Temporomandibular Joint Dislocation Research Articles

The experience of chronic protracted mandibular dislocation treatment: manual vs. surgical reduction

Temporomandibular joint dislocation is a common challenge in dental care, but it can be promptly addressed through manual realignment, making it standard procedure in the realm of oral health. Nonetheless, effectively preventing and treating chronic protracted mandibular dislocation (CPMD), characterized by prolonged dislocation, remains a significant challenge. Hence, a retrospective analysis was conducted on the clinical data of 10 patients diagnosed with chronic protracted mandibular dislocation (CPMD), encompassing diagnosis, treatment, and prognosis details. CPMD tends to be more prevalent among the elderly population, with an average age of 67.2±11.9 years and a male-to-female ratio of 1:9. All diagnosed patients presented with bilateral anterior dislocation, each requiring diverse pre-treatment approaches. The most significant risk factor contributing to CPMD was unconsciousness resulting from nervous system injury, which delayed the perception of symptoms associated with temporomandibular joint dislocation. 90% of CPMD patients experienced successful treatment through manual reduction, while a refractory CPMD cohort, resistant to manual reduction, necessitated surgical intervention for resolution. All patients underwent treatment involving elastic intermaxillary traction, which served as the primary means of achieving reduction. Subsequent analysis of CT data revealed that condylar displacement beyond the zygomatic arch served as an indication for surgical reduction. Consequently, manual reduction under general anesthesia combined with elastic intermaxillary traction proved effective for managing CPMD cases. However, cases displaying excessive vertical displacement beyond the zygomatic arch should be considered for surgical intervention based on CT findings.

Mandibular Deviation With Longstanding Temporomandibular Joint Dislocation Caused by Lateral Pterygoid Muscle Hyaline Degeneration.

The present report described a rare case of mandible deviation with longstanding unilateral temporomandibular joint dislocation caused by lateral pterygoid muscle hyaline degeneration. A 28-year-old male was referred for mandible deviation for 2 years. It was found that the left condyle was dislocated just below the articular eminence with the dilated capsule in magnetic resonance imaging images. After surgical dissection of the lateral pterygoid muscle, which was excessively attached to the condyle, the left condyle was reduced, and the patient's mandibular deviation was greatly improved. The pathologic results showed lateral pterygoid muscle hyaline degeneration.

Diagnostic value and clinical significance of high-resolution ultrasonography compared to magnetic resonance imaging in diagnosing temporomandibular joint dislocation: a systematic review

BACKGROUND Temporomandibular joint (TMJ) dislocation is uncommon, yet it is associated with a significant negative effect on the patient’s quality of life. Magnetic resonance imaging (MRI), a gold standard for diagnosing TMJ dislocation, is expensive, time-consuming, and cannot be performed on patients with pacemakers and metallic prostheses. On the other hand, high-resolution ultrasonography (HRUS) has low cost, high accessibility, and is less time-consuming. This study aimed to compare the accuracy and reliability of HRUS to MRI in diagnosing TMJ dislocation. METHODS A comprehensive literature search was conducted using PubMed, Cochrane Library, ScienceDirect, and EBSCOhost databases. Keywords such as temporomandibular joint dislocation, temporomandibular displacement, MRI, and ultrasonography were utilized for the search. The articles obtained were then selected based on the inclusion and exclusion criteria, and the quality assessment was conducted using the QUADAS-2 tool. RESULTS 5 studies were included in this systematic review. The critical appraisal results showed sensitivity ranging from 74.3–93.7%, specificity from 84.2–100%, positive predictive value from 68.2–100%, negative predictive value from 64.0–98.3%, and accuracy from 77.7–91.7% of HRUS compared to MRI. CONCLUSIONS HRUS is a reliable method for diagnosing TMJ dislocation. However, MRI is still necessary in selected and more advanced cases.

Oral Complications in Patients With Psychiatric Illness Undergoing Electroconvulsive Therapy in Istanbul, Turkey.

Despite advances in pharmacotherapy, electroconvulsive therapy (ECT) remains a mainstay treatment option in psychiatry. This study aims to determine the occurrence of oral injury from ECT modified with the use of an inexpensive, disposable, hand-made oral protector customized to the dental needs of the individual patient. Based on data collected between January 1, 2013, and December 31, 2018, registered patients who had received ECT were evaluated retrospectively. We investigated the incidence of oral complications such as dental fractures, dental avulsion, temporomandibular joint dislocation, jaw pain, and soft tissue, lip, and tongue injuries in a single center. There were 1750 male patients (59.6%) and 1187 female patients (40.4%), with a mean age of 35.20 ± 11.59 years. The incidence of oral injury was 0.1% per patient (4/2937) and 0.01% per session (4/22135). Oral complication characteristics included mucosal abrasion in 2 patients, dental fracture in 1 patient, and tooth avulsion in one. No dental fracture or avulsion in our patient population has resulted in aspiration. We found no evidence of jaw pain, temporomandibular joint dislocation, or injury to the lip or tongue. Our results demonstrate a minimum risk of oral complications during ECT and also provide additional justification for an adequate oral assessment by the ECT team before the procedure.

The Trick of the Trade: Effective Use of Bimanual Reduction Techniques in Treating Acute Temporomandibular Joint Dislocation – A Review and Case Report

Abstract Dislocation of the condyle of the mandible is a common condition. It may be unilateral or bilateral and can be acute, recurrent and rarely chronic. Dislocation can occur in any direction, with anterior dislocation being the most common. Acute mandibular dislocation is defined as displacement of the mandibular condyle anterior to the articular eminence, causing complete separation of articulating surfaces and fixation in that position. The event is painful and distressing for the patient and their family and poses quite a challenge to the dental team addressing it.

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.

Ethoxysclerol injection into the posterior ligament under single puncture arthroscopy for the treatment of recurrent temporomandibular joint dislocation: a novel technique

The pathogenesis of recurrent chronic dislocation of the temporomandibular joint has been attributed to multiple factors, such as hyperlaxity of the soft tissues or alterations in the size of the temporal eminence. When there are no bone alterations, the injection of sclerosing solutions is an effective treatment that can be performed using a blind technique or with arthroscopy. This study presents an innovative technique for injecting ethoxysclerol into the posterior ligament through single puncture arthroscopy. This approach offers a safe and effective alternative for surgeons without experience in high-complexity arthroscopy who want to ensure precise injection of the agent into the desired anatomical areas.

Unraveling the intricacies of acute temporomandibular joint dislocation in emergency department: a multidimensional exploration of reduction techniques and success rate by emergency physicians

Temporomandibular joint (TMJ) dislocation is a distressing condition that requires prompt management in the emergency setting. This retrospective study aimed to assess the success rate of TMJ reduction performed by emergency physicians (EPs) and evaluate the commonly used reduction techniques and sedative choices. The EPs achieved an overall success rate of 86.29% in reducing the dislocations. Among the successful reductions, 68.21% were accomplished in the first attempt, with only 7.29% requiring three or more attempts. Procedural sedation and analgesia were commonly employed, with midazolam (34.44%) and fentanyl (21.85%) being the most frequently used in successful cases. The Classic intraoral technique (29.14%) was the preferred method for successful reductions. No significant differences were observed in drug utilization or reduction techniques between the groups of successful and failed reductions. The findings demonstrate the high competence of EPs in managing acute TMJ dislocations in the emergency department. The study provides valuable insights into the commonly employed reduction techniques and sedative choices, offering important guidance for emergency medical practice.

Redução de luxação da articulação temporomandibular (ATM) em equino - relato de caso

ABSTRACT Luxation of the temporomandibular joint (TMJ) in horses, despite being an uncommon condition, is often associated with local trauma involving the head. Its clinical importance is mainly related to the painful injury and impairment of the multiple movements involved in chewing and breaking foods. The objective of the current work is to describe the manual reduction technique of TMJ dislocation in a 6-year-old Mangalarga Marchador stallion with a history of inability to close the oral cavity and lateral displacement of the mandible. In the radiographic and ultrasonographic evaluation of the region a rostral displacement of the mandibular condyle was observed. Manual reduction was effective with the patient under dissociative anesthesia, progressing to medical discharge within 12 days.

Management of Unilateral TMJ Dislocated Facial Bone Fracture due to an rarely Industrial Accident

Introduction: Traffic accidents commonly cause maxillofacial trauma but rarely industrial accidents. Treatment of multiple maxillofacial traumas needs comprehensive and immediate care to prevent further complications. Objective: Management of a maxillofacial fracture accompanied by dislocation of the right temporomandibular joint due to a fall in a rice mill. Case report: A 20-year-old male patient complained of bleeding and facial fractures due to a rice milling accident approximately one day before admission. The case diagnosis was multiple maxillofacial fractures with condyle dislocation. Emergency oral and maxillofacial surgery was performed immediately and quickly with minimal intervention on the upper jaw to prevent persistent cerebrospinal fluid leakage and prevent infection. Definitive treatment was soft tissue reconstruction, ORIF of the maxillary and mandibular fractures, and repositioning of the condyle dislocation. Conclusion: Multiple facial bone fractures accompanied by TMJ dislocation can result in deformity and loss of facial function affecting the patient's social life. Immediate action and open reduction internal fixation (ORIF) procedure performed in this case were able to restore stomatognathic and facial function. Keywords: Industrial accident, maxillofacial trauma, open reduction internal fixation, temporal mandibular joint dislocation Introduction: Traffic accidents commonly cause maxillofacial trauma but rarely industrial accidents. Treatment of multiple maxillofacial traumas needs comprehensive and immediate care to prevent further complications. Objective: Management of a maxillofacial fracture accompanied by dislocation of the right temporomandibular joint due to a fall in a rice mill. Case report: A 20-year-old male patient complained of bleeding and facial fractures due to a rice milling accident approximately one day before admission. The case diagnosis was multiple maxillofacial fractures with condyle dislocation. Emergency oral and maxillofacial surgery was performed immediately and quickly with minimal intervention on the upper jaw to prevent persistent cerebrospinal fluid leakage and prevent infection. Definitive treatment was soft tissue reconstruction, ORIF of the maxillary and mandibular fractures, and repositioning of the condyle dislocation. Conclusion: Multiple facial bone fractures accompanied by TMJ dislocation can result in deformity and loss of facial function affecting the patient's social life. Immediate action and open reduction internal fixation (ORIF) procedure performed in this case were able to restore stomatognathic and facial function. Keywords: Industrial accident, maxillofacial trauma, open reduction internal fixation, temporal mandibular joint dislocation

Recent Advances in Temporomandibular Joint Surgery.

Temporomandibular disorders (TMDs) affect a high percentage of children and adults worldwide. Surgery may be indicated in severe or recalcitrant cases. Several recent advancements in TMD and temporomandibular joint (TMJ) surgery have elevated understanding and the ability to treat affected patients. We discuss recent advances in TMD epidemiology, juvenile idiopathic arthritis (JIA) of the TMJ, and surgical techniques and technologies. Technical advancements have been identified in TMJ arthroscopy, the treatment of TMJ subluxation and dislocation, and extended prosthetic total TMJ reconstruction (eTMJR). Overall, this review provides valuable insights into significant recent advancements in TMJ disorders and their surgical management.

Increased Prevalence of Generalized Joint Hypermobility Observed in Patients With Recurrent Temporomandibular Joint Dislocation

Generalized joint hypermobility (GJH), determined by the Beighton score, is a fundamental part of diagnosing benign joint hypermobility syndrome (BJHS), which may also present extra-articular manifestations, and is determined by the Brighton criteria. This study was designed to investigate whether there is an association between recurrent temporomandibular joint (TMJ) dislocation and these disorders. A retrospective cross-sectional study was conducted. Hospital-based patients with a history of recurrent TMJ dislocation were compared to population-based patients that did not experience TMJ dislocations or any other TMJ disorders. Age and sex matching were performed between the study groups. All subjects reached the age of skeletal maturity. A history of recurrent TMJ dislocations. Measurements of Beighton score (range from 0 to 9 with a score of ≥ 4 indicating GJH) and correspondence to the Brighton criteria (with at least two "major" criteria or one "major" criterion plus two "minor" criteria or four "minor" criteria indicating BJHS). Included age and sex. Mann-Whitney U-test for continuous variables and the χ2 test or Fisher's exact test for categorical variables. Statistical significance was set at P<.05. A total of 68 participants were included, of whom 34 patients presented with recurrent TMJ dislocations compared with a control population of 34. The Mean participants were 31.35±8.06years, and 29.4% (n=20) were males. Of the dislocation group, 16 (47.0%) patients had a Beighton score of 4 or higher. The Beighton sum score was significantly higher, with a TMJ dislocation group mean score of 3.06±2.8, compared with a control score of 0.82±1.1 (P=.001). A total of 58.8% (n=20) of the TMJ dislocation group participants met the Brighton criteria versus none (0.0%) of the control group (P=.001). We found an association between recurrent TMJ dislocation and GJH. An association with BJHS was also found, based mainly on articular manifestations. Early detection of these disorders in patients suffering from recurrent TMJ dislocation may help identify individuals at increased risk for joint instabilities and allow the implementation of appropriate preventive management strategies.

Mechanism and clinical use of botulinum neurotoxin in head and facial region.

Botulinum neurotoxin (BoNT) is a biological toxin produced by Clostridium botulinum. BoNT is a potent toxin extensively used in therapeutic interventions. This review provides an updated overview of the mechanisms of action and clinical applications of BoNT in head and facial region. MEDLINE/PubMed searches were conducted using the terms "botulinum neurotoxin" and "dentistry" along with a combination of other related terms. In addition, studies were manually selected from reference lists of the selected articles. The Food and Drug Administration in the United States initially approved BoNT to treat strabismus, blepharospasm, and hemifacial spasms. The use of BoNT in dermatology and cosmetics has been widely established and has created a revolution in these fields. Over the years, its applications in various medical specialties have expanded widely. Owing to its safety, efficacy, and long duration of action, it is well-accepted by patients. BoNT/A and BoNT/B are widely used in clinical practice. Several off-label uses of BoNT in the dental fraternity have yielded promising results. We have elaborated on the speculated mechanism of action, dosage, effective sites of injection, and adverse effects of each therapeutic application. The various clinical indications for BoNT include bruxism, myofascial pain, temporomandibular joint dislocation, hemifacial pain, orofacial dystonia, facial paralysis, chronic migraine, and trigeminal neuralgia. BoNT is a safe treatment that can be used effectively, provided that the clinician has adequate knowledge regarding the mechanism, injection techniques, and local and systemic side effects and that it is administered cautiously and purposefully.

Surgical Treatment of Habitual Temporomandibular Joint Dislocation Caused by Aging

Temporomandibular joint dislocation occurs not only in the elderly but in all age groups. However, in recent years, the number of elderly people with various underlying diseases such as dementia, cerebral infarction, and Parkinson’s disease has increased, and the number of elderly people who suffer habitual dislocation of the temporomandibular joint has also increased. It is considered that there are potential patients in special nursing homes and health care facilities for the elderly, and thus a large-scale fact-finding survey is desired. There is a consensus that non-invasive therapy is the first choice for the treatment of habitual temporomandibular joint dislocation. Currently, non-invasive treatments as well as invasive treatments such as the mandibular condyle anterior motion inhibition method and the mandibular condyle reduction method are being performed at many facilities for treating habitual temporomandibular joint dislocation. It is our duty as surgeons to choose minimally invasive surgery as surgical therapy. Therefore, there is an urgent need to accumulate cases and determine trends through joint research with other institutions and to select minimally invasive surgery.

Clinical negligence in temporomandibular joint surgery

This study reviewed the medical reports of 25 patients (21 female and 4 male) who were found to have been treated inappropriately by temporomandibular joint (TMJ) surgery. One of more Breaches of Duty and resultant harms (Causation) were identified for each of the patients in this series. Their ages ranged from 18–64 (mean 36.2, median 35) years. A narrative review of free text data revealed six main patterns of Breach of Duty which were to do with consent, inadequate pre-surgical imaging, injection of botulinum toxin into jaw muscles, TMJ arthroplasty, management of TMJ dislocation and subluxation, and failure or reluctance to request second opinions. Harms identified included surgical damage to the TMJ, facial nerve dysfunction, and social isolation. One sum claimed was in excess of £1 million.

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

&#x0D; &#x0D; &#x0D; &#x0D; ABSTRACTObjective: This study aims to describe a new extraoral technique for reducing bilateral temporomandibular joint (TMJ) dislocations.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Methods: &#x0D; Design: Retrospective Preliminary Case Series&#x0D; Setting: Tertiary Government Training Hospital&#x0D; Participants: Ten (10) adults with bilateral TMJ dislocation&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; 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).&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; 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.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

TEMPOROMANDIBULAR JOINT DISLOCATION DUE TO NEAR SELF-EXTUBATION

TEMPOROMANDIBULAR JOINT DISLOCATION DUE TO NEAR SELF-EXTUBATION

Comparative Analysis of Autologous Blood Injection and Conservative Therapy for the Management of Chronic Temporomandibular Joint Dislocation

Aim: To evaluate the efficacy, safety, and stability of TMJ autologous blood injection for the treatment of recurrent TMJ dislocation in an effort to standardize the procedure and compare it with the conservative management. Materials and Methods: Twenty patients diagnosed with chronic recurrent TMJ dislocation (complete/incomplete) were treated by conservative method, and five patients who did not respond to conservative therapy were treated by injections of autologous blood into the upper joint space and around the TMJ capsules. Statistical Analysis Used: Statistical analysis of collected data was done using SPSS version 23. The values were evaluated statistically with t-test and Kruskal–Wallis test for descriptive, intergroup, and intragroup comparison. Results: Hundred percent of successful outcome and required no further treatment at their 3-month follow-up in autologous blood injection. Conclusion: This procedure has proven to be safe, simple, and cost-effective for the treatment of chronic recurrent TMJ dislocation.

LUXATION DE LARTICULATION TEMPOROMANDIBULAIRE LORS DUNE ANESTHESIE GENERALE : A PROPOS DUN CAS

The incidence of temporomandibular joint (TMJ) dislocation in anaesthesia is poorly reported. Patients with a history of TMJ dislocation, algodysfunctional syndrome of the mandatory apparatus or retro mandibular facial dysmorphosis are predisposed to this complication. We report a case of TMJ dislocation, diagnosed just after a general anaesthesia for a vicious callus of a humeral palette fracture in a patient without risk factors for this dislocation. The patient had a normal pre-anaesthetic clinical exam. The clinical diagnosis is simple. Its reduction is an emergency which can be performed with or without sedation by any practitioner familiar with the Nelaton manoeuvre.

ELASTIC TRACTION TREATMENT FOR THE MANAGEMENT OF CHRONIC DISLOCATION OF BILATERAL MANDIBULAR CONDYLE - A REPORT OF 2 CASES

Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. Temporomandibular joint (TMJ) dislocation is a common problem faced in outpatient setting by maxillofacial surgeons and dentist. Chronic recurrent TMJ dislocation is a challenging situation to manage. Though the chronic dislocation of bilateral condylar of mandible is not very common, but if it occur to the patient, there is no fixed noninvasive protocols to manage it. This study is an attempt to establish the noninvasive treatment protocols for further studies with larger sample size.