Temporomandibular Dislocation Research Articles

Autologous Blood Injections in Temporomandibular Hypermobility: A Systematic Review.

The injection of autologous blood (AB) is one of the methods of treatment of recurrent dislocations in the temporomandibular joints (TMJs). Due to the low invasiveness of this technique, it is reasonable to evaluate it in accordance with the standards of evidence-based medicine. The purpose of this systematic review is to identify primary studies on AB injection for the treatment of TMJ hypermobility and assess the therapy for effectiveness. This systematic review was conducted in accordance with the current "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. Controlled randomized trials comparing dislocation episode rates, range of motion in the TMJ, or articular pain intensity were adopted as the eligibility criteria. Final searches were conducted on 11 June 2023 using Bielefeld Academic Search Engine, Elsevier Scopus, and the National Library of Medicine: PubMed. Trials were assessed using the "Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence" scale and "A revised Cochrane risk-of-bias tool for randomized trials". The results of the individual studies were tabulated, syntheses were illustrated in graphs. Twenty two studies involving 982 patients were included in the qualitative analysis, of which seven studies involving 390 patients were subject to quantitative analysis. None of the included randomized controlled trials presented a high risk of bias, 75% of them raised some concerns. In a three-month observation, administration of AB was more efficient in limiting temporomandibular dislocations than hypertonic dextrose (1 study, 32 patients, relative risk = 0.33, odds ratio = 0.29) and no difference in outcomes was observed between intracavitary and pericapsular administration compared to pericapsular injection alone (2 studies, 70 patients, relative risk = 1.00, odds ratio = 1.00). Injections of AB into the temporomandibular joints are effective in preventing further TMJ dislocation episodes in 75-94% of patients. This study received no funding.

Comparison of Autologous Blood Injection and Dextrose Prolotherapy in the Treatment of Chronic Recurrent Temporomandibular Dislocation: A Randomized Clinical Trial.

Prolotherapy is a minimally invasive technique that aims to functionally restore or repair the soft and hard tissues of the TMJ by injecting a stimulant. The present study was conducted to compare the effectiveness of dextrose and autologous blood injection (ABI) as prolotherapy agents in the treatment of patients with chronic recurrent TMJ dislocation (CRTD). Thirty-two patients were divided into two groups-ABI and dextrose (n = 16 each). The superior joint space was located by means of cantho-tragal line and lavage. Delivery of prolotherapy agent was performed by single-needle technique. An elastic bandage was applied for a week and rehabilitation was initiated three weeks after the treatment. Pain level, joint hypermobility, maximal mouth opening, and frequency of dislocations were recorded at various follow-up intervals up to one year post-treatment. No significant difference (p > 0.05) was seen for the values between both groups at all time intervals in the pain level. At the 6-month and annual follow-ups, the mouth opening of the patients treated with ABI was significantly lower (p < 0.01) as compared to those treated with dextrose. The patients treated with ABI therapy exhibited fewer dislocations (p < 0.05) within the following year. Prolotherapy is a relatively noninvasive, safer, and effective treatment modality with a high success rate for patients with CRTD. Both, ABI and dextrose, proved effective in reducing the pain and joint hypermobility associated with CTRDs within a week. ABI proved to be more efficient in reducing the mouth opening and limiting the dislocation of TMJ as compared to dextrose therapy.

A new atraumatic temporomandibular joint dislocation reduction technique. Note preview

In light of the new coronavirus pandemic, emotional temporomandibular joint disorders have become more common. As a result, abnormal wear of the bones and cartilages in this joint may favor the triggering of temporomandibular dislocations. This technical note describes a new atraumatic method for reducing temporomandibular dislocation, with advantages over the traditional Nelaton maneuver. The corresponding author states that he has been using this technique for over 20 years in Brazilian public hospitals with absolute success. The note is original and has never been submitted, in full or in part, to any journal. This work aims to present an innovative technique, easy to perform and free of cost, in order to facilitate the reduction of temporomandibular dislocations.

Post-traumatic superolateral temporo-mandibular dislocation with intact condyle: case series and literature review

Introduction: Supero-lateral temporomandibular dislocations with intact condyles are very rare, particularly in countries of sub-Saharan Africa where they are poorly documented. Materials and method: This was a retrospective study that included all patients received for superolateral temporomandibular dislocation with intact condyle following a maxillofacial trauma. The period covered by the study was from January 2011 to July 2021. Results: 3 patients were studied. According the classification of temporomandibular superolateral dislocation with intact condyle, the first patient had a Type II A, the second and the third patient, type II B. The manual reduction of the first patient luxation was unstable requiring an osteosynthesis of mandibular symphysis to stabilise the reduction of the temporomandibular dislocation. The second patient manual reduction was unsuccessful requiring an open reduction by preauricular approach. The third left against medical advice. Discussion: The occurrence of temporomandibular superolateral dislocation with intact condyle in an underdeveloped city like Bouaké, is not related to the density of road traffic but to the indiscipline of the many motorcyclists who do not wear helmets. Early reduction of the dislocation, early mobilisation of the joint and mechanotherapy positively influence the postoperative outcome.

Eminectomy versus eminoplasty for treatment of recurrent temporomandibular dislocation: Randomized controlled clinical trial

Purpose: The aim of this study was to compare recurrence, operation time, and temporomandibular joint (TMJ) pain following eminectomy versus eminoplasty in patients with recurrent TMJ dislocation. Materials and methods: 12 patients with bilateral TMJ recurrent dislocation were included in this study. Bilateral eminectomy was performed for 6 patients, and bilateral reduction eminoplasty was performed for the other 6 patients. Recurrence rate, operation time, TMJ pain, TMJ noise, postoperative complications were assessed and compared between the 2 groups. Results: No recurrence was observed in the eminectomy group. While in the eminoplasty group, recurrent dislocation occurred in 33.3% of the patients. Operation time was shorter in the eminoplasty group compared to the eminectomy group (40.75 ± 5.17, 47.3 ±7.27 minutes. TMJ pain at different time points, and TMJ noise were was comparable in the 2 groups. Conclusions: Eminectomy is superior to eminoplasty for treatment of recurrent TMJ dislocation. Eminoplasty can represent an alternative for eminectomy in cases with risk of intracranial perforation, subjected for further investigations.

MODERN VIEWS ON ETHIOPOLOGICAL FACTORS OF THE DEVELOPMENT OF TEMPOROMANDIBULAR JOINT DISORDERS (LITERATURE REVIEW)

In the analysis of literature devoted to the temporomandibular joint, attention is concerned with differentiation of etiological factors and variants of the mechanism of development of TMD’s which were proposed by various authors. These disorders are due to peculiarities of the structure and function of the TMJ. Occlusion is the first and perhaps the most controversial etiological factor in the occurrence of TMD. The price was also important reason for temporomandibular disorders. Nowadays, most researchers include occlusion to the factors associated with the development of TMD, which plays possible role both in the tendency and in preserving TMD. Angle and others of their studies determined the effect of pathological dentition on the development of temporomandibular joints . The authors found that in patients with TMD, the difference between the height of central occlusion and the height of physiological rest was higher than in patients without TMD. Summarizing the results of the study, the authors have established a close relationship between pathological erosion of teeth and the appearance of temporomandibular dislocation. Discussions about the effect of occlusion on TMD have been influenced and limited by therapeutic measures in the occurrence of TMD, but modern researchers work to isolate the multifactorial etiology of temporomandibular disorder and reduce the role of occlusion as the main etiological factor in the onset of TMD.&#x0D; &#x0D; Ockeson, one of the main etiological factors of temporomandibular disorder, considers psychoemotional factor and stress susceptibility as the main dominance of the muscular component of functional disorders of the masticatory apparatus in combination with myofascial pain. The less important element of occlusion (about 20% of etiological factors) is associated with occurrence of occlusive dysfunctions.&#x0D; &#x0D; Probert et al. having conducted a large-scale study that included 20,673 patients who were victims of road accidents, it has been shown that the incidence of TMD after injury from the seat belt was very low and injury as an independent etiologic factor can not be a trigger factor for TMD. Endotracheal anesthesia is also suggested as a risk factor for the development of TMD in a number of clinical cases and systemic studies. Any association between endotracheal intubation and the development of short-term symptoms of TMD’s is likely to occur in patients with such a history of dysfunctional disorders.&#x0D; The physician should be aware of the TMD's etiology, because it allows determining the purpose of the examination and planning of the treatment, as well as to confirm the results of treatment and rehabilitation of the patient.

A survey on temporomandibular dislocation in facilities for elderly people

A survey on temporomandibular dislocation in facilities for elderly people

MORPHOMETRIC PARAMETERS OF THE TEMPOROMANDIBULAR JOINT ELEMENTS AT ITS CHRONIC LUXATION’S AND SUBLUXATION

The paper notes the relevance of the temporomandibular joint, in particular, chronic dislocation and subluxation. The aim of the study was to study morphometric parameters of the temporomandibular joint using computed tomography and to identify anatomical and topographical features of those with chronic dislocation and subluxation of the joint. The article describes the method of measurement of bone structures, which we studied 27 patients with chronic dislocation and subluxation of the temporomandibular joint. This study allows to conclude that in patients with dislocation and subluxation of the temporomandibular joint have structural violations of the elements of the joint, their proportions that have a significant asymmetry.

Temporomandibular dislocation caused by pancreatic cancer metastasis: A case report.

Metastasis-induced dislocation of the temporomandibular joint (TMJ) is rare. The present study describes a case of TMJ dislocation caused by metastasis from pancreatic cancer, and discusses this in the context of literature on occlusal abnormality and/or dislocation due to metastasis. In the present case, unilateral TMJ dislocation was suspected when the patient first presented; destructive bone changes were not observed on conventional radiographs, and magnetic resonance imaging (MRI) revealed a tumorous lesion. The present case suggests that healthcare professionals should consider whether a malignant disease is present in cases of occlusal abnormality and/or dislocation of the TMJ, and that, in patients with TMJ dislocation that cannot easily be repositioned, additional imaging examinations, including MRI, should be performed as soon as possible, regardless of whether destructive bone changes are present. Metastasis to the TMJ is typically associated with generalized skeletal metastasis in the final stage of malignancy. Therefore, it is crucial to consider the possibility of cervical spine metastasis in order to decrease the risk of cervical fracture when attempting reduction of a TMJ dislocation, particularly in patients with a history of cancer.

The historical materials of stomatology in the All Things, Prescriptions of Fifty-two Diseases and Yinshu

All Things, Prescriptions of Fifty-two Diseases and Yinshu were three bamboo and silk medical manuscripts which form-time was no later than the late Warring States period. From the visible bamboo and silk, the ancient Chinese knew the relationships between some drugs and the volume of saliva and used compound drugs to treat dental caries. Some oral and maxillofacial diseases, such as inflammation and pain of oromaxillo-facial region, temporomandibular dislocation and the methods of treatment were descriped in these books. Mouth-rinsing and tooth-picking were the more often used methods for maintaining oral hygiene. Kouchi(clicking the tooth)was also used for prevention and/or treatment of caries. Most of these knowledge were the first documents in ancient China.

Treatment of recurrent temporomandibular dislocation by displacement of the zygomatic arch: Bouguila and Khochtali's technique

Treatment of recurrent temporomandibular dislocation by displacement of the zygomatic arch: Bouguila and Khochtali's technique

Traitement de la luxation temporo-mandibulaire récidivante par abaissement de l’arcade zygomatique : modification de la technique de Gosserez et Dautrey

Many methods have been reported for the surgical treatment of recurrent anterior temporomandibular dislocation. Most of these techniques are designed to limit the forward migration of the condylar head. The great number of surgical techniques experimented illustrates the difficulty to find a satisfactory method for the treatment of these recurrent dislocations. We present a modification of Gosserez and Dautrey's surgical technique for the treatment of recurrent anterior temporomandibular joint dislocation. The surgical technique is described and its indications are discussed.

The “Syringe” Technique: A Hands-Free Approach for the Reduction of Acute Nontraumatic Temporomandibular Dislocations in the Emergency Department

BackgroundThe traditional intraoral manual reduction of temporomandibular joint (TMJ) dislocations is time consuming, difficult, and at times ineffective, and commonly requires conscious sedation. ObjectivesWe describe a novel technique for the reduction of acute nontraumatic TMJ dislocations in the emergency department (ED). MethodsThis study was a prospective convenience sample population during a 3-year period at two university teaching-hospital EDs where acute nontraumatic TMJ dislocations were reduced utilizing our syringe technique. Demographics, mechanism, duration of dislocation, and reduction time were collected. Briefly, the “syringe” technique is a hands-free technique that requires a syringe to be placed between the posterior molars as they slide over the syringe to glide the anteriorly displaced condyle back into its normal anatomical position. Procedural sedation or intravenous analgesia is not required. ResultsOf the 31 patients, the mean age was 38 years. Thirty patients had a successful reduction (97%). The majority of dislocations were reduced in <1 min (77%). The two most common mechanisms for acute TMJ dislocations were due to chewing (n = 19; 61%) and yawning (n = 8; 29%). There were no recurrent dislocations at 3-day follow-up. ConclusionWe describe a novel technique for the reduction of the acutely nontraumatic TMJ dislocation in the ED. It is simple, fast, safe, and effective.

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.

Temporomandibular dislocation due to aripiprazole induced dystonia

We wish to report the case of a patient who developed temporomandibular joint dislocation due to dystonia following a single dose of aripiprazole. Our patient was a 23-year-old woman presenting with persistent low mood, fatiguability, insomnia and suicidal ideation. There was no past history of psychiatric morbidity. There was family history of depressive episode and deliberate self harm in her husband who was her paternal cousin. She was given 10 mg escitalopram and 0.5 mg clonazepam for insomnia on a diagnosis of a moderate depressive episode and improved over the next 3 weeks. However she developed irritability and agitation while on the above medications for which she was given a single dose of aripiprazole 10 mg at night by another psychiatrist not attached to our institution, which was not appropriate for her condition. The patient had taken 10 mg escitalopram in the morning. There was no history of intake of any over the counter drugs or herbal preparations. Twelve hours after the first dose she developed sedation and salivation and her care givers withheld subsequent doses of aripiprazole, escitalopram and clonazepam. Twenty hours after the first dose, she developed painful spasms of the muscles of her neck on the right side. She also had forced opening and deviation of jaw, both to the left and right. This was followed by persistent deviation of the jaw to the left and pain in the left temporomandibular joint. She was unable to close her mouth, swallow or talk for which she was brought to the emergency department of our hospital. A left-sided temporomandibular dislocation was diagnosed and a manual reduction was performed, after which the pain subsided. The next morning she was examined by us and seen to have forced mouth opening, excessive salivation and bilateral hand tremors. There were no other dystonic reactions. The dystonia and temporomandibular joint dislocation could not be part of the somatic symptoms of depression. We gave her 50 mg promethazine intramuscularly on suspicion of an aripiprazole induced dystonia. Two hours later, the dystonic movements subsided and the patient was sent home on oral promethazine. She did not have dystonic movements on follow-up the next morning. A rechallenge with aripiprazole could not be done for ethical reasons. The dystonia was rated as possibly due to aripiprozole according to the Naranjo adverse drug reaction probability scale [1]. She was restarted on escitalopram and clonazepam. A 1 month follow-up did not reveal any dystonic reactions. The adverse drug reaction was reported to the regional pharmacovigilance reporting centre. Aripiprazole is a second generation anti-psychotic which has a low propensity to cause extra-pyramidal side effects [2]. There are reports of acute dystonia induced by aripiprazole in drug-naive [3], and cocaine dependent patients [4] and in a patient on sertraline [5]. It has been proposed that aripiprazole caused dystonia because it lacked a protective anti-cholinergic action unlike other second generation anti-psychotics like clozapine [3]. Temporomandibular joint dislocations have been reported with conventional neuroleptics [6, 7] but no case has been reported with aripiprazole. Aripiprazole has been found to have no meaningful effect on the pharmacokinetics of escitalopram [8].We propose that our patient developed temporomandibular dislocation due to a dystonic reaction to aripiprazole possibly mediated through a pharmacodynamic synergism with escitalopram as selective serotonin re-uptake inhibitors can cause extrapyramidal side effects including dystonias through serotonergically mediated inhibition of the dopaminergic system [9]. From our case report we recommend a lower starting dose of aripiprazole especially in drug naive non psychotic patients and close monitoring of such patients.

Traumatic Unilateral Temporomandibular Joint Dislocation Overlooked for More Than Two Decades

Forward dislocation of the temporomandibular joint commonly can be easily diagnosed and successfully reduced by manual repositioning. In this report, we discuss a rare case of prolonged temporomandibular dislocation that had persisted for more than 20 years because the otolaryngologist and dentist had missed the dislocation. This patient underwent open reduction and mandibular joint plasty with preoperative orthodontic therapy. It is possible that strong pain and mouth-closing disability may gradually remit and only deviated mandibular prognathism like malocclusion may persist. Therefore, abnormal occlusion warrants careful attention to temporomandibular joint dislocation.

Articular Eminectomy for Chronic Bilateral Dislocation of the Temporomandibular Joint in Patients with Cerebral Infarction

Three cases of long-standing bilateral dislocation of the temporomandibular joint in patients with cerebral infarction are presented. The frequency of temporomandibular dislocation has been reported to be higher in patients with psychological and cerebral diseases. In this report, all patients successfully underwent articular eminectomy according to Myrhaug's method, with the purpose of repositioning the condyles and preventing re-dislocation. Articular eminectomy increased the ease of reduction and was effective in preventing future dislocation of the temporomandibular joint in these patients.

The origin and development of temporomandibular dislocation reduced intraorally

The earliest records of temporomandibular dislocation reduced inside the oral cavity can be found in Yinshu (The Pulling Book) unearthed in Han Bamboo script in 1984 in Zhangjiashan, Hubei Province. Later on, physicians of different dynasties developed the etiology, pathogenesis, symptoms, signs and treatment of temporomandibular dislocation on the basis of Yinshu (The Pulling Book). Although the manipulations recorded in Yinshu (The Pulling Book) were rather simple, but they were used continuously as a basic clinical manipulation of orthopaedics.

Discomallear and malleomandibular ligaments: anatomical study and clinical applications.

Phylogenesis, ontogenesis and anatomy show the existence of two discomallear and malleomandibular ligaments, arising from the first branchial arch and uniting the middle ear with the temporomandibular joint and to the mandible. The intra-articular discomallear ligament is the involuted tendon of the lateral pterygoid muscle on the primitive quadrato-articular joint. The malleomandibular ligament is the fibrous remnant of Meckel's cartilage. In the physiology of the temporomandibular joint, the discomallear ligament alone limits the anterior movement of the disc. Its stretching accompanies disco-condylar disunity, hyperlaxity and temporomandibular dislocation. The malleomandibular ligament, wrongly limited to its sphenomandibular part in classic anatomy, has no physiological role. However, it can be responsible for the dislocation of the ear ossicle chain after disarticulation or temporomandibular trauma. These two ligaments do not play any role in otological manifestations in dysfunction of the manducatory apparatus.

Ｔ字型チタンミニプレートを用いたＢｕｃｋｌｅｙ‐Ｔｅｒｒｙ法による治療が有用であった習慣性顎関節脱臼の２例

We treated two cases of habitual temporomandibular dislocation by the Buckley-Terry procedure using a T-type titanium miniplate. Both patients had mental or cerebrovascular disorders and had recurrent dislocation of the temporomandibular joint. Using an Al Kayat-Bramley type approach to the joint, we applied a bent T-type titanium miniplate to limit the movement of the condyle head. After Buckley-Terry surgical intervention, there was no clinical evidence of recurrent dislocation in either patient. This procedure appears to be a very simple and useful technique for the surgical treatment of habitual temporomandibular joint dislocation.