Chronic Long-Standing Temporomandibular Joint Dislocation: Report of Three Cases and Review of Literature

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.

Chronic Protracted Dislocation of Temporomandibular Joint in a Trauma Patient - A Case Report

Rationale

Chronic protracted temporomandibular joint (TMJ) dislocation refers to a condition that persists for more than one month without reduction.

Patient Concerns

A 47-year-old male patient first presented to the Department of Maxillofacial Surgery complaining of the inability to close his mouth for nine months.

Diagnosis

Chronic protracted dislocation of the temporomandibular joint.

Treatment

An initial conservative approach was attempted to reduce the condyle, which was unsuccessful. As literature suggests, open-joint surgery with eminectomy and condylectomy of bilateral joints was performed.

Outcomes and Take-away Lessons

A stagewise treatment is essential for such cases of long-standing TMJ dislocations. A conservative approach is first attempted followed by surgery if the conservative approach is unsuccessful. Postsurgery physiotherapy is essential for a better prognosis.

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

Background

Noninvasive management by closed reduction is a desirable treatment for temporomandibular joint dislocation. However, reduction of long-standing temporomandibular joint dislocation is often difficult. Various conservative treatments have been attempted, but these often render poor outcomes. This article reports the case of long-standing temporomandibular joint dislocation that was successfully closed using intraoral condylectomy.

Case presentation

A 69-year-old Japanese man who sustained an injury in a car collision was unable to close his mouth. Owing to the diagnosis of long-standing temporomandibular joint dislocation, intraoral condylectomy was performed. In the case of temporomandibular joint dislocation, it is convenient to reach the condyle from the oral cavity because sufficient opening is maintained. The condyle can be clearly visualized using an approach similar to sagittal split ramus osteotomy, and the operation using surgical instruments can be facilitated by resecting the coronoid process. By separating the surrounding soft tissue and pulling the cut condyle with sufficient visual field, the condyle can be resected while addressing the hemostasis. During the 12-month postoperative follow-up period, no temporomandibular joint dislocation recurred and the occlusion remained stable.

Conclusions

The limited intraoral incision of this surgical technique provides sufficient access for condylectomy. The results of this case report suggest that condylectomy by intraoral approach could become the treatment of choice for long-standing temporomandibular joint dislocation.

Articular soft tissue injuries associated with mandibular condyle fractures and the effects on oral function

The majority of studies debating the optimization of treatment for condylar mandibular fractures focus on the bony aspect first. However, fractures of the mandibular condyle may go together with soft tissue injury of the temporomandibular joint. An electronic literature search for this topic was undertaken. Assessment of quality was carried out using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Sixteen articles were included in this review. The reviewed literature showed that intracapsular fractures and dislocated condylar fractures result in more severe injuries. Serious injury to the disc and capsule of the temporomandibular joint is a contributing factor towards development of complications after closed treatment. The results of this review give an overview of the published studies focusing on articular soft tissue injuries caused by condylar mandibular fractures. Additionally, an overview of the magnetic resonance imaging (MRI) settings used to detect these injuries is provided. Until now, the relation between soft tissue injuries and type of condylar trauma and their influence on clinical outcome has been insufficiently investigated. Before considering reduction of soft tissues next to reduction of the fracture, more research is needed into the impact of soft tissue injuries on oral functioning, in which a uniform classification is used.