despite being regarded as a ‘gold standard’ or ‘salvage’ procedure for refractory TMJ dislocations, complete mediolateral removal of the articular eminence can still lead to recurrences. A technique aimed at intraoperatively verifying the adequacy of osseous reduction in order to minimize the risk of re-dislocation of the TMJ is described.

Overview on the Prevalence, Risk Factors and Surgical Management of Temporomandibular Joint Dislocation: A Review Article

Temporomandibular joint dislocations account for 3% of all recorded dislocations. Traumatic causes of mandibular dislocations may indicate some masculine taste, as facial trauma is more common among men. Frontal dislocations are the most common type of mandibular dislocations, usually secondary to non-traumatic causes. Magnetic resonance imaging is increasingly being used to investigate the condition of the articular disc to determine whether or not there is an internal defect in the temporomandibular joint. It is more cost-effective than cone-beam CT scans and is made available to many dentists. Management of temporomandibular joint dislocation should be provided promptly. Non-surgical treatment of temporomandibular disorders remains the most effective way to manage over 90% of patients. In relation to surgical management, acute anteromedial, medial, lateral, or posterior dislocations can be manually reduced under analgesic control, with local or general anesthesia, sedation or not, but other methods Used in the literature.

Temporomandibular joint dysfunction following the use of a supraglottic airway device during general anaesthesia: a prospective observational study.

Supraglottic airway devices are commonly used to manage the airway during general anaesthesia. There are sporadic case reports of temporomandibular joint dysfunction and dislocation following supraglottic airway device use. We conducted a prospective observational study of adult patients undergoing elective surgery where a supraglottic airway device was used as the primary airway device. Pre-operatively, all participants were asked to complete a questionnaire involving 12 points adapted from the Temporomandibular Joint Scale and the Liverpool Oral Rehabilitation Questionnaire. Objective measurements included inter-incisor distance as well as forward and lateral jaw movements. The primary outcome was the inter-incisor distance, an accepted measure of temporomandibular joint mobility. Both the questionnaire and measurements were repeated in the postoperative period and we analysed data from 130 participants. Mean (SD) inter-incisor distance in the pre- and postoperative period was 46.5 (7.2) mm and 46.3 (7.5) mm, respectively (p=0.521) with a difference (95%CI) of 0.2 (-0.5 to 0.9) mm. Mean (SD) forward jaw movement in the pre- and postoperative period was 3.6 (2.4) mm and 3.9 (2.4) mm, respectively (p=0.018). Mean (SD) lateral jaw movement to the right in the pre- and postoperative period was 8.9 (4.1) mm and 9.1 (4.0) mm, respectively (p=0.314). Mean (SD) lateral jaw movement to the left in the pre- and postoperative period was 8.8 (4.0) mm and 9.3 (3.6) mm, respectively (p=0.008). The number of patients who reported jaw clicks or pops before opening their mouth as wide as possible was 28 (21.5%) vs. 12 (9.2%) in the pre- and postoperative period, respectively (p<0.001) with a difference (95%CI) of 12.3% (6.7-17.9%). There was no significant difference in the responses to the other 11 questions or in the number of patients who reported pain in the temporomandibular joint area postoperatively. No clinically significant dysfunction of the temporomandibular joint following the use of supraglottic airway devices in the postoperative period was identified by either patient questionnaires or objective measurements.

Temporomandibular Joint Dislocations and Extraoral Reduction

Temporomandibular Joint Dislocations and Extraoral Reduction

Recurrent TMJ Dislocation in a Child: A Case Report and Discussion

Temporomandibular joint (TMJ) dislocation demonstrate a displacement of the mandibular condyle from it functional position within the glenoid fossa and articular eminence. TMJ dislocation is an acute episode can be transformed into chronic dislocation after multiple repeated episodes. Oral surgeon is frequently called for the management of recurrent TMJ dislocation in adults. In pediatric population, TMJ dislocation sometimes caused by trauma or other than trauma related to wide opening of the mouth during vomiting, yawning and dental procedures considerably under general anesthesia. A 3-year-old baby girl came to Emergency department with a complaint of open mouth for the last 6 hours. Initial examination was carried out and patient was sent for CT-Scan. CT-Scan reported an asymmetric soft tissue density mass in retropharyngeal area at the level of C1 and C2, showing more bulk on right side. Some subtle radiolucency are also identified within the mass. The possibility of a low-density foreign body or retropharyngeal abscess could not be entirely excluded. A quick examination under anesthesia (EUA)was performed to relieve the patient from the abscess/growth. During EUA, they did not find any growth or collection or pus. The patient was sent to oral and maxillofacial surgeon, on initial examination and previous CT Scan findings, TMJ dislocation was diagnosed. In order to completely examine the patient, reduction of the jaw was attempted on chair side. This was achieved by digital manipulation with little effort and the baby’s jaw was secured with Barton’s bandage to prevent repeated dislocation. She continued tablet baclofen for 6 months as prescribed by the pediatrician. KEYWORDS: Temporomandibular Joint (TMJ), Recurrent dislocation, pediatric

Autologous blood injection as a modality of the treatment of temporomandibular joints dislocation: A case report

Many specific surgical procedures have been identified for treating the dislocation of chronic recurrent temporomandibular joints (TMJs). This article addresses an autologous blood injection (ABI) procedure for the TMJ diagnosis of chronic recurrent TMJ dislocation. A 22-year-old patient reported with chronic TMJ dislocation for 3 months. Autologous blood was injected into upper joint space and surrounding pericapsular tissue under local anesthesia. The patient was followed up regularly. The treatment was successful and the patient had no more dislocation of TMJ as inferred from favorable improvement in mouth opening. Autologous blood infusion (ABI) within the articular capsule and/or pericapsular space or joint depression, is one of the most negligibly intrusive treatments methodology for repetitive separations of TMJ, was as of now presented.