Symptoma

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).

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].

  • Pain

    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]

    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. [symptoma.com]

    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]

  • Odynophagia

    Various complications are reported with TEE use such as dental injuries, odynophagia, pharyngeal abrasion, upper gastrointestinal haemorrhage and oesophageal perforation. [1], [2] Here we are reporting an uncommon complication of temporomandibular joint [jnaccjournal.org]

  • 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]

    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]

    Some people who have jaw pain also tend to clench or grind their teeth (bruxism), although many people habitually clench or grind their teeth and never develop TMJ disorders. [mayoclinic.org]

    Jaw pain may occur on one side or on both sides, depending upon the cause. Also depending upon the exact cause, the pain may occur when chewing or may occur at rest. [medicinenet.com]

    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]

  • Depersonalization

    As this is a retrospective study involving only depersonalized data, clearance from the institutional review board was not necessary. From case records, all relevant details were collected. [ijdr.in]

  • 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]

  • 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 [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].

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]

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]

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]

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]

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]

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]

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]

Most commonly, reduction of a temporomandibular joint (TMJ) dislocation is performed via the intraoral route. [8] To prevent trauma, the practitioner’s fingers should be gloved with thick gauze taped securely on both thumbs. [emedicine.medscape.com]

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]

  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.