treatment of long term anterior dislocation of TMJ

7/29/2019 treatment of long term anterior dislocation of TMJ

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D.A.BAUR,J .R .JANNUZI ,U .MERCAN,FAISAL

.QUERESHY

IJOMS;2012

Treatment of long term anterdislocation of TMJ


2/22

Introduction

Dislocation of TMJ typically occurs when thmandibular condyle becomes displaced out oglenoid fossa and anterior to the articular em

Rarely the displacement may be in posterior

and superior direction. May be unilateral or bilateral.


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Etiology

Yawning

Trauma

Medications

Dental treatments

Congenital joint weakness Ehler Danlos and Marfan syndrome

Psychogenic and neurologic disorders


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Classification

Acute

Habitual/recurrent

Chronic


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Case report


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Chief complaint

Inability to close mouth since four mon


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History

Yawning led to the present state

No prior history of TMJ dislocation

Condition misdiagnosed as stroke;admitted

Discharged when found negative(in open lock)

Consulted general dentist

Referred to oral and maxillofacial surgeon

Delay in presentation to surgeon due to restrictilimitations in insurance plan(12 weeks)


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Examination

Edentulous; with upper and lower dentures

Occlusion altered and nonfunctional

Downward and forward displacement of chin

Anterior open bite

No palpable condyle in pre auricular region

Tenderness to palpation in pre auricular reg


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Investigations

OPG

Showed bilateral anteriorly displaced condylbeyond articular eminence

CT

Confirmed OPG findings and also showed culateral pole of condyle consistent withpseudoarticulation with zygomatic arch


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11/22


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Management

Unsuccessful attempts to reduce with LA in and under GA and muscle relaxants in operaroom at the time of presentation.

Again attempted unsuccessfully with LA in t

Surgical intervention was indicated.


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Surgical intervention

Manual attempts made unsuccessfully.

Bilateral incisions with preauricular approacTMJ.

Intraoperative findings:

Glenoid fossa empty of condyles and consisdense scar tissue.

Condyles found anterior to the eminence anto the zygomatic arch.


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Surgical intervention..

Attempts made to reposition the condyle budue to:

Dense fibrosis

Masticatory muscle shortening


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Condylectomy was agreed upon.

Reconstruction with TMJ prosthesis was sugowing to:

Patients edentulism

Ramus shortening due to bilateral condylec


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Condylectomies were performed.

IMF given utilizing dentures.

Ramus accessed via

submandibular approach and

fossa components and mandibular

components were secured.

IMF was released

Patient discharged next day


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Follow up

Followup at 1,2,4 and 8 weeks postoperative

No further episodes during this period.

Mouth opening was 35mm.

Diet was regular.

At 7 month follow up patient was pain free wgood range of motion.


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Discussion

TMJ dislocations account for 3% of all joint disl

Signs and symptoms include:

Inability to close mouth

Depression of preauricular skin

Excessive salivation Tense spastic muscles of mastication

Severe TMJ pain


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Discussion..

Acute dislocations proceed to long standing when left untreated.

Soft tissues become fibrosed and muscle spaoccur over time

More the time has elapsed more are thecomplexities.


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Discussion..

Huang et al suggested that cases persisting for 4-12 week

treated by open reduction. The also suggested a treatment strategy which suggested Dislocations greater than 3 weeks : closed reduction Dislocations of 1-3 months :open reduction with strippin

periosteum and muscles and traction with wire or other r Dislocations for 3-6 months :stripping as in 1-3 months a

unsucessful ,follow the recommendations for more than Dislocations for more than 6 months :open reduction an

condylectomy,condylotomy,myotomy and/or TMJ prosth


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Discussion..

Currently, there are no guidelines or protoco

which surgical method is best and for whichsituations.

Documents

treatment of long term anterior dislocation of TMJ