Surgical managements of subluxation and dislocation of the temporomandibular joint: clinical and experimental studies

Subluxation and dislocation of the temporomandibular joint (TMJ) are very unpleasant and distressing conditions to patients; they are not common diseases, but large groups of people in countries such as Yemen and Somalia are affected owing to daily chewing of Qat for several hours every day, but in Iraq, the conditions are not common. These clinical studies were conducted on 133 patients: 87 men and 36 women; their age ranged between 18 and 72 years (mean, 45 y), and their complains were difficulties of chewing food, speech, laughing, or yawning. Patients were divided into 3 groups: the first group included 65 patients (45.53%) who were treated by surgical reconstruction of the TMJ by using a fingerlike fascial flap from the temporal fascia for reconstruction of a lax capsule and reenforcement and a block of corticocancellous bone graft from the iliac crest squeezed and impacted in a gap in front of the eminence of TMJ; the second group included 15 patients with delayed dislocation of TMJ (12.20%) who were treated by surgical release fusion of the capsule and condyle from the infratemporal fascia with reenforcement of the capsule by reverse L-shaped plication technique and eminectomy; and the last group included 45 patients with acute dislocation of the TMJ (34.96%) who were treated by modified manual reduction, and follow-up of the patients was between 1 and 20 years. An experimental study was done on rabbits to support our clinical study by using a temporal fascial flap for the reconstruction of a rabbit TMJ capsule, and the aim was to show that any pathologic changes might occur in the capsule or the condyle. The result was very optimistic, and there were no cellular changes observed in the condyle or surrounding structures.