Dislocation of the temporomandibular joint can occur in the setting of trauma or during a wide opening of the mouth (eg. yawning, or during various medical procedures, such as transesophageal echocardiography). Inability to close the mouth is the main sign. The diagnosis, although often made solely on clinical criteria after a thorough physical examination, often requires the use of imaging studies, the most valuable being magnetic resonance imaging (MRI).
An array of conditions and risk factors have been described as potential causes of temporomandibular joint (TMJ) dislocation, which may be partial (subluxation) or complete (luxation)   . Trauma, epilepsy, laxity of the articular disc and weak supporting structures (muscles, ligaments, or tendons, seen in the elderly population who suffer from degenerative osteoarthritic changes), but also laughing, yawning, and attempting a large bite have all been documented as potential inducers of TMJ dislocation   . Furthermore, various medical and dental procedures (eg. transesophageal ultrasonography, extubation, endoscopy, etc.) that require profound and forced mouth opening are also documented as events that led to dislocation   . Regardless of the subtype (anterior, posterior, superior, medial, or lateral), spasm of the masseter, temporalis and pterygoid muscles ensues and prevents the mandibular condyle from attaching into the glenoid fossa . Thus, the inability of patients to close their mouth is the hallmark of TMJ dislocation, whereas deviation of the chin to the opposite side of the fracture is often seen in unilateral fractures . As the oral cavity remains open, patients experience drooling, inability to speak properly, and many report pain in the preauricular region (the pain is pronounced when patients attempt to close their mouth), in the proximity of the dislocated TMJ . Several complications may arise, including injury to the external auditory canal (posterior and superior dislocations), damage of the facial (VII) and vestibulocochlear nerves (VIII) that can result in deafness, as well as cerebrospinal fluid (CSF) leakage (superior) .
Entire Body System
The patient experienced complete resolution of symptoms and resumed an unrestricted diet 6 months after removal of devices and has been pain-free for more than 24 months. [utexas.influuent.utsystem.edu]
The conservative methods in its management include symptomatic pain relief with analgesics and manual reduction 13. •. [slideshare.net]
There were 3 patients who reported the alleviation of pain and/or sound postoperatively. Two older patients with long-term course of disease reported no improvement of the TMJ symptoms in terms of pain and sound postoperatively. [ncbi.nlm.nih.gov]
Pain relief may be achieved with nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, or mild opiates. [emedicine.medscape.com]
His associated myofascial muscle pain has resolved, as well. [pennmedicine.org]
Jaw & Teeth
- Anterior Open Bite
Treatment was satisfactory for all patients surgically handled except for one case of anterior open bite postoperatively. [ncbi.nlm.nih.gov]
On clinical examination, the patient revealed an inability to occlude teeth, protruding lower jaw, an anterior open bite and drooling saliva. The patient was unable to speak, drink or eat properly [Figure 1]. [jisppd.com]
When the patient presented to the oral and maxillofacial outpatient unit 3 mo after his primary injury, he had a prognathic appearance with a long face, anterior open bite, and inability to close his mouth or speak. [journals.lww.com]
Intraoral findings included anterior displacement of the lower jaw and anterior open bite [Figure 7] with an interincisal distance of 15 mm. Anterior displacement of both condyles was seen on the panoramic radiograph [Figure 8]. [saudijos.org]
She also revealed an anterior open bite and drooling saliva. The child was unable to drink or eat properly. Both condyles could be palpated outside the fossa. [contempclindent.org]
- Jaw Pain
You have one joint on each side of your jaw. TMJ disorders — a type of temporomandibular disorder or TMD — can cause pain in your jaw joint and in the muscles that control jaw movement. [mayoclinic.org]
Pain, swelling, and bleeding are the most immediate symptoms of a broken jaw. [healthline.com]
Signs and symptoms of temporomandibular joint (TMJ) syndrome include jaw pain, jaw clicking and popping, ear pain / earache, popping sounds in ears, headaches, stiff or sore jaw muscles, pain in the temple area, or locking of the jaw joint. [medicinenet.com]
The symptoms of a broken jaw include: pain in the face or jaw pain when moving the jaw, such as opening the mouth or chewing bruising and swelling on the face stiffness and difficulty moving the jaw dislodged teeth numbness of the face jaw moving to the [medicalnewstoday.com]
When the temporomandibular joints, jaw muscles and ligaments are prevented from working together properly, a painful TMJ disorder may occur. [ucsfhealth.org]
Face, Head & Neck
This report describes a rare case of repeated, voluntary, TMJ in a 73-year-old woman with dysphagia and dysarthria. [ncbi.nlm.nih.gov]
- Nasal Speech
speech, nasal regurgitation, painful chewing, and dysarthria. [ncbi.nlm.nih.gov]
- Gait Ataxia
He was apparently well 6 months back when he complained of headache, vertigo along with asymmetry of face, decreased hearing on right ear and gait ataxia. He underwent craniotomy surgery for the same, 8 years back. [jnaccjournal.org]
Early recognition of the condition allows the physician to perform manual reduction without the use of anesthesia, thus a prompt diagnosis should be made . Temporomandibular joint dislocation mandates a thorough clinical assessment, starting with a detailed patient history that will determine the event which led to the dislocation and observation of typical symptoms  . During the physical examination, a vacant space in the preauricular area (the location of the joint) strongly suggests TMJ dislocation, as does chin deviation . Although clinical criteria are considered sufficient for the diagnosis , imaging studies are the cornerstone in assessing the exact subtype of injury. Plain radiography and computed tomography (CT) are useful in showing the displacement of the condylar head and the assessment of bony structures, and the three-dimensional (3D) CT scan is often recommended for its benefit of providing a complete view of the temporomandibular joint   . Due to its superior role in differentiating between soft tissue injuries, however, magnetic resonance imaging (MRI), is necessary in order to define the exact type of fracture and thus aid in optimizing the therapeutic approach    .
RESULTS: Eighty percent had a successful outcome and required no further treatment at their 1-year follow-up. CONCLUSION: This procedure has proven to be safe, simple, and cost effective for the treatment of chronic recurrent TMJ dislocation. [ncbi.nlm.nih.gov]
Treatment of the condition is dependent on the causative diagnosis, as there are many treatment options. [nature.com]
If this condition becomes chronic, surgical treatment is the only option. The goal of surgical treatment is to reposition the condyle and prevent further recurrences. [link.springer.com]
What is the prognosis for this injury? The prognosis for people with TMJ dislocation is good, especially if treatment is sought right away. [wodenoptics.com]
Prognosis The outlook is excellent for returning the dislocated ball of the joint to the socket. However, in some people, the joint may continue to become dislocated. If this happens, you may need surgery. 4/16/13 © 2002- 2018 Aetna, Inc. [colgate.ph]
Prognosis The outlook is excellent for returning the dislocated ball of the joint to the socket. However, in some people, the joint may continue to become dislocated. If this happens, you may need surgery. 4/16/13 © 2002- 2017 Aetna, Inc. [colgate.com]
What is the prognosis for TMJ syndrome? The prognosis for TMJ syndrome is generally good. There are numerous causes for TMJ syndrome, so the outlook depends on the cause, if known. [medicinenet.com]
The early click has a better prognosis than a late click. The late click indicates the disc is severely displaced. The disc must move back and forth to protect the condyle from rubbing on the fossa. [sabbaghoralsurgery.com]
By contrast, recurrent TMJ dislocation has a much more complicated etiology and a much greater impact on overall quality of life. [pennmedicine.org]
Although odontogenic infection is the most common etiology for MSI, other possible etiologies are bacterial or viral pharyngitis, retropharyngeal abscess, peritonsillar abscess, acute otitis media, mastoiditis, parotitis, submandibular sialadenitis and [omicsonline.org]
This article reports two cases of chronic protracted dislocation having unusual etiology treated systematically along with review of literature. [papers.ssrn.com]
Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation. [ncbi.nlm.nih.gov]
The etiology of the dislocation includes laughing, chewing, opening the mouth wide (e.g., eating, for procedures, yawning, vomiting), seizures, and trauma. [accessemergencymedicine.mhmedical.com]
[…] conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology [ncbi.nlm.nih.gov]
Epidemiology Dislocations of the temporomandibular joint (TMJ) are common and occur in as many as 7% of the entire population, at some point in their lives 3. They can occur at any age but are most common between 20-40 years of age 3. [radiopaedia.org]
Epidemiology: Anterior dislocations are most common Mechanism Atraumatic (most common) from extreme mouth opening (yawning, eating, dental procedure, etc). [coreem.net]
Epidemiology and treatment needed for temporomandibular disorders. Journal of Orofacial Pain 13(4): 232-37. 7.deBont, L. G. M., Kijkgraaf, L.C., Stegenga, B. (1997, Jan). Epidemiology and natural progression of articular temporomandibular disorders. [oralhealthgroup.com]
Dislocation of the temporomandibular joint is one of many pathophysiologic joint conditions that the oral and maxillofacial surgeon is challenged with managing. [ncbi.nlm.nih.gov]
• The pathophysiology of dislocation is the movement of the condylar process in front of the articular eminence and an inability to descend back to its normal position. • It can be partial (subluxation) or complete (luxation), bilateral or unilateral [slideshare.net]
For the jaw to open it requires the lateral pterygoid muscle. Pathophysiology There are four different positions of jaw dislocation: posterior, anterior, superior and lateral. [en.wikipedia.org]
Conclusion From the aforementioned, it is clear that the disorders that we classify in the TMD group are complex and sometimes multifactorial etiology and pathophysiology. [peertechz.com]
Basic Science and Pathophysiology The mandible is a U shaped bone comprising two hemimandibles which are completely fused at the symphysis by the age of two years. [rcemlearning.co.uk]
Most commonly, reduction of a temporomandibular joint (TMJ) dislocation is performed via the intraoral route.  To prevent trauma, the practitioner’s fingers should be gloved with thick gauze taped securely on both thumbs. [emedicine.medscape.com]
Eminectomy, whose validity has been demonstrated by several authors, acts on the bony obstacle, preventing condylar locking, but does not have a therapeutic effect on TMJ ligament and capsular laxity or masticatory muscle incoordination, which seem to [ncbi.nlm.nih.gov]
The patient should be cautioned to avoid wide opening of the mouth to prevent recurrent dislocation. A Barton's bandage is applied to prevent wide mouth opening and recurrent dislocation. [exodontia.info]
Prevention TMJ dislocation can continue to happen in people with loose TMJ ligaments. To keep this from happening too often, dentists recommend that people limit the range of motion of their jaws. [colgate.ph]
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