Skip to main content

Advertisement

SpringerLink
Log in

A Conservative Surgical Approach in the Management of Longstanding Chronic Protracted Temporomandibular Joint Dislocation: A Case Report and Review of Literature

  • Case Report
  • Published:
Journal of Maxillofacial and Oral Surgery Aims and scope Submit manuscript

Abstract

Chronic protracted dislocation of the TMJ is a relatively uncommon but extremely unpleasant and distressing condition for a patient. It is also particularly challenging and difficult to treat as it worsens with time due to continuing spasm of the masticatory muscles and progressive fibrosis, adhesions and consolidation in and around the dislocated joint. No definite guidelines or treatment protocols have been laid down in literature till date, towards management of such dislocations. A range of extensive and invasive surgical procedures such as eminectomy, condylectomy, menisectomy, and various osteotomies of the mandibular ramus and body have been performed to reduce these dislocations. A chronic longstanding unilateral TMJ dislocation in a 64-year-old woman was managed successfully and effectively using a modified, rather conservative surgical technique. The aim was to reduce the dislocated condyle (without excessive manipulation of the intra-articular space or extra-articular joint components); and at the same time, to limit further excessive translation of the condyle and restore physiological TMJ biomechanical constraints, to prevent future recurrence. This was achieved by surgically exposing the dislocated joint and manipulating the anterosuperiorly positioned condyle back into the glenoid fossa, aided by a downward distraction of the mandible; followed by soft tissue tethering of the meniscus and fibrous capsule of the joint to the temporal fascia above. The procedure yielded excellent results without any functional limitations or recurrence, and can hence constitute a viable and effective treatment option which can be attempted prior to resorting to the more invasive surgical procedures as described in literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Lovely FW, Copeland RA (1981) Reduction eminoplasty for chronic recurrent luxation of the temporomandibular joint. J Can Dent Assoc 3:179–184

    Google Scholar 

  2. Talley RL, Murphy GJ, Smith SD, Baylin MA, Haden JL (1990) Standards for the history, examination, diagnosis, and treatment of temporomandibular disorders (TMD): a position paper. American Academy of Head, Neck and Facial Pain. Cranio 8(1):60–77

    Article  CAS  PubMed  Google Scholar 

  3. Luyk NH, Larsen PE (1989) The diagnosis and treatment of the dislocated mandible. Am J Emerg Med 7(3):329–335

    Article  CAS  PubMed  Google Scholar 

  4. Boudreau RG, Tidemann H (1976) Treatment of chronic mandibular dislocation. Report of a case. Oral Surg Oral Med Oral Pathol 41:169–173

    Article  CAS  PubMed  Google Scholar 

  5. Thomas ATS, Wong TW, Lau CC (2006) A case series of closed reduction for acute temporomandibular joint dislocation by a new approach. Eur J Emerg Med 13:72–75

    Article  Google Scholar 

  6. Avidan A (2002) Dislocation of the mandible due to forceful yawning during induction with propofol. J Clin Anaesth 14:159–160

    Article  Google Scholar 

  7. Tesfaya Y, Skorzewska A, Lal S (1991) Hazard of yawning. CMAJ 14:156

    Google Scholar 

  8. Stone KC, Humphries RL (2008) Maxillofacial and head trauma. Mandible fractures. Current diagnosis & treatment emergency medicine, 6th edn. McGraw Hill, New York

    Google Scholar 

  9. Harstall R, Gratz KW, Zwahlen RA (2005) Mandibular condyle dislocation into the middle cranial fossa: a case report and review of literature. J Trauma 59(6):1495–1503

    Article  PubMed  Google Scholar 

  10. Gassner R, Tuli T, Hachl O, Rudisch A, Ulmer H (2003) Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg 31(1):51–61

    Article  PubMed  Google Scholar 

  11. Hoard MA, Tadje JP, Gampper TJ, Edlich RF (1998) Traumatic chronic TMJ dislocation: report of an unusual case and discussion of management. J Craniomaxillofac Trauma 4(4):44–47

    CAS  PubMed  Google Scholar 

  12. Bhandari S, Swain M, Dewoolkar LV (2008) Temporomandibular joint dislocation after laryngeal mask airway insertion. Internet J Anaesthesiol 16(1):1–4

    Google Scholar 

  13. Sia Swee-Leong, Chang Yin-Lung, Lee Tsang-Mu, Lai Yu-Yung (2008) Temporomandibular joint dislocation after laryngeal mask airway insertion. Acta Anaesthesiol Taiwan 46(2):82–85

    Article  PubMed  Google Scholar 

  14. Sosis M, Lazar S (1987) Jaw dislocation during general anaesthesia. Can J Anaesth 34:407–408

    Article  CAS  PubMed  Google Scholar 

  15. Sensoz O, Ustûner ET, Celebioglu S, Mutaf M (1992) Eminectomy for the treatment of chronic subluxation and recurrent dislocation of the temporomandibular joint and a new method of patient evaluation. Ann Plast Surg 29(4):299–302

    Article  CAS  PubMed  Google Scholar 

  16. Sato J, Suzuki T, Fujimura K (2003) Clinical evaluation of arthroscopic eminoplasty for the habitual dislocation of the temporomandibular joint: comparative study with conventional open eminectomy. J Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95:390–395

    Article  Google Scholar 

  17. Kai S, Kai H, Nakayama E (1992) Clinical symptoms of open lock position of the condyle. Relation to anterior dislocation of the temporomandibular joint. Oral Surg Oral Med Oral Pathol 74:143–147

    Article  CAS  PubMed  Google Scholar 

  18. Lewis JES (1981) A simple technique for long-standing dislocation of the mandible. BJOMS 19:52–56

    Google Scholar 

  19. Kim Chul-Hwan, Kim Dae-Hyun (2012) Chronic dislocation of temporomandibular joint persisting for 6 months: a case report. J Korean Assoc Oral Maxillofac Surg 38:305–309

    Article  Google Scholar 

  20. Debnath SC, Kotrashetti SM (2006) Bilateral vertical-oblique osteotomy of ramus (external approach) for treatment of a long-standing dislocation of the temporomandibular joint: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:e79–e82

    Article  PubMed  Google Scholar 

  21. Adekeye EO (1976) Inverted L shaped osteotomy for prolonged bilateral dislocation of the temporomandibular joint. J Oral Surg 41:563–576

    Article  Google Scholar 

  22. Lee SH (2006) Reduction of prolonged bilateral temporomandibular joint dislocation by midline mandibulotomy. Int J Oral Maxillofac Surg 35:1054–1056

    Article  PubMed  Google Scholar 

  23. Shorey CW, Campbell JH (2000) Dislocation of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89:662–668

    Article  CAS  PubMed  Google Scholar 

  24. Dimitroulis G (2005) The use of dermis grafts after discectomy for internal derangement of the temporomandibular joint. J Oral Maxillofac Surg 63(2):173–178

    Article  PubMed  Google Scholar 

  25. Güven O (2005) Review of inappropriate treatments in temporomandibular joint chronic recurrent dislocation: presenting three particular cases. J Craniofac Surg 16(3):449–452

    Article  PubMed  Google Scholar 

  26. Lipp M, Von Domarus H, Daublender M (1987) Temporomandibular joint dysfunction after endotracheal intubation. Anaesthesist 36:442–445

    CAS  PubMed  Google Scholar 

  27. Vasconcelos BC, Porto GG, Neto JP, Vasconcelos CF (2009) Review treatment of chronic mandibular dislocations by eminectomy: follow-up of 10 cases and literature review. Med Oral Patol Oral Cir Bucal 14(11):e593–e596

    Article  PubMed  Google Scholar 

  28. Terakado N et al (2004) Conservative treatment of prolonged bilateral mandibular dislocation with the help of intermaxillary fixation screw. BJOMS 44:62–63

    Google Scholar 

  29. Miller Tara D, Neuhaus Isaac M, Zachary Christopher (2008) Botulinum toxin type A for treating temporomandibular joint dysfunction. Cosmet Dermatol 21(2):104–106

    Google Scholar 

  30. Rowe NL, William JLI (1994) Maxillofacial injuries. In: Williams JLI (ed) Chapter 14, injuries of the condylar and coronoid process, 2nd edn, vol 1. Churchill Livingstone, Edinburgh London, Madrid Melbourne, New York and Tokyo, pp 421–422

  31. Caminiti MF, Weinberg S (1998) Review chronic mandibular dislocation: the role of non-surgical and surgical treatment. J Can Dent Assoc 64(7):484–491

    CAS  PubMed  Google Scholar 

  32. Shakya S, Ongole R, Sumanth KN, Denny CE (2010) Chronic bilateral dislocation of temporomandibular joint. Kathmandu Univ Med J 8:251–256

    CAS  Google Scholar 

  33. Lewis JES (1981) A simple technique for reduction of longstanding dislocation of mandible. Br J Oral Surg 19:52–56

    Article  Google Scholar 

  34. EL-Attar A, Ord RA (1986) Long standing mandibular dislocation: report of a case, review of literature. Br Dent J 160:91

    Article  CAS  PubMed  Google Scholar 

  35. Laskin DM (1973) Myotomy for the management of recurrent and protracted mandibular dislocation. Trans Int Conf Oral Surg 4:264–268

    CAS  PubMed  Google Scholar 

  36. Helman J, Laufer D, Minkov B, Gutman D (1984) Eminectomy as surgical treatment for chronic mandibular dislocations. Int J Oral Surg 47:179–184

    Google Scholar 

  37. Güven O (2008) A clinical study on treatment of temporomandibular joint chronic recurrent dislocation by a modified eminoplasty technique. J Craniofac Surg 19(5):1275–1280

    Article  PubMed  Google Scholar 

  38. de Norman JE (1984) B. Recurrent dislocation of the temporomandibular joint. Glenotemporal osteotomy and a modified dowel graft. European Association for Maxillofacial Surgery, 7th congress. Abstracts 97

  39. Medra AM, Mahrous AM (2008) Glenotemporal osteotomy and bone grafting in the management of chronic recurrent dislocation and hypermobility of the temporomandibular joint. Br J Oral Maxillofac Surg 46:119–122

    Article  CAS  PubMed  Google Scholar 

  40. Dautrey J (1975) Surgery of the temporomandibular joint. Acta Stomatol Belg 72:577–581

    CAS  PubMed  Google Scholar 

  41. Lawlor MG (1982) Recurrent dislocation of the mandible: treatment of ten cases by the Dautrey procedure. Br J Oral Surg 20:14–21

    Article  CAS  PubMed  Google Scholar 

  42. Gadre KS, Kaul D (2010) Dautrey’s procedure in treatment of recurrent dislocation of the mandible. J Oral Maxillofac Surg 68:2021–2024

    Article  PubMed  Google Scholar 

  43. To EW (1991) A complication of the Dautrey procedure. Br J Oral Maxillofac Surg 29:100–101

    Article  CAS  PubMed  Google Scholar 

  44. Revington PJD (1986) The Dautrey procedure—a case for reassessment. Br J Oral Maxillofac Surg 24:217

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Command Military Dental Centre, Udhampur, Jammu & Kashmir, 182101, India

    Priya Jeyaraj

  2. Military Dental Centre, Jabalpur, Madhya Pradesh, 482001, India

    Ashish Chakranarayan

Authors
  1. Priya Jeyaraj
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashish Chakranarayan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Priya Jeyaraj.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jeyaraj, P., Chakranarayan, A. A Conservative Surgical Approach in the Management of Longstanding Chronic Protracted Temporomandibular Joint Dislocation: A Case Report and Review of Literature. J. Maxillofac. Oral Surg. 15 (Suppl 2), 361–370 (2016). https://doi.org/10.1007/s12663-016-0900-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12663-016-0900-z

Keywords

Search

Navigation