Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation

Abstract

BackgroundVirtually all the articles in literature addressed only a specific type of dislocation. The aim of this review was to project a comprehensive understanding of the pathologic processes and management of all types of dislodgement of the head of the mandibular condyle from its normal position in the glenoid fossa. In addition, a new classification of temporomandibular joint dislocation was also proposed.Method and materialsA thorough computer literature search was done using the Medline, Cochrane library and Embase database. Key words like temporo-mandibular joint dislocation were used for the search. Additional manual search was done by going through published home-based and foreign articles. Case reports/series, and original articles that documented the type of dislocation, number of cases treated in the series and original articles. Treatment done and outcome of treatment were included in the study.ResultA total of 128 articles were reviewed out which 79 were found relevant. Of these, 26 were case reports, 17 were case series and 36 were original articles. 79 cases were acute dislocations, 35 cases were chronic protracted TMJ dislocations and 311 cases were chronic recurrent TMJ dislocations. Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation. Various treatment modalities are outlined in this report as indicated for each type of dislocation.ConclusionThe more complex and invasive method of treatment may not necessarily offer the best option and outcome of treatment, therefore conservative approaches should be exhausted and utilized appropriately before adopting the more invasive surgical techniques.

The Effect of Chronic Temporomandibular Joint Dislocation: Frequency on the Success of Autologous Blood Injection

“…As compared with other nonsurgical and surgical techniques, ABI has the advantages of being repeatable, not requiring tissue dissection, and having fewer post-operative complications [8,15]. The uncertain nature of the pathophysiology of the procedure is the main disadvantage of ABI [9,11].…”

“…In a literature review, Akinbami reported the different types of TMJ dislocations and discussed the structural factors predisposing patients to dislocation [15]. Considering the predisposing factors, patients with different dislocation frequencies might have different responses to treatment.…”

Skeletal Factors Related to Open Lock of the Temporomandibular Joint

“…In addition, age, dentition, cause and duration of the dislocation as well as the function of the masticatory muscles contribute significantly in the mechanism and management of TMJ open lock. 5) The previous studies have highlighted the predisposing and etiological factors for condyle dislocations, such as poor development of the articular fossa, laxity of the temporomandibular ligament or joint. 6) Based on such factors, various therapeutic approaches such as the introduction of a sclerosing agent into the capsular space of the TMJ, scarification of the temporalis tendon, bone grafting augmentation of articular eminence have been applied to limit the forward excursion of condyle head.…”

“…3) TMJ dislocation or open lock, one of the TMD, has been described mainly in terms of an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. [4][5][6][7] The patient with the dislocated joint is unable to close the mouth with or without pain and this can occur as a single or chronic recurrent episode.…”

“…The capsule of the joint is the most important structure that plays a role in TMJ open lock because it stabilizes the joint reinforced by the lateral ligaments. 4,5) {Sindet-Pedersen, 1988 #3} The displacement of the head of the condyle out of the glenoid fossa is also greatly influenced by the morphology of the condyle, glenoid fossa, articular eminence, zygomatic arch and squamotympanic fissure. In addition, age, dentition, cause and duration of the dislocation as well as the function of the masticatory muscles contribute significantly in the mechanism and management of TMJ open lock.…”