Unilateral Dislocation Research Articles

Arthroscopic Bankart Repair after Anterior Traumatic Shoulder Dislocation in Workers

Objectives:The objective of this study was to evaluate clinical results in workers after Arthroscopic Bankart repair for traumatic unidirectional shoulder dislocation.Methods:A total of 45 patients (42 male- 3 female) meet the inclusion criteria: traumatic anterior dislocation, workers´ compensation patient, minimum of 2 years follow-up and exclusion criteria: bony Bankart >25%, engaging Hill Sachs, previous surgery, rotator cuff injury. Number of dislocations were 1 in 35 patients, 2 in 7 patients and 3 in 3 patients. Artroscopic Bankart repair was performed by a single surgeon. UCLA shoulder Score and ROWE score for shoulder instability were scored for clinical assessment. The mean follow up was 64 (SD+- 21.6) month with a mean age of 30 (SD+-10) years. Type of work and workload was recorded according to Canadian classification and dictionary of occupations. Time to return to work was also recorded. Statistical analysis was performed at the center for biostatistics at Facultad de Ciencias Medicas, Universidad Nacional del Litoral using SPSS 23.0-IBM.Results:The mean UCLA Shoulder Score was 33 (SD+-2) and ROWE Score 95 (SD +-7), none of the patients presented recurrent dislocation at the time of follow up. Time to return to work was mean 123 days (+-60 SD) of whom 52% were heavy workers, 39% medium and 9% light workers. All patients except one could return to his previous level of work. Pearsons bi variate correlation coefficient between days to return to work between heavy and medium/light workers was not significative (p>0,05) but in heavy workers return to work take more days than in medium/light workers. Age and return to work with 35 years as a cut point was not significative either.Conclusion:Workers treated with Arthroscopic Bankart repair after traumatic unilateral dislocation, presents good results and high rate of return to work at the previous level.

A case report: Simultaneous bilateral posterior shoulder and unilateral central acetabular fracture dislocations secondary to epileptic seizure

Fracture dislocations of extremities are a possible complication following epileptic seizures. Management mainly depends on the severity of the injury and the current medical status of the patient. We describe a rare case of bilateral posterior shoulder and unilateral central acetabular fracture dislocations without direct trauma after a convulsive seizure related to lung cancer with brain metastases. Two weeks after the seizure, we performed an open reduction and internal fixation (ORIF) with locking plate to treat bilateral posterior shoulder fracture dislocations when the patient’s neurological condition became more stable. However, nonoperative treatment was selected for the acetabular fracture dislocation because of the patient’s advanced-stage cancer. Since the patient was responding well to the newest target therapy for his lung cancer, and his life span is beyond our estimate, we, therefore, performed a total hip replacement 6 months later because of traumatic osteoarthritis development. The clinical outcome was satisfactory at the 6-month follow-up. Due to medical progress in non-small cell lung cancer treatment, we consider aggressive treatment may be necessary even in such advanced stage patients.

Immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine

BackgroundDistraction-flexion of the lower cervical spine is a severe traumatic lesion, frequently resulting in paralysis. The optimal surgical treatment is controversial. It has been a challenge for orthopedic surgeons to manage distraction-flexion injury in the lower cervical spine while avoiding the risk of iatrogenic damage. Thus, safer strategies need to be designed and adopted.This study aimed to evaluate the clinical efficacy of immediate reduction under general anesthesia and combined anterior and posterior fusion in the treatment of distraction-flexion injury in the lower cervical spine.MethodsTwenty-four subjects of traumatic lower cervical spinal distraction-flexion were retrospectively analyzed from January 2010 to December 2013. Traffic accident was the primary cause of injury, with patients presenting with dislocated segments in C4–5 (n = 8), C5–6 (n = 10), and C6–7 (n = 6). Sixteen patients had unilateral facet dislocation and eight had bilateral facet dislocation. Spinal injuries were classified according to the American Spinal Injury Association (ASIA) impairment scale (2000 edition amended), with four cases of grade A, four cases of grade B, ten cases of grade C, four cases of grade D, and two cases of grade E. On admission, all patients underwent immediate reduction under general anesthesia and combined anterior and posterior fusion. The mean follow-up time was 3.5 years.ResultsAll operations were completed successfully, with no major complications. Postoperative X-rays showed satisfactory height for the cervical intervertebral space and recovery of the vertebral sequence. Bone fusion was completed within 4 to 6 months after surgery. Surgery also significantly improved neurological function in all patients.ConclusionImmediate reduction under general anesthesia and combined anterior and posterior fusion can be used to successfully treat distraction-flexion injury in the lower cervical spine, obtaining completed decompression, safe spinal re-alignment, and excellent immediate postoperative stability.

Management of irreducible unilateral facet joint dislocations in subaxial cervical spine: two case reports and a review of the literature

BackgroundSkeletal and soft tissue damage are often associated with unilateral facet dislocations, which undoubtedly lead to instability of the spine and further increase difficulties in cervical reduction. This type of irreducible facet dislocation is usually accompanied with potential catastrophic consequences including neurological deficit and severe disability. Therefore, a consistent and evidence-based treatment plan is imperative.Case presentationThe literature regarding the management of traumatic unilateral locked cervical facet dislocations was reviewed. Two patient cases (a 30-year-old Asian man and a 25-year-old Asian woman) who suffered irreducible cervical facet dislocations were presented. These two patients received surgical treatments including posterior reduction by poking facet joints, adjacent spinous process fixation by wire rope banding, anterior plate fixation, and intervertebral fusion after the failure of skull traction and closed reduction. At the postoperative 24-month follow-up, intervertebral fusion was achieved and our patients’ neurological status improved based on the American Spinal Injury Association scale, compared with their preoperative status.ConclusionsUnilateral facet joint dislocations of subaxial cervical spine are difficult to reduce when complicated with posterior facet fractures or ligamentous injury. Magnetic resonance imaging can be beneficial for identifying ventral and dorsal compressive lesions, as well as ligamentous or capsule rupture. The combination of posterior reduction and anterior fixation with fusion has advantages in terms of clinical safety, ease of operation, and less iatrogenic damage.

High congenital hip dislocation in adults – arthroplasty and functional results

ObjectiveRetrospective case–control study on the authors’ experience regarding arthroplasty in high congenital dislocations of the hip in adults. MethodsSample with 11 high congenital hip dislocations (Hartofilakidis type C) that occurred in seven patients, who were submitted to hip arthroplasty by the same surgeon and with the same surgical technique. Mean follow-up period was 4.32±2.67 years (minimum one year) and all patients were evaluated by the same examiner. ResultsAll the arthroplasties had cementless fixation, with application of screwed acetabular cups, conical femoral stems, and a metal-polyethylene articular pars. In every patient, shortening femoral osteotomies were performed at subtrochanteric or supracondylar locations. The mean Harris Hip Score at the last evaluation was 88.55±4.50 (range 81–94). The mean time with high dislocation of the hip (42.91±14.59 years, range 19–68) showed a significant inverse correlation with Harris Hip Score (r=0.80; p=0.003). All patients reported important relief of pain complaints and are capable of ambulation without any external support. In the unilateral dislocations, leg length discrepancies were fully corrected; in the bilateral cases, isometric limbs were achieved in all patients. All osteotomies consolidated, with a mean interval of 3.27±0.47 months. There were complications in 18.18% of the sample: one iatrogenic intraoperative fracture of the greater trochanter and a transitory sciatic neurapraxia. ConclusionDespite being a demanding surgery with a reportedly high complication rate, total hip arthroplasty in high congenital dislocations, when properly indicated and technically correctly performed, allows an improvement in function and quality of life.

AB232. 106. Atypical presentation of facet joint subluxation following syncopal events during phlebotomy in the general practitioners (GP) setting

: Cervical facet dislocations and fractures represent a spectrum of spinal column injuries that are often missed on plain film imaging. Unilateral facet joint dislocations are the most frequently missed of these injuries followed closely by bilateral facet joint dislocations. Unilateral dislocations typically result in approximately 25% subluxation of the vertebra relative to the adjacent level with a mono-radiculopathy that often improves with closed reduction by way of traction. Road traffic accidents and falls account for the majority of facet dislocations in the literature. There are no reports of such injuries being sustained following syncopal events during medical procedures. We present 2 such cases where both patients sustained their injuries in their general practitioners (GP) practice during routine phlebotomy. A 25-year-old male was referred to our unit having presented to his local orthopaedic department complaining of neck pain. He had attended his GP 3 days prior for routine phlebotomy and suffered a vasovagal event and struck his occiput against the ground. He was found to have bilateral dislocations of his C5/6 facet joints. A 42-year-old with a history of previous vasovagal episodes was referred to his local emergency department by his GP having suffered a syncopal event during routine phlebotomy. He was subsequently transferred to hospital where he was found to have a right-sided unifacetal fracture and perched C6/7 facet on CT. There should be a low threshold for multi-planar imaging of the cervical spine in cases of cranio-axial injuries.

Bilateral Luxatio Erecta: A Case Report

Luxatio erecta is a highly uncommon type of shoulder dislocation, representing approximately 0.5% of all shoulder dislocations fitting into this category. In this paper, we present the case of a patient who presented post trauma with bilateral inferior glenohumeral joint dislocations (also called Luxatio Erecta). Considering that Luxatio Erecta only has a 0.5% chance of being present with a unilateral dislocation, the probability of a patient presenting 2 of these dislocations at the same time is approximately 0.25% (0.5% × 0.5% = 0.25%). In addition to this, Luxatio Erecta frequently presents with injuries to the brachial plexus and/or a humeral fracture. Despite this, neither of our patient’s dislocations were associated with any fractures or neurovascular injury and both were successfully reduced the Emergency Department. Both the patient’s presentation and outcome are quite uncommon, which makes this case an invaluable opportunity to go over the unique characteristics to Luxatio Erecta.

Jednostronne urazowe sportowe zwichnięcie stawu ramiennego z porażeniem splotu ramiennego u 16-letniej pacjentki. Analiza przypadku

Jednostronne urazowe sportowe zwichnięcie stawu ramiennego z porażeniem splotu ramiennego u 16-letniej pacjentki. Analiza przypadku

Lower cervical trauma an orthopaedician domain

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Lower cervical spinal injuries are potentially devastating injuries of the axial skeleton. Many effective procedures are available for degenerative cervical spinal injuries that are unresponsive to conservative management. Our present aimed to observe the outcome for the treatment of different types of spinal injuries based onASIA impairment scale (modified Frankels scoring system) by using different treatment concepts.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This study was conducted at Indira Gandhi institute of medical sciences and Nalanda medical college during the period 2012 – 2015. 14 patients with lower cervical spine injury attended to emergency department were included in the study. All the 14 cases were operated by different surgical procedures based on type of injury. The outcome was measured by using ASIA impairment scale (modified Frankels scoring system)</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Out of 14 cases, 3 were burst fractures, 4 were unilateral facet dislocations, 5 were bilateral facet dislocations and 2 with distractive extension injury. Cases with burst fractures operated with corpectomy with cage and plate, for unilateral and bilateral dislocations open reduction and Bohlmantriple-wiring and posterior fusion was done and for distraction injury, open reduction and anterior plating was done. Improvement in Frankel scoring system was good in about 3 cases with unilateral dislocations. Overall, neurological recovery was observed in 35% cases. Recovery was much better in Quadriparesis patients. None of the patients had iatrogenic paresis. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Satisfactory results and outcome was observed in unilateral facet dislocations after treatment by open reduction and Bohlman triple-wiring and posterior fusion. The outcome in bilateral facet dislocations was poor as they are easily reduced with closed traction methods.</span></p>

Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-IV developmental dysplasia of the hip: classification and management.

There is no consensus about the best method of achieving equal leg lengths at total hip arthroplasty (THA) in patients with Crowe type-IV developmental dysplasia of the hip (DDH). We reviewed our experience of a consecutive series of patients who underwent THA for this indication. We retrospectively reviewed 78 patients (86 THAs) with Crowe type-IV DDH, including 64 women and 14 men, with a minimum follow-up of two years. The mean age at the time of surgery was 52.2 years (34 to 82). We subdivided Crowe type-IV DDH into two major types according to the number of dislocated hips, and further categorised them into three groups according to the occurrence of pelvic obliquity or spinal curvature. Leg length discrepancy (LLD) and functional scores were analysed. Type-I included 53 patients with unilateral dislocation, in which 25 (category A) had no pelvic obliquity or spinal deformity, 19 (category B) had pelvic obliquity with a compensated spinal curvature and nine (category C) had pelvic obliquity and decompensated spinal degenerative changes. Type-II included 25 patients with one dislocated and one dysplastic hip, in which there were eight of category A, 15 of category B and two of category C. Pre-operatively, there were significant differences between the anatomical and functional LLD in type-IB (p = 0.005) and -IC (p < 0.001), but not in type-IA, -IIA or -IIB. Post-operatively, bony LLD increased significantly in types-IB, -IC and -IIB, whereas functional LLD decreased significantly in each type except for IIA. The mean functional LLD decreased from 30.7 mm (standard deviation (sd) 18.5) pre-operatively to 6.2 mm (sd 4.4) post-operatively and the mean anatomical LLD improved from 35.8 mm (sd 19.7) pre-operatively to 12.4 mm (sd 8.3) post-operatively. Pelvic and spinal changes are common in patients with Crowe type-IV DDH and need to be taken into consideration when planning THA, in order to obtain equal leg lengths post-operatively. The principal subdivisions of Crowe type-IV DDH which we describe proved effective in achieving equal leg lengths and satisfactory outcomes. Cite this article: Bone Joint J 2017;99-B:872-9.

Luxações congênitas altas da anca no adulto – Artroplastia e resultados funcionais

ObjectiveRetrospective case‐control study on the authors’ experience regarding arthroplasty in high congenital dislocations of the hip in adults. MethodsSample with 11 high congenital hip dislocations (Hartofilakidis type C) that occurred in seven patients, who were submitted to hip arthroplasty by the same surgeon and with the same surgical technique. Mean follow‐up period was 4.32±2.67 years (minimum one year) and all patients were evaluated by the same examiner. ResultsAll the arthroplasties had cementless fixation, with application of screwed acetabular cups, conical femoral stems, and a metal‐polyethylene articular pars. In every patient, shortening femoral osteotomies were performed at subtrochanteric or supracondylar locations. The mean Harris Hip Score at the last evaluation was 88.55±4.50 (range 81‐94). The mean time with high dislocation of the hip (42.91±14.59 years, range 19‐68) showed a significant inverse correlation with Harris Hip Score (r=0.80; p=0.003). All patients reported important relief of pain complaints and are capable of ambulation without any external support. In the unilateral dislocations, leg length discrepancies were fully corrected; in the bilateral cases, isometric limbs were achieved in all patients. All the osteotomies consolidated, with a mean interval of 3.27±0.47 months. There were complications in 18.18% of the sample: one iatrogenic intraoperative fracture of the greater trochanter and a transitory sciatic neurapraxia. ConclusionDespite being a demanding surgery with a reportedly high complication rate, total hip arthroplasty in high congenital dislocations, when properly indicated and technically correctly performed, allows an improvement in function and quality of life.

Long-term unilateral temporomandibular joint dislocation — a case report

Long-term unilateral temporomandibular joint dislocation — a case report

The outcomes of the modified Fulkerson osteotomy procedure to treat habitual patellar dislocation associated with high-grade trochlear dysplasia

BackgroundHabitual patellar dislocation is not common in clinical practice, but it has a deep impact on the patient's lifestyle and movement. There has been no large case-control study on habitual patellar dislocation, and the management of it is still controversial.The aim of this study was to observe the efficacy of the modified Fulkerson procedure on patients with habitual patellar dislocation with high-grade trochlear dysplasia without trochleoplasty and to evaluate the results of this procedure.MethodsA total of 25 patients who were admitted to our hospital from April 2007 to October 2013 were included: 7 males and 18 females, aged 17–28 years old, with an average age of 21.5 years old, including 21 cases of unilateral dislocation and 4 cases of bilateral dislocation. The tibial tuberosity transfer procedure (internal rotation, medial transfer and elevation osteotomy) and medial patellofemoral ligament (MPFL) reconstruction were performed in all cases of habitual patellar dislocation that were accompanied by trochlea dysplasia.ResultsThe mean follow-up duration was 36.8 months (range, 25–68 months). A CT scan was performed to compare the tibial tuberosity–trochlear groove distance (TT-TG), the patellar tilt angle (PTA), and the mean Kujala and Lysholm scores before surgery and at follow-up and to measure the angle of internal rotation of the tibial tubercle after surgery. The mean Kujala and Lysholm scores improved significantly (P < 0.05) from 55.65 ± 6.10 and 50.34 ± 6.54 preoperatively to89.24 ± 4.66 and 88.53 ± 4.75, respectively, at follow-up. The tibial tuberosity–trochlear groove distance (TT-TG) decreased significantly (P < 0.05) from 20.24 ± 2.80 mm to 10.50 ± 4.50 mm, and the patellar tilt angle (PTA) decreased significantly (P < 0.05) from28.58 ± 3.28to7.54 ± 5.56. No recurrence was observed, and only one patient had a mild skin infection after surgery. The mean angle of internal rotation of the tibial tubercle was 10 ± 4° after surgery. There were no cases of stiffness.ConclusionsThe modified procedure of tibial tubercle transfer, especially the internal rotation, which can improve the patella stability and knee function, is an effective surgical procedure for the treatment of habitual patellar dislocation associated with high-grade trochlear dysplasia without trochleoplasty.Level of evidenceIII

Complete dislocation of the ulnar nerve at the elbow: a protective effect against neuropathy?

Recurrent complete ulnar nerve dislocation has been perceived as a risk factor for development of ulnar neuropathy at the elbow (UNE). However, the role of dislocation in the pathogenesis of UNE remains uncertain. We studied 133 patients with complete ulnar nerve dislocation to determine whether this condition is a risk factor for UNE. In all, the nerve was palpated as it rolled over the medial epicondyle during elbow flexion. Of 56 elbows with unilateral dislocation, UNE localized contralaterally in 17 elbows (30.4%) and ipsilaterally in 10 elbows (17.9%). Of 154 elbows with bilateral dislocation, 26 had UNE (16.9%). Complete dislocation decreased the odds of having UNE by 44% (odds ratio = 0.475; P = 0.028), and was associated with less severe UNE (P = 0.045). UNE occurs less frequently and is less severe on the side of complete dislocation. Complete dislocation may have a protective effect on the ulnar nerve. Muscle Nerve 56: 242-246, 2017.

The appropriate time for closed reduction using local anesthesia in arytenoid dislocation caused by intubation: a clinical research

Conclusion: Closed reduction is effective and safe for the treatment of arytenoid dislocation, and the selection of an appropriate time window to perform closed reduction is crucial in achieving relatively stable treatment outcomes and short treatment duration.Objective: The aim of this study was to investigate whether there is an appropriate time window to perform closed reduction for unilateral arytenoid dislocation caused by intubation.Methods: A retrospective chart review was carried out for the cases collected from September 2014 to May 2016 at Second Affiliated Hospital of Zhejiang University, China.Results: Thirty-five patients with arytenoid dislocation were identified. Endotracheal intubation was the cause for 33 of the patients and gastric tube caused arytenoid dislocation in two patients. The patients were treated by closed reduction, and no major complications resulting from surgical intervention were observed. All patients regained normal voice and vocal fold movement after the surgery, except one patient who recovered spontaneously. As one of the most significant findings in the current study, we observed the relatively stable treatment outcomes and shortened recovery duration were obtained in the patients treated during a period between the 13th day and 26th day after arytenoid dislocation.

Current research on unilateral cervical facet dislocation of the lower cervical spine

Unilateral facet dislocation of the lower cervical spine is an important subgroup of cervical spine injuries, accounting for from 12% to 16% of all cervical spine injuries. Unilateral facet dislocation occurs the most commonly at the C5-6 level, and is closely related to the anatomic and morphometric features of the cervical facet. This injury has been attributed to combined flexion and rotation, but it remains unclear whether flexion or rotation is the component of greater importance. Its treatment includes nonoperative and operative measures but optimal treatment has not been established. It is generally accepted that a recommendable treatment protocol begins with closed reduction and proceeds depending on whether the closed reduction succeeds and traumatic disc herniation is present or not. Key words: Cervical vertebrae; Dislocation; Treatment; Unilateral cervical facet

Secondary pathological changes in infant with developmental dysplasia of the hip: the application value of high frequency ultrasound

Objective To investigate the clinical value of high frequency ultrasound in discovering secondary pathological changes in infant with developmental dysplasia of the hip (DDH). Methods Thirty-four infants with 36 dislocation hips were involved. Among them, 32 were with unilateral dislocation of hip joint, 2 were with bilateral dislocation of hip joint. High frequency ultrasound were used to observe the morphological changes of hip glenoid labrum, adipose hyperplasia in acetabulum, thickness variation of articular capsule, and development of the ossification center of the femoral head. Besides, the morphological changes of hip glenoid labrum and adipose hyperplasia in acetabul were compared with those from MRI. Results The sensitivity and specificity of ultrasound in diagnosing glenoid labral introversion were 82% and 100% respectively. The coincidence rate of diagnosing glenoid labral introversion and glenoid labral extroversion were both 83%. Adipose hyperplasias in acetabul were clearly seen in 31 hips using ultrasound. The thickness of articular capsule in the affected hip and in the healthy hip was (2.8±0.6)mm versus (1.7±0.4)mm, and the difference was obviously significant (P<0.01). The ossification center of the femoral head in the 34 infants were classified as the following four types: ①which was smaller in the affected side than in the healthy side (22/34); ②which was shown in the healthy side (7/34) but not in the affected side; ③which in both sides were not shown(4/34); ④which in both sides were small(1/34). Conclusions Ultrasound is a method of simple, rapid, non-invasive in diagnosing DDH, and it can be used to discover secondary pathological changes in infant with DDH, which provide important reference for clinical diagnosis and treatment. Key words: Ultrasonography; Hip dislocation; Infants; Pathological changes

Bilateral Shoulder Combined with Unilateral Knee Dislocation After a Fall

A 54-year-old overweight woman presented to the emergency department (ED) complaining of severe pain and lack of movement in both shoulders and her left knee. Her medical history revealed that the episode began after slipping on the wet floor in the bathroom. The first dislocation of the knee joint occurred during the fall when she lost her balance, and the second occurred when she tried to use her arms to avoid hitting her head on the wet floor. There was no history of connective tissue disease, seizure, or prior dislocations. During clinical examination, there was no evidence of neurovascular deficit for upper extremities and left knee. Radiographs confirmed bilateral anterior glenohumeral dislocation combined with anterior left knee dislocation (Figure 1). Bilateral anterior shoulder dislocations are reported less often. A recent review of 70 patients demonstrated that the causes of anterior injuries were trauma (50%), muscle contractions (37%) due to seizures or electrocution, and atraumatic events (13%). Because of various etiologies, dislocation mechanisms are different. Lever effect is a type of dislocation mechanism that forces abduction and external rotation of the arm. With the greater tuberosity pressing against the acromion, the humeral head is forced anteriorly out of the glenohumeral joint (1, 2). The patient, in this case, had low-energy trauma as well as left knee dislocation. Complete dislocation of the knee causes devastating extremity injuries, particularly in the popliteal artery and peroneal nerve. The incidence of nerve and artery injury due to knee dislocation is 10%–40%. Even worse, when a vascular injury secondary to a traumatic knee dislocation cannot be repaired within 8 h, the amputation rate increases to nearly 85%. Therefore, vascular assessment should include examination of both the dorsalis pedis and posterior tibial pulses, ankle-brachial index measurement, and computerized tomography (CT) angiography or arteriography. The patient had no clinical signs of vascular and nerve injury at the time of admission and observation, so she did not urgently need further radiological study such as CT angiography (3, 4).

Closed reduction for arytenoid dislocation under local anesthesia

Conclusion: Closed reduction under local anesthesia continues to be an effective and well-tolerated method for treating arytenoid dislocation. Bilateral arytenoid dislocation is an uncommon occurrence, and the principles of management are the same as for unilateral dislocation. Objectives: To evaluate the treatment outcomes of closed reduction for arytenoid dislocation under local anesthesia and to conduct an exhaustive review of the literature on bilateral arytenoid dislocation. Methods: Thirty-three patients with arytenoid dislocation were treated with closed reduction under local anesthesia. Arytenoid motion, GRBAS (grade, roughness, breathiness, asthenia, strain), maximum phonation time (MPT), self-assessed Voice Handicap Index (VHI), and acoustic voice analysis were used to evaluate the clinical outcomes. Results: Following closed reduction, 33 patients were divided into a ‘satisfied’ group (n = 26) and a ‘dissatisfied’ group (n = 7). In the ‘satisfied’ group, G, R, B, A, MPT, VHI, jitter%, shimmer%, normalized noise energy (NNE), and noise-to-harmonic ratio (NHR) were significantly improved compared with measurements taken before closed reduction (p < 0.05). The results for F0 and S score were not significantly different. In the ‘dissatisfied’ group, VHI, MPT, F0, and shimmer% were not significantly different 1 month after reduction. However, statistically significant change was observed in jitter% and NHR.

Recurrent spontaneously reduced unilateral temporomandibular joint dislocation masquerading as a transient ischemic attack

Abstract Transient ischemia attack (TIA) is a daily challenge for emergency department (ED) doctors, particularly in patients who cannot express themselves clearly. Without a patient's precise subjective description, the doctor's clinical judgment may be influenced by the statements of bystanders. Symptoms might mimic focal neurological symptoms and lead to a misdiagnosis of a TIA. We report a 79-year-old woman with recurrent spontaneously reduced unilateral temporomandibular joint (TMJ) dislocation masquerading as a TIA. She experienced unilateral facial droop, deviation of the angle of the mouth, and difficulty speaking three times while eating. Because the patient's family and both the ED doctor and neurologist focused on TIA from the onset, TMJ dislocation was overlooked in the interpretation of the head computed tomography (CT) scan. When another episode occurred after the patient yawned while at the ED, unilateral TMJ dislocation was considered and confirmed. In conclusion, when patients present purely facial neurological signs after mouth opening, unilateral TMJ dislocation should be excluded first.