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]

  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]

  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]

  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]

• Nasal Speech

  • The adverse effect involves diffusion into the adjacent tissues, transient dysphagia, nasal speech, nasal regurgitation, painful chewing, and dysarthria. • It is contraindicated in a few conditions like hypersensitivity to BTX and myasthenia gravis [slideshare.net]

  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 [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].

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.