Reduction of prolonged bilateral temporomandibular joint dislocation by midline mandibulotomy

Various surgical procedures have been used to reduce prolonged bilateral dislocation of the temporomandibular joint, but with some complications. A prolonged bilateral dislocation of the mandibular condyle was simply reduced by a midline mandibulotomy without any complications. One year postoperatively, joint function was unimpeded and there was no recurrence of condylar dislocation.     

Arthrocentesis followed by intra-articular autologous blood injection for the treatment of recurrent temporomandibular joint dislocation

Temporomandibular joint (TMJ) dislocation is an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. This study was conducted to assess autologous blood injection to the TMJ for the treatment of chronic recurrent TMJ dislocation. Fifteen patients with bilateral chronic recurrent condylar dislocation were included in the study. Bilateral TMJ arthrocentesis was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxation, recurrence rate, and presence of facial nerve paralysis. Eighty percent of the subjects (12 patients) had a successful outcome with no further episodes of dislocation and required no further treatment at their 1-year follow-up, whereas three patients had recurrent dislocation as early as 2 weeks after treatment. Autologous blood injection is a safe, simple, and cost-effective treatment for chronic recurrent TMJ dislocation.     

手法复位在单侧颞下颌关节前脱位复位中的应用

目的:探讨单侧颞下颌关节前脱位手法复位法。方法:对32例单侧颞下颌关节前脱位患者,采用单手法复位。结果:全部病例均复位成功,复位时间短,复位过程中患者配合好,无明显痛苦。结论:单手复位法是单侧颞下颌关节前脱位的有效复位方法。     

Posterior dislocation of the temporomandibular disc

In the literature, posterior dislocation of the disc of the temporomandibular joint is seldom mentioned. Although this dislocation occurs rarely, it is important to differentiate this clinical entity from other joint disturbances. After a review of the literature, 3 patients are presented. Repositioning of the disc is succeeded in all 3 cases by manipulation. There were no signs of osteoarthrotic changes on follow-up.     

自体血注射治疗复发性颞下颌关节脱位的临床观察

对19例复发性颞下颌关节脱位患者行关节腔和囊周组织自体血注射治疗。1年后随诊,16例无关节脱位复发,有效率为84.2%。也没有观察到TMJ骨质破坏和关节强直的现象。自体血注射治疗复发性颞下颌关节脱位是一种简单、安全、经济、有效的微创治疗方法。     

Increasing the articular eminence by the use of blocks of porous coralline hydroxylapatite for treatment of recurrent TMJ dislocation

Surgical operations are performed on some patients with recurrent dislocation of the temporomandibular joint. The surgical procedures applied are usually eminectomy and augmentation of the articular eminence. In this article, a surgical procedure for increasing the articular eminence using coralline porous hydroxylapatite is described. The implant is used as an interpositional bone graft placed into a gap created by an osteotomy of the articular eminence. Meniscoplasty is performed simultaneously as an additional operation. This procedure has been performed on eight TMJ's in five patients who had had severe recurrent dislocation. The immediate and further postoperative results were highly successful and no recurrence of dislocation was observed during this period of time.     

Risk factors for intraoperative dislocation of the total temporomandibular joint replacement and its management

Total replacement of the temporomandibular joint (TMJ) is an effective treatment for intractable pain and impaired function that is a consequence of end-stage joint disease. Prospective assessment of 138 joint replacements identified an 8% risk of intraoperative dislocation of the joint, which was associated primarily with coronoidectomy (30%) and inflammatory arthropathy (24%). Management included the use of intermaxillary elastic traction and treatment of masticatory dystonia when present. Of the 11 patients who had light elastic traction for one week, only one required further treatment for dislocation. Patients with no intraoperative dislocation did not require elastics, and joints remained stable postoperatively.     

Treatment of recurrent temporomandibular joint dislocation with intramuscular botulinum toxin injection

Recurrent dislocation of the mandibular condyle poses a difficult problem for affected patients. In the course of time, dislocations often become more frequent and more difficult to avoid. Even with good patient compliance, conservative treatment is often not sufficient. Operative procedures have also been described for the treatment of temporomandibular joint dislocation. However, these interventions are invasive, involving open arthrotomy with possible complications, and cannot safely guarantee a successful outcome. On the other hand, botulinum toxin injections into the lateral pterygoid muscles offer the option of a predictable and prolonged period without renewed dislocation. We present the results of this treatment carried out in 21 patients with recurrent temporomandibular joint dislocation. Four patients were treated following unsuccessful physical therapy and the use of occlusal splints. The remaining 17 patients were treated for a number of conditions resulting in dislocation, including some with senile dementia and mental impairment in whom compliance with conservative measures was poor or completely absent. Injections were given on a 3-month basis in order to have a sustained effect. Within the study period of 6 months to 3 years, only two of the 21 patients suffered further dislocation. There were no side effects recorded as a result of treatment.     

Bilateral Posterior Dislocation of Mandibular Condyle: A Rare Entity in Maxillofacial Injuries

BackgroundDislocation of the mandibular condylar head refers to ectopic positioning of the intact condylar head out of the glenoid fossa. Most commonly reported anterior dislocation results from anteromedial pull of the lateral pterygoid muscle and laxity of the surrounding tissue with advanced age.PurposeThis case report brings forth a unique case of bilateral posterior condylar dislocation in an edentulous patient who reported after 4 weeks of traumatic injury.MethodThe condition was managed surgically by reduction of the dislocated condyle and placement of mersilene tape on one side and temporalis muscle on the other side as anchorage ligament to stabilize the condyle and prevent any future recurrence.ResultsThe patient was maintained on long-term follow-up for up to one year with no reported recurrence or reduction in mouth opening.ConclusionThis is the first ever case report that highlights bilateral posterior dislocation of intact mandible unlike the previous four reports which have brought forth unilateral dislocation on English literature search. Posterior dislocation of mandibular condyle is encountered in edentulous patients who experience posteriorly directed impact which forces the condylar head behind the postarticular ridge. Unlike anterior dislocation, clinical features include reduced mouth opening and retruded mandible in bilateral dislocation. It has been observed that manual correction by pressing the mandible downwards and forwards yields good results in early cases. Cases that are reported late require surgical exploration for reduction and placement of anchorage ligament to prevent recurrence in unstable condyle.     

Arthroscopic electrothermal capsulorrhaphy for the treatment of recurrent temporomandibular joint dislocation

Acute temporomandibular joint dislocation is a common occurrence that is generally treated by conservative therapy. In some patients, this can become a chronic recurrent condition. This recurrent temporomandibular joint dislocation (RTD) can significantly decrease the patient's quality of life and require some form of surgical intervention for correction. The purpose of this study is to present a minimally invasive alternative treatment for RTD using operative arthroscopy. 11 patients treated for recurrent temporomandibular dislocation between 2004 and 2010 were retrospectively analyzed. Electrothermal capsulorrhaphy was performed using a standard double puncture operative arthroscopy with a Hol:YAG laser and/or electrocautery. Postoperatively the patients were monitored for 6 months to 6 years. Of the 11 subjects, 2 suffered a recurrence of temporomandibular dislocation and required open arthrotomy for correction. The other 9 patients had no signs of recurrence or any significant postoperative loss of function. Electrothermal capsulorrhaphy is an effective and minimally invasive method for the treatment of RTD.     

Long-term results following miniplate eminoplasty for the treatment of recurrent dislocation and habitual luxation of the temporomandibular joint

Twenty patients with recurrent mandibular dislocation or habitual luxation of the temporomandibular joint who underwent miniplate eminoplasty between 1994 and 1999 are presented. The follow-up period ranged from 2 to 7 years. Clinical examination showed no evidence of recurrent dislocation. No significant reduction of normal mouth opening was found one year postoperatively. The pain level, self-estimated by the patients on a scale from 0 to 10, decreased significantly from 4.1 preoperatively to 1.2 one year postoperatively. In seven patients fractures of the miniplates occurred 3 to 7 years after eminioplasty (two bilateral fractures, five unilateral fractures). Due to the high incidence of plate fractures miniplate eminoplasty cannot be recommended as the surgical treatment of choice for recurrent dislocation or habitual luxation of the mandible, although the recurrence rate is low and pain is reduced considerably.     

Chronic recurrent anterior luxation of the mandible. A review of 12 patients treated by the LeClerc procedure

A follow-up study was performed on 12 patients surgically treated because of chronic recurrent anterior dislocation of the temporomandibular joint by the LeClerc procedure which was refined by Gosserez & Dautrey. In all of the 12 patients, there had been no recurrence of the dislocation since the operation (follow-up period: up to 5 years and 3 months). This procedure did not disturb normal functional movement of the joint, yet prevented excessive forward excursion of the condyle. The surgical technique is presented and the results of this operation are evaluated.     

Surgical treatment of chronic temporomandibular joint dislocation: A case report

Introduction

Chronic dislocation of temporomandibular joint is usually treated with conservative approaches, but in some cases, surgery is needed to avoid recurrencies. The present paper described a case report of a bilateral intervention for articular tubercle height augmentation by means of calvaria bone grafts.

Materials and Methods

A 32-year-old woman attended the Department of Maxillofacial Surgery, University of Padova, Italy, in January 2007 seeking treatment for a bilateral recurrent temporomandibular joint dislocation. She was treated with a surgical procedure providing an antero-posterior osteotomy of the caudal portion of the articular eminence and the insertion of a calvaria bone graft, preserving the periosteum of the borders of the osteotomic beach. The newly remodeled articular eminence has an increased height, thus representing a barrier to condylar dislocation out of the glenoid fossa. No ostheosynthesis fixation was provided, and physiotherapic rehabilitation was started in the immediate postoperative phases to help the patient gain a good jaw function as soon as possible.

Results

Such a technique showed to be effective, as during an 8-month follow-up span, the patient referred no recurrencies of joint dislocation. Jaw motion parameters maintained good over the entire follow-up period, and radiological assessments showed no signs of bone grafts reabsorption.

Conclusions

The technique described in the present case report has some potential advantages over other surgical approaches to the treatment of recurrent temporomandibular joint dislocation that need to be assessed with future studies.     

脱位性髁突矢状骨折手术治疗的近期疗效观察

目的总结脱位性髁突矢状骨折（DSFMC）的手术治疗经验。方法将22例28侧DSFMC分型,总结各类型DSFMC的手术治疗方法,并对术前及术后6个月患者的咬合关系、最大张口度、张口偏斜、髁突术后形态等进行观察比较。结果①DSFMC以Ⅱ型骨折最多,占57%;其次为Ⅲ型骨折和Ⅰ型骨折,分别占25%和18%。②5侧Ⅰ型骨折均行骨折片摘除术;16侧Ⅱ型骨折中,9侧行骨折片游离再植加微型接骨板坚固内固定术,5侧行骨折片摘除,2侧切除髁突;Ⅲ型骨折中有5侧行骨折片游离再植加微型接骨板坚固内固定术,2侧行摘除骨碎片,修整髁突残端。③22例患者术后6个月平均张口度为33.9 mm,平均张口偏斜1.5 mm,均比术前明显改善（P<0.05）。术后6个月咬合关系完全恢复正常17例,5例术后仍有1~2 mm的前牙开!,经调!后,咬合关系恢复良好。④术后再植髁突未见明显吸收,微型接骨板无明显变形。结论DSFMC手术治疗可以取得较好的效果,张口度、张口型均较术前明显改善,咬合关系恢复良好,再植髁突无明显吸收。     

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目的研究超强纤维在替牙期儿童脱位牙固定中的临床效果。方法2005年5月至2008年3月采用超强纤维对辽宁医学院附属二院口腔修复科16例23颗替牙期儿童脱位牙进行固定,随访观察固定后患牙有无脱落、松动,牙龈、牙髓状况以及能否正常行使功能等。结果23颗再植牙于固定后0.5～2.5年期间观察效果良好,无脱落。X线片复查显示3颗于固定后1年时发现根侧有轻微吸收,4颗牙髓坏死。其余牙齿均无明显松动,牙龈附着正常,能正常行使功能。结论超强纤维作为一种新型材料,对脱位牙进行固定时具有美观、舒适、操作简单、有利于软硬组织愈合及对牙周健康无明显影响等优点,特别是对替牙期儿童术后护理及心理影响方面均具有良好的优势。     

Treatment of long term anterior dislocation of the TMJ

Acute dislocation of the temporomandibular joint (TMJ) is a relatively common occurrence; chronic long-term dislocation is rare. Variance in the duration of dislocation and anatomical considerations make the treatment for long-standing dislocation complex and controversial. This paper attempts to review the literature associated with chronic TMJ dislocation treatment options and presents the authors’ experience with a particularly long term dislocation.     

Traumatic injuries of deciduous teeth

Review of literature regarding frequency of traumatic injuries of primary teeth, types of injuries, therapy and possible consequences in permanent dentition. The diagram of prevalence shows no direct correlation to age, whereas according to diagram of incidence 70% of injuries occur in the second and third years of life. Injuries without dislocation of the deciduous tooth: fractura coronae dentis decidui, contusio seu concussio dentis decidui, fractura radicis decidui. Injuries with dislocation: luxatio totalis dentis decidui, luxatio partialis dentis decidui, intrusio dentis decidui. Consequences of traumas can be detected in disturbances of second dentition, in developmental anomalies of enamel and in considerable deformities of homologous permanent tooth.     

Botulinum toxin treatment for upper airway collapse resulting from temporomandibular joint dislocation due to jaw-opening dystonia

To examine the effects of botulinum toxin injection application for the treatment of upper airway obstruction due to hyperactive lateral pterygoid muscle contraction, we applied botulinum toxin injection. A 20 year-old male patient had involuntary mouth opening after a diabetic coma. His mouth opened excessively (84 mm) particularly when he was in a nervous or stressed condition. This resulted in a bilateral temporomandibular dislocation and, consequently, upper airway collapse. The differential diagnosis of jaw-opening oromandibular dystonia was made. Botulinum toxin type A was bilaterally injected into the lateral pterygoid muscle. The excessive mouth opening was reduced, and the patient showed no temporomandibular joint (TMJ) dislocation or experienced any further airway collapse after the injections. We successfully applied botulinum toxin to a patient with upper airway obstruction and TMJ dislocation relative to jaw-opening dystonia.     

Superolateral dislocation of the intact mandibular condyle into the temporal fossa: review of the literature and report of a case

Anterior dislocation of the mandibular condyle is common, but superolateral dislocation is quite rare. Because of its rarity, this type of dislocation is often misdiagnosed or completely overlooked. We describe an additional case of superolateral dislocation of the intact condyle into the temporal fossa. We review all of the available English literature on superolateral dislocation and discuss a causative mechanism, the diagnostic features, and clinical management.     

Mitek anchors for treatment of chronic mandibular dislocation.

OBJECTIVE: The purpose of this study was to present a new technique for limiting mandibular translation in patients with chronic mandibular dislocation. TECHNIQUE DESIGN: This relatively simple procedure uses 2 Mitek mini bone anchors with osseointegration potential. One anchor is placed in the lateral pole of the condyle, and the other is placed in the posterior root of the zygomatic arch. Heavy suture material is threaded through the eyelet of each anchor and tightened to function as a restraining ligament. RESULTS: This technique has been used on 5 patients with a follow-up of 2 to 4 years, with no failures. CONCLUSIONS: This technique provides an effective method for the prevention of condylar dislocation while permitting some controlled translation.