Recurrent Temporomandibular Joint Dislocation Research Articles

Arthroscopic electrothermal capsulorrhaphy for the treatment of recurrent temporomandibular joint dislocation

Acute temporomandibular joint dislocation is a common occurrence that is generally treated by conservative therapy. In some patients, this can become a chronic recurrent condition. This recurrent temporomandibular joint dislocation (RTD) can significantly decrease the patient's quality of life and require some form of surgical intervention for correction. The purpose of this study is to present a minimally invasive alternative treatment for RTD using operative arthroscopy. 11 patients treated for recurrent temporomandibular dislocation between 2004 and 2010 were retrospectively analyzed. Electrothermal capsulorrhaphy was performed using a standard double puncture operative arthroscopy with a Hol:YAG laser and/or electrocautery. Postoperatively the patients were monitored for 6 months to 6 years. Of the 11 subjects, 2 suffered a recurrence of temporomandibular dislocation and required open arthrotomy for correction. The other 9 patients had no signs of recurrence or any significant postoperative loss of function. Electrothermal capsulorrhaphy is an effective and minimally invasive method for the treatment of RTD.

Autologous blood injection to the temporomandibular joint: magnetic resonance imaging findings

PurposeThe aim of this study was to investigate the effect of the autologous blood injection (ABI) for chronic recurrent temporomandibular joint (TMJ) dislocation using magnetic resonance imaging (MRI).Materials and MethodsABI was applied to 14 patients who had chronic recurrent TMJ dislocation. MRIs of the patients were taken and compared before and one month after the injection.ResultsAll of the patients had no dislocations of their TMJs on clinical examination one month after the injection. In the pre-injection, unilateral or bilateral TMJ dislocations were observed on MRIs in all patients. One month after the injection, TMJ dislocations were not observed in MRI evaluation of any patients. A significant structural change that caused by ABI was not observed.ConclusionThe procedure was easy to perform and it caused no foreign body reaction. However, it was unclear how the procedure prevented the dislocation.

Histopathologic Evaluation of Autologous Blood Injection to the Temporomandibular Joint

Chronic recurrent temporomandibular joint dislocation is treated by surgical and nonsurgical techniques described in the literature. However, these techniques have some complications noted in the literature. Recently, the autologous blood injection in temporomandibular joint technique has been applied to treat chronic temporomandibular joint dislocation. However, to date, there has been no study that describes the histopathologic effects of autologous blood injection within the literature. The aim of this study was to evaluate the histopathologic effects of autologous blood injection in rabbit temporomandibular joints. Eight New Zealand white rabbits underwent bilateral autologous blood injection. After the injection, mandibles were fixed by orthodontic brackets and elastics for 24 hours. One rabbit was included in the control group. After 1-month follow-up period, the animals were killed. Temporomandibular joints were dissected and sent to histological examination. Only fibrin accumulations were seen in the tissue samples. There was no evidence of degeneration in the joint cartilage, and a fibrous bed was not formed in the injected regions. Although the procedure has successful results in the literature, a fibrous bed that is supposed to be the outcome of the treatment was not seen in the tissue samples. According to this study, therefore, the autologous blood injection does not change the structure of temporomandibular joint in rabbits.

Neurogenic temporomandibular joint dislocation treated with botulinum toxin: report of 4 cases

Many patients suffer recurrent episodes of temporomandibular joint (TMJ) dislocation due to an excess of muscle contraction or spasticity in the depressor muscles of the jaw. The manual repositioning using the Nelaton maneuver is the first treatment. Occasionally, it may be necessary to use sedation or general anesthesia to achieve the desired muscle relaxation. In case of recurrence, surgical treatment is indicated. One nonsurgical method of treatment is the local infiltration of botulinum toxin type A. We present 4 cases of recurrent TMJ dislocation in patients suffering from conditions of neurologic origin, with considerable motor deterioration, treated with local infiltration of botulinum toxin type A. In conclusion, the injection of botulinum toxin type A is an effective method in cases of neurogenic TMJ dislocation, with low morbididty and side effects, improving patients' quality of life.

Autologous blood injection as a new treatment modality for chronic recurrent temporomandibular joint dislocation

Many different surgical and nonsurgical techniques have been used to treat patients with chronic recurrent temporomandibular joint (TMJ) dislocation. The nonsurgical techniques consist of injecting different substances into the TMJ area. This study was carried out to assess autologous blood injection to the TMJ for treatment of chronic recurrent TMJ dislocation. Thirty patients having chronic recurrent TMJ dislocation were randomly divided into 2 equal groups (15 patients in each). Group A was treated only by autologous blood injection into the superior joint space (SJS), whereas group B received autologous blood injections to the SJS and the pericapsular tissues (PT). At the end of the follow-up period of 1 year, the results of the current study have showed that injection of autologous blood to the SJS and PT gave a higher success rate (80%) than its injection only into the SJS (60%). Moreover, the patients of group B had an average decrease in their maximal mouth opening (5.3 +/- 2.1) higher than that of group A (3.6 +/- 1.5). Also, the digital radiographic imaging of the joints in group B only showed the condylar head posterior to the articular eminence, in open position, instead of being anterior to it before the injection. In both groups, no destructive changes to the bony components of the joint have been observed. We could conclude from this study that the injection of autologous blood into the TMJ in patients with chronic recurrent dislocation is a simple, safe and cost-effective technique. So, we encourage injection of autologous blood to the SJS and PT for treatment of patients with chronic recurrent TMJ dislocation, as it has shown better clinical and radiographic results than its injection only to the SJS.

Poster 48: Minimally Invasive Alternative for Treatment of Recurrent Temporomandibular Joint Dislocation

Statement of the Problem: Acute temporomandibular joint dislocation is a common occurrence that is generally treated by conservative therapy, namely manual reduction. This treatment, followed by some form of temporary immobilization, most often prevents recurrence. In some cases, possibly due to predisposing factors such as joint laxity, this can become a chronic recurrent condition requiring multiple trips to a physician or emergency room for reduction. This recurrent temporomandibular joint dislocation (RTD) can significantly decrease the patient's quality of life and require some form of surgical intervention for correction. Historically the most common treatment of RTD involves alteration of the condylar path by either eminectomy or eminoplasty. Many variations of each have been described in the literature, each with satisfactory results, but also with the inherent morbidities associated with open arthroplasty. Other methods for the treatment of RTD that have been proposed including intracapsular injection of sclerosing agents, intracapsular injection of autologous blood, botulinum toxin type A injection into the lateral pterygoid muscle, myotomy of the lateral pterygoid muscle, and scarification of the temporalis tendon. The purpose of this study is to present a minimally invasive alternative treatment for RTD using operative arthroscopy.

Conservative treatment for recurrent dislocation of temporomandibular joint

Recurrent dislocation of the temporomandibular joint is difficult to treat with nonsurgical methods. A new nonsurgical method for the treatment of this condition is presented. Routine dental arch bars were applied to the teeth, and two latex elastic bands were placed between the two arch bars on either side of the dental arch. Muscular exercises (i.e. active mouth opening) were then performed regularly over approximately three months. Patients were followed up for two to five years, and the treatment proved successful in five of five cases (i.e. no recurrence was seen). The advantages of this treatment are its simplicity and the lack of special equipment needed. No surgery is required, although patients must perform regular muscular exercises. Surgical complications such as trismus and facial nerve palsy are avoided. The disadvantages of this method are the requirement for patient compliance, and its lack of usefulness in patients without teeth. The described method is useful for patients complaining of recurrent dislocation of the temporomandibular joint.

Oromandibular Dystonia in Cerebrotendinous Xanthomatosis

She was treated with speech therapy and serial titrated electromyography-guided BTX injections (Figure 5). A maximum of 15 units of BTX were administered to each of the external pterygoid muscles and 5 units of toxin were administered to each anterior belly of the digastric muscles. Following chemodenervation of these muscles, the patient experienced decreased frequency, intensity, and duration of the dyskinesias. Her speech articulation and fluency improved. Her ability to masticate and swallow both solids and liquids improved, although she remained PEG dependent. She is currently working with a nutritionist to maximize her oral caloric intake, with the goal of reducing or eliminating her PEG dependence. Oromandibular dystonia (OMD) is a neurologic disorder characterized by involuntary movements of the masticatory, lingual, and pharyngeal muscles. Oral pharmacologic agents have limited efficacy in alleviating the symptoms of OMD. OMD complicated by recurrent temporomandibular joint dislocation has previously been described in a patient with CTX4. BTX is a safe and effective treatment for OMD5. In addition to directly weakening the affected muscles, some authors suggest that BTX also modulates inhibitory and excitatory intracortical pathways6.

Autologous Blood Injection for the Treatment of Chronic Recurrent Temporomandibular Joint Dislocation

Many different surgical techniques for the treatment of chronic recurrent temporomandibular joint (TMJ) dislocation have been described. This article discusses a technique of autologous blood injection to the TMJ for treatment of chronic recurrent TMJ dislocation. Twenty-five patients diagnosed with chronic recurrent TMJ dislocation were treated by bilateral injections of autologous blood into the upper joint space and around the TMJ capsules bilaterally. Eighty percent had a successful outcome and required no further treatment at their 1-year follow-up. This procedure has proven to be safe, simple, and cost effective for the treatment of chronic recurrent TMJ dislocation.

Management of chronic recurrent temporomandibular joint dislocations: A retrospective study

The purpose of this study is to evaluate the clinical results of patients who received surgical treatment for chronic recurrent dislocations (CRD). In our clinical practice CRD patients were classified into 5 types depending upon their aetiology. These patients were treated by two different surgical techniques, eminectomy or augmentation of the eminence by autograft depending on their classification. Nineteen patients with CRD attended the clinic for surgical treatment. Patients were classified accordingly into 5 types of CRD. Eminoplasty was used in the treatment of twelve patients with type I and II disease. An oblique osteotomy of the eminence was carried out. Harvested chin graft was contoured to a wedge form and inserted tightly into the osteotomy site. The augmentation of the eminence was provided by an inlay cortical bone graft without using any of the conventional fixation materials. The remaining 7 patients with type III, IV and V disease were treated by eminectomy. The factors evaluated were pre- and post-operative maximal incisor opening, sex, age, number and type of previous operations, cause and type of the CRD, and the previous treatment of the patients. The survey is based on nineteen patients who were treated in the same department. Patients age ranged from 22 to 80 years. Females are dominated in the study. The follow-up period ranged from 1 to 12 years. Free excursions of the condyles were achieved in the patients treated by two different techniques. On the other hand, maximum interincisal openings were higher in the patients treated by eminectomy when compared with the patients who had eminoplasty. So far as the quality of life for the patients with CRD is concerned, the most appropriate technique (whether it be to confine the condyle or allow its free movement) to be employed should be decided by following an comprehensive evaluation of the patients' history.

Surgical treatment of chronic temporomandibular joint dislocation: A case report

Chronic dislocation of temporomandibular joint is usually treated with conservative approaches, but in some cases, surgery is needed to avoid recurrencies. The present paper described a case report of a bilateral intervention for articular tubercle height augmentation by means of calvaria bone grafts. A 32-year-old woman attended the Department of Maxillofacial Surgery, University of Padova, Italy, in January 2007 seeking treatment for a bilateral recurrent temporomandibular joint dislocation. She was treated with a surgical procedure providing an antero-posterior osteotomy of the caudal portion of the articular eminence and the insertion of a calvaria bone graft, preserving the periosteum of the borders of the osteotomic beach. The newly remodeled articular eminence has an increased height, thus representing a barrier to condylar dislocation out of the glenoid fossa. No ostheosynthesis fixation was provided, and physiotherapic rehabilitation was started in the immediate postoperative phases to help the patient gain a good jaw function as soon as possible. Such a technique showed to be effective, as during an 8-month follow-up span, the patient referred no recurrencies of joint dislocation. Jaw motion parameters maintained good over the entire follow-up period, and radiological assessments showed no signs of bone grafts reabsorption. The technique described in the present case report has some potential advantages over other surgical approaches to the treatment of recurrent temporomandibular joint dislocation that need to be assessed with future studies.

A New Surgical Approach for the Treatment of Chronic Recurrent Temporomandibular Joint Dislocation

Chronic recurrent temporomandibular joint (TMJ) dislocation is defined as the complete loss of articular relationships, during mouth-wide opening, between the articular fossa of the temporal bone and the condyle-disk complex. The most frequent pathogenetic factors involved in chronic recurrent dislocation of the TMJ are supposed to be trauma, abnormal chewing movements, TMJ ligaments, capsule laxity, and masticatory muscles disorders. In fact, TMJ dislocation occurs more frequently in people with general joint laxity and in patients with internal derangement of the TMJ or with occlusal disturbance. Management of TMJ dislocation remains a challenge. Eminectomy, whose validity has been demonstrated by several authors, acts on the bony obstacle, preventing condylar locking, but does not have a therapeutic effect on TMJ ligament and capsular laxity or masticatory muscle incoordination, which seem to be the real cause of TMJ dislocation in most cases. The authors present a mini-invasive modified technique of eminectomy, which aims to act on both the obstacle and the cause with respect and restoration of TMJ biomechanical constraints.

Autologous blood injection into the articular cavity for the treatment of recurrent temporomandibular joint dislocation: a case report

Autologous blood injection around the articular capsule and/or into the articular cavity, which is one of the treatments for recurrent temporomandibular joint dislocation, was recently reintroduced. Here, we present the management of recurrent temporomandibular joint dislocation by autologous blood injection in an 84-year-old female. After the treatment, although the right condylar process had settled just beneath the articular tubercle, the dislocation had improved and the patient was able to close her mouth without difficulty.

Four cases of recurrent temporomandibular joint dislocation successfully improved with autologous blood injection

Four cases of recurrent temporomandibular joint dislocation successfully improved with autologous blood injection

Oral health in prevalent types of Ehlers–Danlos syndromes

The Ehlers-Danlos syndromes (EDS) comprise a heterogenous group of heritable disorders of connective tissue, characterized by joint hypermobility, skin hyperextensibility and tissue fragility. Most EDS types are caused by mutations in genes encoding different types of collagen or enzymes, essential for normal processing of collagen. Oral health was assessed in 31 subjects with EDS (16 with hypermobility EDS, nine with classical EDS and six with vascular EDS), including signs and symptoms of temporomandibular disorders (TMD), alterations of dental hard tissues, oral mucosa and periodontium, and was compared with matched controls. All EDS subjects were symptomatic for TMD and reported recurrent temporomandibular joint (TMJ) dislocations. Abnormal pulp shape (13%) and pulp calcification (78%) were observed in subjects affected with classical EDS. Caries experience was higher in EDS compared with controls and was related to poor oral hygiene, influenced by increased mucosal fragility and restraint of (wrist) joint mobility. The overall periodontal status in EDS was poor, with 62% of EDS subjects presenting high periodontal treatment needs (community periodontal index for treatment need, CPITN = II). Oral health may be severely compromised in EDS as a result of specific alterations of collagen in orofacial structures. When considering dental treatment in EDS, a number of tissue responses (mucosa, periodontium, pulp) and precautions (TMJ dislocation) should be anticipated.

Comparative study of eminectomy and use of bone miniplate in the articular eminence for the treatment of recurrent temporomandibular joint dislocation

SummaryDislocation of the temporomandibular joint occurs when the mandibular condyle exits the glenoidal cavity and remains anteriorly locked to the articular eminence. It is repetitive (recurrent dislocation), usually associated with mandibular hypermobility and inclination of the articular eminence.AimThis study intended to clinically and radiologically assess the technique of eminectomy and the use of a miniplate on the articular eminence for the treatment of recurrent dislocation of the temporomandibular joint of patients operated on at Oswaldo Cruz University Hospital from January to September 2003.Study designRetrospective cohort.Material and MethodThe sample consisted of 11 patients. Eminectomy was performed on nine joints of five patients and the placement of a miniplate on the articular eminence was performed on 11 joints of six patients. Data collection was carried out through analysis of patient's medical charts and new postoperative visit.ResultsThe results showed that there were no major postoperative complications with either technique. Maximum mouth opening was greater with eminectomy procedure and none of the patients operated on presented any recurrence of dislocation.ConclusionIt is concluded that both techniques were effective in the treatment of recurrent dislocation of the temporomandibular joint.

Recurrent temporomandibular joint dislocation treated with botulinum toxin: report of 3 cases

Dislocation of the mandible is uncommon but distressing. There are many causes, including trauma, hypermobile or deranged temporomandibular joints (TMJs) and involuntary movements. 1,2 Manual reduction is the primary treatment, but repeated mandibular dislocation requires preventive measures. Current treatments include injection of sclerosing agents or autologous blood around the TMJ to create fibrosis and limit jaw movement or the more invasive eminectomy or Dautry procedure. The purpose of this report was to present 3 different cases of recurrent mandibular luxation treated with botulinum toxin type A (BTA).

Arthroscopic laser surgery and disc suture-fixation technique for recurrent dislocation of temporomandibular joint

Arthroscopic laser surgery and disc suture-fixation technique for recurrent dislocation of temporomandibular joint

自己血注入療法が奏効した習慣性顎関節脱臼の１例

Many different techniques have been described for the treatment of recurrent temporomandibular joint dislocation. Surgical procedures, however, have risks in application, especially in compromised patients.Bilateral recurrent condylar dislocation in a 66-year-old man who had hemiplegia after cerebral infarction was successfully treated by autologous blood injection. Under local anesthesia, a 21-gauge needle was inserted in the superior compartment of the temporomandibular joint, and 3 cc of fresh autologous blood was injected in the compartment and 1 cc was injected in the pericapsular tissue. At follow-up 8 months after the procedure, the patient did not complain of recurrent dislocation.Autologous blood injection is an alternative treatment for recurrent temporomandibular joint dislocation, particularly in patients in whom surgical procedures should be avoided.

Temporomandibular joint and masticatory muscle involvement in myotonic dystrophy: A study by magnetic resonance imaging

The purpose of this study was to evaluate the masticatory muscles and the temporomandibular joint (TMJ) by magnetic resonance imaging (MRI) in myotonic dystrophy (MD) patients. MRI of the masticatory muscles and TMJ was performed in 15 MD patients, 11 male and 4 female, aged 16 to 53 years (mean, 31 years). Many of them had dental malocclusion, especially Angle class III and anterior open bite, and 3 complained of recurrent TMJ dislocation. TMJ and masticatory muscle pain was not observed, and joint sounds were noted in only 1 patient. The analysis of MRI scans showed masticatory muscle involvement in 13 patients (86.6%). In 11, the involvement was moderate to intense. The main abnormalities observed were increased intramuscular tissue signal on T1 (fatty infiltration) and volumetric reduction of muscles. Regarding the TMJ, articular disk displacement was seen in only 1 patient, but abnormalities of disk shape were common. Mild bone abnormalities were frequently observed, including changes of shape and contour of bone surface, and sclerosis of bone marrow. In 4 patients the condyle moved anterior to the eminence with the mouth opened fully (condylar hyperexcursion). This study shows that masticatory muscles are frequently and intensively affected in MD patients. Bone changes are the most consistent abnormalities observed in the TMJ. It is possible that remodeling is caused by biomechanical changes in the jaw as a result of masticatory muscle involvement.