Temporomandibular joint dislocation

Acute Bilateral Dislocation of the Temporomandibular Joint With Left Old Zygomaticomaxillary Complex Fracture Treated With Coronoidectomy Authors

The majority of various types of temporomandibular joint dislocation can be easily reduced to normal position through nontraumatic procedures. We present a rare case of temporomandibular joint dislocation with a left old zygomaticomaxoid complex fracture in a 48-year-old hemiplegic male. Due to the lock-in state of dislocated coronoid process and deformed zygomaticomaxoid complex, this type of dislocation combined with an old fracture is rare and difficult to reduce with conservative therapy. Therefore, coronoidectomy was performed to release the lock and reduce the condylar.

Causes and treatment of temporomandibular luxation-a retrospective analysis of 260 patients

OBJECTIVES

We aimed to clarify the etiology, diagnostic process, and treatment of temporomandibular joint (TMJ) luxation, as the standard care is mainly based on case-reports and systematic studies are lacking. The hypotheses were that luxation occurs spontaneously, recurrence manifests particularly among geriatric patients, and surgery is needed infrequently.

PATIENTS AND MATERIALS

A retrospective study of TMJ luxation patients (n = 260) from 2007 to 2020 was designed and implemented. The primary outcome was type of TMJ luxation (i.e., recurrent or non-recurrent), and secondary outcomes were the need for and type of surgical intervention. Predictor variables comprised age, sex, presence of neurological condition, and mechanism of luxation. Administered treatment and clinical outcomes were recorded.

RESULTS

Of luxation, 61.9% was recurrent and 40.0% due to spontaneous cause. Only 1.9% of patients underwent surgical intervention. The presence of neurological condition caused a 1.34-fold risk for recurrence of luxation and general condition a 1.57-fold risk.

CONCLUSIONS

TMJ luxation is often recurrent, bilateral, and spontaneous. Recurrent luxation is associated with geriatric and neurological conditions, and in this group recurrent TMJ luxation predicted death.

CLINICAL RELEVANCE

Our findings contribute to more effective diagnostics and treatment of TMJ luxation patients. We show that there is a need to standardize diagnostic measures and treatment patterns. Moreover, collaboration with other specialities, especially neurology and geriatrics, is important.

Evaluation of congruency of condyle convexity and fossa concavity and interrelationship bony components in temporomandibular joint anterior dislocation

OBJECTIVES

This study aimed to compare the congruency of surface geometry of the articulating bones and morphologic differences in temporomandibular joint (TMJ) structure, between patients with TMJ anterior dislocation and healthy controls.

METHODS

The study included 15 patients with TMJ anterior dislocation and 15 controls who underwent cone-beam computed tomography. The surface angle of the articular fossa (fossa-concavity) and condyle (condyle-convexity) and joint spaces were measured from both sagittal and coronal views. The articular eminence morphology and horizontal condyle position were also evaluated.

RESULTS

Coronal fossa angles were significantly lower in controls than in patients (p < 0.05). There was a positive correlation between coronal condyle and fossa angle values in controls and in patients' joints (p < 0.05), however, the fossa-condylar congruence was higher in controls than in patients. Superior joint space was significantly higher in controls than in patients (p < 0.05). There were no significant differences in articular eminence measurements, mean condyle angle variables and condyle position between the patients and controls (p > 0.05).

CONCLUSIONS

The findings of this study which include lower joint congruency, higher fossa concavity and superior joint space distance in patients with anterior dislocation may be related to the inferior positioning of the condyle away from the fossa and potentially the elongation of the capsular ligament.

Chronic craniomandibular pain after craniotomy: A long-term clinical study

OBJECTIVE

Chronic craniomandibular/cervical pain and temporomandibular disorders have not been studied in patients who had a craniotomy several years previously. The aim of the current clinical work was to address these issues.

METHODS

A total group of 150 ambulant patients who had a previous craniotomy was subclassified according to whether or not the temporalis muscle was manipulated.

RESULTS

The average incidence of multiple subsite regional head and neck pain was 69.3% a number of years after a craniotomy. Evidence of internal derangement of the temporomandibular joint was significantly higher in the group that required manipulation of the temporalis muscle during the procedure.

CONCLUSION

The pattern of chronic craniomandibular/cervical pain experienced years after a craniotomy supports the brain neuromatrix theory of pain.

A clinical study on the incidence of internal derangement of the temporomandibular joint following harvesting of temporalis fascia

OBJECTIVE

The aim of the current clinical study was to reveal whether harvesting of a temporalis fascia graft would be associated with a higher incidence of temporomandibular joint (TMJ) internal derangement.

METHODS

The study group involved 104 patients who had middle-ear operations, 67 of which involved harvesting of temporalis fascia and 37 that did not. The TMJs were clinically examined in each group.

RESULTS

The total incidence of internal derangement of the TMJ was significantly higher in the group that had temporalis fascia harvesting (79.1%), compared to the group that did not have temporalis fascia harvesting (29.7%), (p= 0.001).

CONCLUSION

Harvesting of temporalis fascia probably alters mandibular kinematics and predisposes to internal derangement of the TMJs.

Ultrasound-guided lateral pterygoid muscle botulinum toxin: an injection for recurrent temporomandibular joint dislocation in a brain injury patient

Botulinum toxin type A (BTX-A) injection using nerve stimulation or electromyography for recurrent temporomandibular joint (TMJ) dislocation has been reported for several years. However, using the available equipment like a nerve stimulator or an electromyograph is uncommon, and ultrasound guidance is convenient and requires no additional resources. In this report, we used ultrasound as a tool to achieve BTX-A injections in a patient with a traumatic brain injury to treat her TMJ dislocation. One week after the injections, she had no more dislocation. She remained symptom free during the 3 months of follow-up, and her clinical symptoms improved without significant complications. This is the first report using ultrasound guidance for BTX-A injections to treat recurrent TMJ dislocation. This treatment is an effective and safe technique that could be performed timely and locally without referral to a center with electromyography facilities.

The influence of mandibular condyle morphology on TMJ anterior dislocations

OBJECTIVES

The present study was designed to investigate the correlation between the bony morphology of the mandibular condyle and the occurrence of temporomandibular joint (TMJ) idiopathic anterior dislocation.

STUDY DESIGN

A comparative retrospective study was conducted among 14 patients presenting idiopathic anterior dislocations (study group) and 15 patients who did not suffer from any TMJ disorders (control group). All patients underwent a multidetector computed tomography scan demonstrating the full extent of their joints. The scans of 58 joints were reconstructed and analyzed by tools available in Dolphine3 software. Mandibular condyle size and volume were measured, and its shape was characterized.

RESULTS

Shape, width, length, height, and volume of the mandibular condyles did not differ statistically between the study and control groups.

CONCLUSION

Mandibular condyle morphology does not affect TMJ idiopathic anterior dislocation.

Bilateral temporomandibular joint dislocations post-bronchoscopy in a case of paclitaxel-induced pneumonitis

This case report presents the unusual complication of bilateral temporomandibular joint dislocation following bronchoscopy, highlighting the importance of recognising it as a differential diagnosis in patients having jaw symptoms. The delayed diagnosis in this case resulted in multiple unsuccessful reduction attempts under sedation, which added to the distress of the patient. Notably, the procedure yielded a rare diagnosis for the patient that intrinsically changed the management of her breast cancer.

Temporomandibular joint dislocation in patients with cleft lip and palate after maxillary distraction osteogenesis: Three case reports

INTRODUCTION

Distraction osteogenesis (DO) is a widely used for cleft and palate related maxillary hypoplasia. There has been little research on temporomandibular joint (TMJ) dislocation after maxillary DO. We present these 3 cases and analyze the possible causes for reference by other clinicians.

PATIENT CONCERNS

In the late stages of maxillary DO, the patients gradually felt a decrease in mandibular mobility and suffered from limited mouth opening. Case 2 and 3 could open their mouth up to 1 and 2 fingers and Case 1 barely able to open her mouth at the completion of distraction.

DIAGNOSIS

Case 1 and Case 3 were diagnosed as right TMJ dislocation and Case 2 had a TMJ dislocation on her left side.

INTERVENTIONS

Patients with TMJ dislocation were repositioned with manipulation as soon as detected.

OUTCOMES

There was no recurrence in all three cases during the postoperative follow-up period.

CONCLUSIONS

Maxillary DO can sufficiently advance the maxilla in cleft lip and palate patients. Clinicians should be mindful of the TMJ dislocations that maxillary DO can exert on patients.

Total Joint Replacement After Condylar Destruction Secondary to Long-Standing Dislocation of the Temporomandibular Joint

BACKGROUND

To describe the treatment of 2 long-standing chronic dislocation of the temporomandibular joints (TMJs) and 1 chronic recurrent dislocation.

METHODS

This report describes the treatment of 3 patients; 2 with a long-standing chronic dislocation of the TMJ and 1 with a chronic recurrent dislocation. Duration of dislocation and anatomical considerations make the treatment challenging and controversial. The patients presented in this report all developed destruction of their condyles. They were successfully treated with total joint replacement with alloplastic devices.

RESULTS

All the 3 patients underwent successful surgery and recovery. Mandibular function and pain level were significantly improved.

CONCLUSION

Long-standing dislocation of the TMJ is rare. This condition can be successfully treated by resection of the damaged condyles and reconstruction with alloplastic total TMJ replacements.

Treatment of temporomandibular joint luxation: a systematic literature review

Objectives

To evaluate the effectiveness of surgical and nonsurgical treatment of temporomandibular joint (TMJ) luxation.

Materials and methods

This systematic literature review searched PubMed, the Cochrane Library, and Web of Science databases to identify randomized controlled trials on TMJ luxation treatment published between the inception of each database and 26 March 2018.

Results

Two authors assessed 113 unique abstracts according to the inclusion criteria and read nine articles in full text. Eight articles comprising 338 patients met the inclusion criteria, but none of these evaluated surgical techniques. Three studies including 185 patients concerned acute treatment with manual reduction of luxation while five studies including 153 patients evaluated minimally invasive methods with injection of autologous blood or dextrose prolotherapy for recurrent TMJ luxation. These studies reported that mouth opening after treatment was reduced and that independent of type of injection, recurrences of TMJ luxation were rare in most patients.

Conclusions

In the absence of randomized studies on surgical techniques, autologous blood injection in the superior joint space and pericapsular tissues with intermaxillary fixation seems to be the treatment for recurrent TMJ luxation that at present has the best scientific support. Well-designed studies on surgical techniques with sufficient numbers of patients, long-term follow-ups, and patient experience assessment are needed for selection of the optimal surgical treatment methods.

Clinical relevance

Autologous blood injection combined with intermaxillary fixation can be recommended for patients with recurrence of TMJ luxation.

Spontaneous Temporomandibular Joint Dislocation

Dislocation of the temporomandibular joint (TMJ) is the displacement of the head of the condyle from its normal position in the glenoid fossa. Anterior dislocations are the most common type of TMJ dislocations. Prognathism of the lower jaw, anterior crossbite, and open bite are the classic features in bilateral TMJ dislocations.The treatment of acute TMJ dislocation involves manual reduction with or without general anesthesia. The use of maxillomandibular fixation is reserved for chronic, more complex dislocations. Determining the presence of a predisposing factor is very important in guiding the correct treatment and management for this condition.The authors present a case of acute spontaneous temporomandibular joint dislocation where multiple predisposing factors were recognized, requiring treatment with maxillomandibular fixation after manual reduction.

Surgical management of recurrent TMJ dislocation-a systematic review

PURPOSE

Recurrent temporomandibular joint (TMJ) dislocation can be challenging to treat and the current understanding regarding aetiology and management of this condition is limited. The aim of this paper was to conduct a systematic review regarding the management of recurrent TMJ dislocation.

METHODS

A literature review was conducted using PRISMA guidelines to identify papers published between 2006 and 2016. The resultant papers were analysed.

RESULTS

A total of 33 papers were found relevant to the study. Minimally invasive techniques described included autologous blood injection, which was associated with an overall success of 80% at 12 months. Other modalities investigated included OK-432 sclerotherapy, laser capsulorrhaphy, botulinum toxin of the lateral pterygoid muscle or modified dextrose. These publications show promising success rates. Surgical techniques described included disc plication, eminoplasty and eminectomy. These modalities had a similar success rate, although numbers were limited. The true incidence of recurrent TMJ dislocation is unknown and aetiology is limited to expert opinion.

CONCLUSION

The current understanding of management for recurrent TMJ dislocation is limited to case series and case reports. This paper compiles the current understanding of management of recurrent TMJ dislocation. Compared to previous reviews, this paper describes some novel minimally invasive techniques with promising success in the management of recurrent TMJ dislocation.

Temporomandibular joint dislocation: a retrospective study from a Swiss urban emergency department

Purpose

Temporomandibular joint (TMJ) dislocation is an uncommon and debilitating condition of the facial skeleton. The condition may be traumatic or nontraumatic, in an acute or chronic form, and with bilateral or monolateral expression.

Patients and methods

In this study, conducted from May 2012 to July 2016, we retrospectively analyzed TMJ dislocations treated in the Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, by focusing on the following parameters: age, gender, reason, localization, frequency, and therapy.

Results

Thirty-two patients were included. The mean age was 42.06 years and there was no predominant gender. Most cases of TMJ dislocation were nontraumatic (93.7%). Dislocations were mostly bilateral (59.4%) and appeared in a chronic situation and with repetitive events (62.5%). Thirty-one patients received conservative treatment, which consists of reposition of the TMJ with (38.7%) or without (61.3%) analgosedation. Only one patient needed surgical reposition due to previous surgical treatment.

Conclusion

This is the first attempt to evaluate TMJ dislocations in Switzerland in an acute hospital setting. To our knowledge, there are no other studies that systematically analyze these injuries by focusing on the patients’ characteristics. Surgical reposition is only indicated in complicated and very rare situations. Conservative approaches are commonly used and should be exhausted before any surgery.

Surgical management of recurrent dislocation of the temporomandibular joint: a new treatment protocol

Recurrent dislocation of the temporomandibular joint (TMJ) is rare. It is distinct from acute or chronic dislocation and is associated with considerable morbidity and deterioration in quality of life. To formulate a practical surgical treatment algorithm, we retrospectively reviewed the management and long-term outcomes of 14 patients who presented to a single hospital department over a period of six years (2010-2016), and collected data on demographics, clinical features, operation, and outcome. Patients were followed up for a minimum of 12 months and a maximum of seven years. Results showed effective long-term resolution of symptoms after a combination of eminectomy and disc plication (meniscopexy). Patients whose symptoms had resulted from dystonia of the lateral pterygoid muscle also benefitted from additional lateral pterygoid myotomy. A combination of eminectomy and disc plication (meniscopexy) effectively provides successful long-term outcomes in this group of patients.

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

Purpose

To present three cases of chronic long-standing TMJ dislocation and discuss our treatment protocol with other options in the literature.

Patients and methods

Three cases of chronic TMJ dislocation (more than 4 months) that has never been reduced previously were treated by open reduction, meniscectomy or meniscoplasty and lateral pterygoid muscle myotomy. After a short period of MMF, TMJ physiotherapy was performed.

Results

During 3 years of follow-up, the condition had not recurred at all and all patients were functional and symptom free.

Conclusion

Based on other therapeutic options in the literature, our treatment protocol seems to be an effectual operation with fewer complications.

Reduction of bilateral dislocation of TMJ and Rendu Osler Weber syndrome: case report and physiopathological model

Temporomandibular joint dislocation (TMJ) is an infrequent clinical situation, representing 3% of all the human body’s dislocations. The etiological factors reported are associated to alterations typical of the joint or of the muscular-ligament apparatus, or to clinical conditions that may cause dislocation. We present the case of a 46-year-old patient with hereditary hemorrhagic telangiectasia with bilateral dislocation of the TMJ. There are several potential causes (antipsychotics, intubation, etc.) although the deposit of manganese in the basal ganglia that produce extrapyramidal symptoms could be the most consistent cause.

Delayed Management of Unrecognized Bilateral Temporomandibular Joint Dislocation: A Case Report

Temporomandibular joint (TMJ) dislocation is a common occurrence, but diagnosis can be missed if patients do not complain. Delayed presentation complicates the management of a straightforward reduction. We present a case of a 24-year-old man who had bilateral TMJ dislocation of unknown duration after motor vehicle accident. The accident left him bedridden with speech difficulty. He was totally dependent on Ryles' and percutaneous endoscopic gastrotomy tubes for feeding. Computed tomography revealed dislocation of condyles anterior to articular eminences. The bilateral TMJ dislocations were reduced surgically via bicoronal with preauricular extension approaches. However, the surgery was challenging due to tissue changes around the joint accompanied by masticatory muscles atrophy. Postoperatively, he was placed on intermaxillary fixation for 2 weeks followed by elastics training. Three months later, the patient's mastication returned completely to function. Delayed management of bilateral TMJ dislocation is undoubtedly challenging and somewhat frustrating; nevertheless, we manage to achieve satisfactory outcome in improving the patient's quality of life.

Management of the Bilateral Chronic Temporomandibular Joint Dislocation

Temporomandibular jaw dislocation is an uncontrolled anterior movement of the condyle beyond the articular eminence. It can occur mostly in young adults, and the symptoms are mouth opening disturbance, preauricular skin depression, tense masticatory muscles, and pain. The main purpose of the eminectomy procedure is removal of a part of the articular eminence to maintain free movement of the condyle. The surgical procedure may be performed by conventional surgery or piezosurgery. The present case report describes the management of a recurrent mandibular dislocation in a 28-year-old patient who had also treated conservatively with autologous blood injection. In this report, bilateral eminectomy was performed by piezosurgery to provide soft-tissue protection, precise cut, and optimal view of the surgical area. The management technique is discussed within the current literature.