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

  The conservative methods in its management include symptomatic pain relief with analgesics and manual reduction 13. •. [slideshare.net]

  She then complained about pain in the right TMJ. The rnouth opening was good with stable closure, and both TMJs were moving freely. [baillement.com]

  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]

  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]

• Swelling

  Physical examination showed a swelling in the left preauricular region without laceration. No thrill or bruit was detected at this time. [ncbi.nlm.nih.gov]

  However, progressive right facial swelling was noted after the closed reduction of the right TMJ. Magnetic Resonance Imaging (MRI) revealed marked soft tissue swelling and mass forming-like change in the periarticular region of the right TMJ. [omicsonline.org]

  including facial swelling bleeding, including bleeding from the mouth breathing difficulties discomfort when chewing jaw stiffness numbness and bruising in the face dental-related discomfort, such as numbness in the gums or loosened teeth Pain, swelling [healthline.com]

  […] blockage Bleeding Breathing blood or food into the lungs Difficulty eating (temporary) Difficulty talking (temporary) Infection of the jaw or face Jaw joint (TMJ) pain and other problems Numbness of part of the jaw or face Problems aligning the teeth Swelling [medlineplus.gov]

  A broken jaw can cause facial bruising and swelling, while a dislocation may cause the lower jaw to become misaligned with the skull. Treatment for a broken jaw depends on the severity of the injury. [medicalnewstoday.com]

• Severe Pain

  Clinical presentation of dislocated TMJ includes inability to close the mouth, deviation of the mandible away from the affected side in unilateral cases, hollowing in front of the tragus, spasm of muscles of mastication and severe pain of the TMt Radiographs [ajol.info]

  Dislocation of the mandible / jaw dislocation / TMJ subluxation is an infrequent A&E presentation.The condition is discomforting to the patient, although most are not in severe pain. [exodontia.info]

  However, a doctor may suggest a person takes pain medication to help to relieve discomfort and eats a liquid or soft food diet to avoid worsening the injury. More severe breaks will require medical interventions or surgery. [medicalnewstoday.com]

  TMD often causes severe pain and discomfort. It can be temporary or last many years. It might affect one or both sides of your face. More women than men have it, and it’s most common among people between the ages of 20 and 40. [webmd.com]

  Case Report A 63-year-old woman visited the emergency room (ER) for dislocation and pain on the right TMJ for 3 weeks. She reported that her occlusion changed gradually and complained of severe malocclusion and poor chewing function. [omicsonline.org]

• Unconsciousness

  The anesthetist should be particularly careful to avoid this complication in an unconscious patient requiring indeterminate ventilatory support. [journals.lww.com]

  Airway patency in the unconscious patient. Br J Anaesth 1985; 57: 306-10. 10. Gambling DR, Ross PL. Temporomandibular joint subluxation on induction of anaesthesia (letter). Anesth and Analg 1988. [ispub.com]

  Prolonged temporomandibular joint dislocation in an unconscious patient after airway manipulation. Anesth Analg 2006;102:1294. 8. Srivastava D, Rajadnya M, Chaudhary MK, Srivastava JL. [ijdr.in]

  Prolonged temporomandibular joint dislocation in an unconscious patient after airway manipulation. Anesth Analg 2006;102:1294. 5. Patton DW. Recurrent subluxation of the temporomandibular joint in psychiatric illness. Br Dent J 1982;153:141-4. 6. [saudijos.org]

• Asymptomatic

  This condition is also self-reducing.5,6 When these subluxations are asymptomatic, they should be viewed as variants of normal.7 A true dislocation (or luxation) is a condition in which a joint is displaced from its articulations and requires manipulation [cda-adc.ca]

  […] symptoms, 1, 6 and occlusal correction does not reliably improve the symptoms or signs of TMJ disorders. 2, 7 Parafunctional habits have been thought to cause TMJ microtrauma or masticatory muscle hyperactivity 8 ; however, these habits are also common in asymptomatic [aafp.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]

  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]

  Pain, swelling, and bleeding are the most immediate symptoms of a broken jaw. [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]

  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]

• Toothache

  A tired feeling in your face Trouble chewing or a sudden uncomfortable bite -- as if the upper and lower teeth are not fitting together properly Swelling on the side of your face You may also have toothaches, headaches, neck aches, dizziness, earaches [webmd.com]

  Signs and symptoms of temporomandibular joint dysfunction include the following: Pain or tenderness in the jaw, especially at the area of the joint Popping/clicking of the jaw (crepitus) Pain that feels like a toothache Ear pain ( earache ) or sounds [medicinenet.com]

• Difficulty Opening the Mouth

  Check if you have TMD Signs of TMD include: pain around your jaw, ear and temple clicking, popping or grinding noises when you move your jaw a headache around your temples difficulty opening your mouth fully your jaw locking when you open your mouth The [nhs.uk]

  Difficulty chewing Jaw stiffness, difficulty opening the mouth widely, or problem closing the mouth Jaw moving to one side when opening Jaw tenderness or pain, worse with biting or chewing Loose or damaged teeth Lump or abnormal appearance of the cheek [medlineplus.gov]

• Ankylosis

  Zins JE, Smith JD, James DR (1989) Surgical correction of temporomandibular joint ankylosis. Clin Plast Surg 16:725–732 PubMed Google Scholar 8. [link.springer.com]

  […] arthroplasty, arthrotomy Open or closed reduction of TMJ dislocation Interdental wire fixation Exceptions: The following diagnosed conditions may require surgical treatment without a preceding non-surgical approach: Acute closed lock Bony or fibrous ankylosis [oxhp.com]

  Ankylosis ‘Fusion’ of the TMJ is the occasional late outcome of trauma or infection. Surgical correction usually involves replacement with an artificial joint. [aoms.co.nz]

  The modern pre-auricular approach has evolved from one which was first described and used in 1913 for the treatment of TMJ ankylosis (Blair 1928). [oralhealthgroup.com]

• Muscle Tenderness

  Masticator space infection (MSI), which is mostly caused by the spread of odontogenic infection, may present as TMJ pain, masticator muscle tenderness, or trismus. [omicsonline.org]

• Joint Stiffness

  After a few weeks, some of the elastics are removed to allow motion and reduce joint stiffness. If the jaw is wired, you can only drink liquids or eat very soft foods. [medlineplus.gov]

• Agitation

  She was agitated and unable to close her mouth, speak or eat (Fig. 1). The dislocation was manually reduced without sedation and the next day using intravenous midazolam following further dislocation. [nature.com]

• Irritability

  The trigeminal nerve supplies nerve impulses to the temporomandibular joint, and when irritated, it can cause facial pain. [medicinenet.com]

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]

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]

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]

A survey of genetic and other etiological factors has been carried out in 589 index patients with congenital dislocation of the hip and their families, with special investigation of acetabular dysplasia, familial joint laxity and a comparison of neonatal [online.boneandjoint.org.uk]

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]

[…] 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). [emdocs.net]

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, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am. 2013;57(3):465-79. 4. Prechel U, Ottl P, Ahlers OM, Neff A. The Treatment of Temporomandibular Joint Dislocation A Systematic Review. [revistas.uis.edu.co]

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.[8] Pathophysiology[edit] 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]

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]

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]

Oral and Maxillofacial Surgeons at the Penn Center for Temporomandibular Joint Disease are performing arthroplastic eminoplasty to prevent recurrent dislocation of the temporomandibular joint (TMJ). [pennmedicine.org]

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]

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.