Edit concept Question Editor Create issue ticket

Temporomandibular Joint Dislocation

Dislocated Jaw

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).


Presentation

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) [1] [2] [3]. 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 [1] [4] [5]. 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 [4] [6] [7]. 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 [2]. 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 [1]. 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 [1]. 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) [2].

Collapse
  • The excessive mouth opening was reduced, and the patient showed no temporomandibular joint (TMJ) dislocation or experienced any further airway collapse after the injections.[ncbi.nlm.nih.gov]
Jaw Pain
  • Dislocated jaw The signs of a dislocated jaw can be different than those of a broken jaw. Pain is a factor, and it may become worse when you move your mouth or your body.[healthline.com]
  • How to ease TMD yourself There are some simple things you can do to try to reduce your jaw pain. eat soft food, like pasta, omelettes and soup take paracetamol or ibuprofen hold ice packs or heat packs to the jaw, whichever feels better massage the painful[nhs.uk]
  • Signs and Symptoms Diagnosis Treatment Symptoms of TMJ disorders may include: Ear pain Jaw pain or tenderness Clicking, grating or popping noises when opening the mouth Headaches and neck aches Diagnosing TMJ disorders is often complex and therefore should[ucsfhealth.org]
Prognathism
  • It is possible that strong pain and mouth-closing disability may gradually remit and only deviated mandibular prognathism like malocclusion may persist. Therefore, abnormal occlusion warrants careful attention to temporomandibular joint dislocation.[ncbi.nlm.nih.gov]
  • 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]
Mandibular Prognathism
  • It is possible that strong pain and mouth-closing disability may gradually remit and only deviated mandibular prognathism like malocclusion may persist. Therefore, abnormal occlusion warrants careful attention to temporomandibular joint dislocation.[ncbi.nlm.nih.gov]
Distractibility
  • The patient was successfully distracted using internal mandibular distractors, rhBMP-2, and a prolonged distraction protocol.[ncbi.nlm.nih.gov]
  • […] molars under general anesthesia, has proven to be successful. 26 Manual reduction of prolonged dislocations, up to 16 months, has also been described. 27 One case involved passing a wire through the inferior aspect of the mandible to aid in posterior distraction[cda-adc.ca]
Dysarthria
  • This report describes a rare case of repeated, voluntary, TMJ in a 73-year-old woman with dysphagia and dysarthria.[ncbi.nlm.nih.gov]

Workup

Early recognition of the condition allows the physician to perform manual reduction without the use of anesthesia, thus a prompt diagnosis should be made [5]. 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 [1] [2]. During the physical examination, a vacant space in the preauricular area (the location of the joint) strongly suggests TMJ dislocation, as does chin deviation [1]. Although clinical criteria are considered sufficient for the diagnosis [4], 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 [1] [5] [8]. 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 [1] [5] [8] [9].

Treatment

  • Treatment done and outcome of treatment were included in the study. RESULT: A total of 128 articles were reviewed out which 79 were found relevant.[ncbi.nlm.nih.gov]
  • Eighty percent of the subjects (12 patients) had a successful outcome with no further episodes of dislocation and required no further treatment at their 1-year follow-up, whereas three patients had recurrent dislocation as early as 2 weeks after treatment[ncbi.nlm.nih.gov]
  • There were no side effects recorded as a result of treatment.[ncbi.nlm.nih.gov]
  • One nonsurgical method of treatment is the local infiltration of botulinum toxin type A.[ncbi.nlm.nih.gov]
  • 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]

Prognosis

  • 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- 2017 Aetna, Inc.[colgate.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]
  • 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]

Etiology

  • 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]
  • […] young women in the age group of 21–30 years, but it is extremely rare in infants. [2] TMJ dislocation has been mainly classified into three categories: acute, chronic, and chronic recurrent. [3] Acute dislocations may be associated with any number of etiologies[contempclindent.org]
  • The etiology of recurrent dislocation is not known, however, the pathogenesisis involves soft tissues or bone.[parjournal.net]
  • Dislocations may also result from dyskenesias that may be psychiatric in etiology, or due to abnormalities in the extrapyramidal system. 58 Anesthetic procedures are commonly associated with dislocations.[cda-adc.ca]

Epidemiology

  • […] 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: Anterior dislocations are most common Mechanism Atraumatic (most common) from extreme mouth opening (yawning, eating, dental procedure, etc).[coreem.net]
  • In more severe cases, surgery may be needed to reposition the jaw, particularly if repeated jaw dislocations have occurred. [12] Epidemiology [ edit ] Jaw dislocation is common for people who are in car, motorcycle or related accidents and also sports[en.wikipedia.org]
  • Epidemiology of mandibular fractures treated in a Brazilian level I trauma public hospital in the city of So Paulo, Brazil.[rcemlearning.co.uk]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • For the jaw to open it requires the lateral pterygoid muscle. [8] Pathophysiology [ edit ] There are four different positions of jaw dislocation: posterior, anterior, superior and lateral.[en.wikipedia.org]
  • 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]

Prevention

  • 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]
  • 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.[symptoma.com]
  • 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.com]
  • Early recognition of joint dislocation can prevent permanent damage and the need for complex surgical treatment. This is an unusual case due to the severity of the patient symptoms and the complexity of the treatment. 1.[eposters.net]

References

Article

  1. Sharma NK, Singh AK, Pandey A, Verma V, Singh S. Temporomandibular joint dislocation. Natl J Maxillofac Surg. 2015;6(1):16-20.
  2. Akinbami BO. 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. Head Face Med. 2011;7:10.
  3. Liddell A, Perez DE. Temporomandibular joint dislocation. Oral Maxillofac Surg Clin North Am. 2015;27(1):125-136.
  4. Thangarajah T, Mcculloch N, Thangarajah S, Stocker J. Bilateral temporomandibular joint dislocation in a 29-year-old man: a case report. J Med Case Reports. 2010;4:263.
  5. Ogura I, Kaneda T, Mori S, Sakayanagi M, Kato M. Magnetic resonance characteristics of temporomandibular joint disc displacement in elderly patients. Dentomaxillofac Radiol. 2012;41(2):122-125.
  6. Roche NC, Paule P, Fourcade L. Temporomandibular joint dislocation during transoesophageal echocardiography: an unusual complication. Arch Cardiovasc Dis. 2011;104(8-9):482-483.
  7. Wang LK, Lin MC, Yeh FC, Chen YH. Temporomandibular joint dislocation during orotracheal extubation. Acta Anaesthesiol Taiwan. 2009;47(4):200-203.
  8. Bag AK, Gaddikeri S, Singhal A, et al. Imaging of the temporomandibular joint: An update. World J Radiol. 2014;6(8):567-582.
  9. Wang P, Yang J, Yu Q. MR imaging assessment of temporomandibular joint soft tissue injuries in dislocated and nondislocated mandibular condylar fractures. AJNR Am J Neuroradiol. 2009;30(1):59-63.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2017-08-09 12:22