Temporomandibular Joint (TMJ) dislocation
The right figure shows closed reduction of TMJ dislocation procedure performed byHippocrates (460-370 BC), the ancient Greek physician who is regarded as the farther of medicine
TMJ dislocation refers to the condylar process displaced out of the glenoid fossa and cannot be self reduced. The most common type of TMJ dislocation is anterior dislocation that the condylar process becomes fixed in the anterior aspect of articular eminence.
TMJ dislocation may happen unilaterally or bilaterally and is usually combined with lateral pterygoid muscle spam and pain. The symptoms include inability to close the mouth completely and depression at the joint area right in front of the ears. TMJ dislocation occurs commonly after the movement of mouth wide open, e.g. laughing, biting big or thick food mass, yawing or underwent dental treatment.
TMJ dislocation can be divided into 3 types:
Once TMJ dislocation occurs, the dislocated condylar process should be relocated back to the original place as soon as possible. Otherwise more severe spams of surrounding muscle and fibrosis of the joint may occur and increase the difficulty of joint reduction （Hayward,1965）。
Acute TMJ dislocation is the most common type
Most cases of acute TMJ dislocation can be solved with close reduction under local anesthesia, sedation or without anesthesia and maxillomandibular fixation, and the patients are advised not to overextend the mouth in short period. However recurrent TMJ dislocation may occur in some patients due to unstable joint structure, ligament laxity and systemic diseases (e.g. Parkinson's disease or medication effects). The incidence of recurrent TMJ dislocation is highest in young women. The patients are troubled by the pain from recurrent TMJ dislocation and frequent visits to emergency room. Few patient would even try to self reduce the dislocated joint.
Management of recurrent TMJ dislocation depends on the following conditions:
Treatment of TMJ dislocation
Intra-articular injection into the articular cavity and ligament/pericapsular tissues? Traditionally TMJ dislocation was treated with intra-articular injection with sclerosing agent to fix the hypermobile joint. But sclerosing agent is likely to be harmful to the surrounding tissues. Later autologous blood was introduced to replace the sclerosing agent for intra-articular injection to induce local inflammation (Brachmann, 1964; Schulz S, 1973; Machon V, 2009), combined with restriction of mandibular movements, leading to local fibrosis and adhesion. The advantages of intra-articular injection with autologous blood for TMJ dislocation are little side effect, easy-to-apply and repeatable properties. More than 80% of successful rate was shown on patients who received the treatment for more than one year. Surgical treatment Open joint surgery with preauricular incision is performed to limit condylar hypermobility under general anesthesia so the condyle cannot be easily dislocated from the fossa or can be easily repositioned. Different types of surgery for TMJ dislocation include: (1) Pplication of lax capsule of TMJ (2) Eminectomy or augmentation of eminence (3) Llateral pterygoid myotomy (4) Combination of the above mentioned surgical approaches
Reposition the dislocated TMJ un the shortest time can minimize the harm
Patients with recurrent TMJ dislocation should closely cooperate with the doctors to keep restricted mandibular movement, practice proper mouth opening exercise and have regular follow-up visits in order to have satisfying treatment results.
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All Written Contents and Pictures Created by Dr. Adrian M. Hsieh and Dr. Scott H. Jiang
Aesthetic Medicine Department Plastic Surgery DepartmentAesthetic Dentistry Department
Results of surgery vary among patients. Please consult your doctor.
