Temporomandibular chronic dislocation: The long-standing condition

Abstract

BackgroundThe temporomandibular joint (TMJ) dislocation can be categorised into three groups: acute, habitual or recurrent and long-standing. The long-standing or protracted lower jaw dislocation refers to a condition that persists for more than one month without reduction. There are a great variety of methods for its treatment, from the manual or non-surgical, to surgical ones like the indirect approach (conservative surgical approach) and direct approach (open joint). Additional procedures in unsuccessful cases may include extra-articular orthognathic techniques to correct a malocclusion until joint replacement.Material and MethodsWe report four new cases with a minimum of 6 weeks dislocation who were seen since 1995 to 2015 in the Maxillofacial Department of the Clínico Hospital (Valencia, Spain), in which the mean age was 57.5 years. Most of them were bilateral and the gender was predominantly female. Additionally, we have reviewed the related literature.ResultsAll of the cases were successfully treated and half of them required open surgery.ConclusionsThe report confirms the difficulty of the treatment and reaffirms the necessity to bear in mind the wide variety of methods available for the treatment of this pathology. We stress the difficulties associated with managing the treatment and of suggesting new guidelines. The best option still remains not to delay the diagnostic and to select the appropriate initial treatment. Key words:Temporomandibular luxation, TMJ dislocation, protracted dislocation, long-standing dislocation.

The Treatment of Temporomandibular Joint Dislocation

“…Consequently, it is a condition as common as, for example, giant-cell arteritis. Although primarily affecting young adults, it may also occur in older people prone to temporomandibular joint dislocation (1,2). Because of the associated painful limitation of joint mobility, patients experience temporomandibular joint dislocation and the resulting impairment of essential functions (speaking, chewing) as very distressing (1).…”

Surgical Management of Chronic and Refractory TMJ Dislocation in Medically Compromised Patients

“…Procedures such as eminectomy, condylotomy, myotomy, and menisectomy have all been employed to aid in restoring the condyle back to a normal position. However, these procedures are only successful if there has been little to no changes in the structural integrity of the joint itself [7]. Other methods that employ the use of orthognathic surgical procedures such as bilateral sagittal split osteotomies and inverted L-osteotomies circumvent the risks associated with open joint surgery and are used to manage malocclusion, while restoring some function when adequate reduction of the joint is not possible [7].…”

“…However, these procedures are only successful if there has been little to no changes in the structural integrity of the joint itself [7]. Other methods that employ the use of orthognathic surgical procedures such as bilateral sagittal split osteotomies and inverted L-osteotomies circumvent the risks associated with open joint surgery and are used to manage malocclusion, while restoring some function when adequate reduction of the joint is not possible [7]. Overall, the consensus among the reports on chronic protracted TMJ dislocation agrees that adequate reduction becomes more difficult over time.…”

Recurrent Temporomandibular Joint Dislocations in Geriatric Patient on Antipsychotic Drugs and Its Conservative Management

“…Injection of autologous blood into the joint space is also a nonsurgical alternative in the treatment of recurrent TMJ dislocations [2]. All the above agents cause an increase in fibrosis in the upper joint space, the pericapsular tissues, or both and produce restriction in condylar movements thus prevent further dislocations.…”

“…Several factors associated with it are trauma, drugs like phenothiazine and metoclopramide, systemic conditions like connective tissue disorders and neuromuscular disorders [2]. They usually present with complaints of the inability to chew and swallow, difficulty in speaking, drooling of saliva.…”