J Stomatol Oral Maxillofac Surg 118 (2017) 40–44

Available online at

ScienceDirect
www.sciencedirect.com

Review

Implication of general anaesthetic and sedation techniques in

temporomandibular joint disorders – a systematic review
J. Talaván-Serna a,*, J.M. Montiel-Company b, C. Bellot-Arcı́s b, J.M. Almerich-Silla b
a
Department of Anaesthesiology and Reanimation, Ontinyent General Hospital, Avda. Francisco Cerdà, 3, 46870 Valencia, Spain
b
Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, C/Gascó Oliag No. 10, 46010 Valencia, Spain

A R T I C L E I N F O A B S T R A C T

Article history: The purpose of this study was to conduct a systematic review of the literature on temporomandibular
Received 15 September 2016 joint damage directly related to general anaesthesia and sedation. We searched MEDLINE, SCOPUS and
Accepted 12 December 2016 the COCHRANE Library for titles and abstracts containing terms related to the subject. The search
Available online 3 February 2017
delimiters were analytical and descriptive studies with abstracts in Spanish, German, English or French,
with no time limit. The search was updated in January 2015. Of the 398 articles found, 89 were duplicates
Keywords: and only 28 were of interest. Of these, 23 (82.14%) were case and case series reports, 4 (14.28%) were
Mandibular
longitudinal studies and 1 (3.57%) was a cross-sectional study. General anaesthesia and sedation are risk
Joint
Sedation
factors for temporomandibular joint damage because of the drop in muscle tone caused by the drugs
Anaesthesia employed and because of airway management manoeuvres involving the joint. Joint complications have
Disorders been described with spontaneous ventilation as well as with ventilation assisted by a face or laryngeal
mask and with intubation. They are more frequent in women and/or patients with previous
temporomandibular problems. Proper assessment is required both before and after anaesthesia or
sedation in order to foresee and avoid or minimize temporomandibular complications. The data should
be treated with caution, as the evidence of case and case series reports is not of a high standard and the
small number of analytical studies is not entirely comparable. General anaesthesia and sedation
techniques can influence the onset of temporomandibular joint disorders. More studies are needed to
provide better clinical evidence.
C 2016 Elsevier Masson SAS. All rights reserved.

1. Introduction under general anaesthetic can predispose to greater joint

Many types of anaesthetic- and sedation-related temporoman-
dibular joint (TMJ) damage or disorder have been described. They
range from slight discomfort and joint sounds [1,2] to headaches
and even to severe impairment of joint movement and malocclu-
sion problems [3–5] that interfere seriously with stomatognathic
system function. However, the ultimate aetiology of such events is
largely unknown [6,7], although it has been suggested that factors
related to anaesthetic techniques may be involved [4,8], since
airway management entails mobilising the mouth and TMJ system
[9,10] while the patient is unconscious and partially or totally
unable to make defensive movements. While manoeuvring the
joint, complications may arise. In the same way, loss of muscle tone
due to the unconsciousness and muscular relaxation of a patient
mobilisation [11,12], which can lead to more complications than
those already involved in mobilisation for airway control. Prior TMJ
dysfunction or certain systemic conditions can favour the
development of new onset TMJ problems or the exacerbation of
existing manifestations when general anaesthetic techniques are
applied to the patient [13,14].
Additionally, there is widespread unawareness of the different
manifestations of TMJ damage that can appear after using
anaesthetic techniques or in relation to the various airway control
techniques [6,7].
In view of the foregoing, the aim of this study was to conduct a
systematic review of the literature concerning damage to the
temporomandibular joint directly related to different general
anaesthesia and sedation methods, in order to acquire a better
understanding of the factors involved.

* Corresponding author. Unidad Docente de Preventiva, Departamento de
Estomatologı́a, Facultad de Medicina y Odontologı́a, Universidad de Valencia, C/
Gascó Oliag No. 10, 46010 Valencia, Spain.
E-mail address: jutaser@alumni.uv.es (J. Talaván-Serna).
2. Methods
We reviewed the bibliography systematically in accordance
with the PRISMA (Preferred Reporting Items for Systematic

http://dx.doi.org/10.1016/j.jormas.2016.12.002
2468-7855/ C 2016 Elsevier Masson SAS. All rights reserved.
 J. Talaván-Serna et al. / J Stomatol Oral Maxillofac Surg 118 (2017) 40–44 41

Reviews and Meta-Analyses) recommendations [15] and the
CONSORT criteria [16].
2.1. Study selection criteria
The selection criteria for inclusion in the review were: articles,
articles in press and reviews; studies conducted in adults. The
types of study included were: systematic reviews and meta-
analyses, randomised controlled trials (RCTs), cohort studies and
case-control studies, both prospective and retrospective, and case
and case series reports. All those that investigated the involvement
of general anaesthetic and sedation techniques in temporoman-
dibular joint disorders were accepted.
2.2. Search strategy and screening of articles
To identify the relevant studies, irrespective of language and
with no time limit, we conducted detailed electronic searches in
the Medline, Scopus and Cochrane Library databases, updating
them on 20 January 2015.
The search equations were formed from the following terms:
temporomandibular, temporomandibular joint, TMJ, temporo-
mandibular disease, TMD, temporal, mandibular, intubation,
laryngoscopy, laryngoscope, extubation, anaesthesia, anesthesia,
anaesthetic, anesthetic, induction, dislocation, jaw, perioperative,
laryngeal mask, LMA, joint, propofol, ketamine and midazolam,
using all the possible combinations of these words.
Two separate reviewers independently assessed the titles and
abstracts of all the articles. If they disagreed they attempted to
reach a consensus, failing which they consulted a third reviewer. If
the information given in the abstract was insufficient for definite
inclusion or exclusion, they reviewed the full article before taking
the final decision.
2.3. Data extraction
The variables recorded for comparison of the studies were:
author(s), publication year, demographic data (gender and age),
sample size, study type and disorder described (Table 1).
3. Results
The database search found 302 articles in Medline, 84 in Scopus
and 12 in Cochrane Library Plus, totalling 398 articles. The
89 duplicates were excluded. A critical reading of the title and
abstract led to excluding 279 articles that did not answer the
research question, leaving a total of 30 articles. On reading the full
text, a further 2 were excluded because they did not answer the
research question, resulting in a total of 28 articles.
Of these 28 articles, 23 were case and case series reports (Table
1), four were longitudinal studies and one was a cross-sectional
study (Table 2). The case and case series reports assessed
28 patients: 19 female (67.8%) and 9 male (32.14%). By anaesthetic
procedure, a general anaesthetic was applied in 27 cases (96.42%)
and sedation techniques in one case (3.57%). By disorder,
21 patients presented dislocation of one or both condyles
(75.0%), six patients (21.4%) had disc dislocation with locking
and one case (3.5%) showed TMJ condyle resorption. The mean age
was 40.89 years (female: 37.3, range 18–66 years, male: 48.5,
range 22–81 years) (Table 1).

Table 1
Distribution of case and case series reports.

Author (year) [reference] n Age Gender Anaesthetic When disorder occurred TMJ disorder
(F/M) technique

Avidan (2002) [20] 1 26 F S Induction CD

Diagnosis: Postoperative
Bellman and Babu (1978) [11] 1 18 F GA Induction (pre-intubation) CD
Gambling and Ross (1988) [19] 1 30 F GA Induction (pre-intubation) CD
Gould and Banes (1995) [9] 2 34 F GA Induction (pre-intubation) in one case. DDL
24 F Not specified in the other case
Diagnosis: post-extubation (postoperative)
Iguchi et al. (2004) [26] 1 43 F GA Induction (pre-intubation) DDL
Knibbe et al. (1989) [3] 3 27 F GA Not specified DDL
31 M Diagnosis: postoperative DDL
81 M CD
Mareque-Bueno et al. (2013) [5] 1 52 F GA Not specified CR
Diagnosis: postoperative (late)
Michot et al. (2010) [24] 1 42 F GA Eduction (removal of laryngeal mask) CD
Oofuvong (2005) [10] 1 30 F GA Induction of anaesthesia (intubation) CD
Patel (1979) [12] 1 55 M GA Induction CD
Pillai and Konia (2013) [22] 1 66 F GA Not specified CD
Diagnosis: postoperative
Quessard et al. (2008) [7] 1 49 M GA Not specified CD
Diagnosis: postoperative
Rastogi et al. (1997) [4] 2 36 F GA Not specified CD
35 M Diagnosis: post-extubation (postoperative)
Rattan and Arora (2006) [30] 1 22 M GA Not specified CD
Diagnosis: post-ICU (late)
Roze des Ordons and Townsend (2008) [29] 1 39 F GA Induction (pre-intubation) DDL
Sia et al. (2008) [6] 2 64 M GA Induction (intubation/insertion of laryngeal mask) CD
60 F
Small et al. (2004) [28] 1 40 F GA Induction of anaesthesia (pre-intubation) CD
Schwartz (2000) [8] 1 69 M GA Postoperative CD
Sosis and Lazar (1987) [25] 1 27 F GA Induction (intubation) CD
Sriganesh et al. (2005) [14] 1 34 F GA Induction (intubation) CD
Ting J. (2006) [21] 1 45 F GA Not specified CD
Diagnosis: after removal of laryngeal mask (postoperative)
Unnikrishnan et al. (2006) [27] 1 31 M GA Induction CD
Wang et al. (2009) [23] 1 35 F GA. Extubation (eduction of anaesthesia) CD

F: female; M: male; GA: general anaesthesia; S: sedation; CD: condyle dislocation; DDL: disc dislocation and locking; CR: condylar resorption.
42 J. Talaván-Serna et al. / J Stomatol Oral Maxillofac Surg 118 (2017) 40–44
Table 2
Analytical articles.
Author/year [reference] n Mean age Gender
(years) (F/M)
Rodrigues et al. (2009) [2] 100 44 M: 34%
F: 66%
Martin et al. (2007) [1] 122 53.4 M: 43.3%
F: 56.7%
Lipp et al. (1987) [18] 100 42.2 (GA) – GA with
46.8 (LRA)
Agró et al. (2015) [13] 68 50.6 M: 58.8
F: 41.2
Domino et al. (1999) [17] 4460 claims – M: 85%
(27 TMJ-related) F: 15%
F: female; M: male; GA: general anaesthesia; LRA: locoregional anaesthesia.
Of the analytical studies, [17] examined the ASA Closed Claims
Project, which records the data from 35 health insurers in the USA,
to identify anaesthesia-related claims and collect information on
airway lesions associated with general anaesthesia, the patients’
clinical manifestations and airway characteristics and the type of
surgery. Agrò et al. [13] examined clinical manifestations in
68 patients before and after tracheal intubation in order to assess
TMJ disorders and/or dysfunctions. Similarly, Martin et al. [1]
conducted a study in 122 patients who had undergone tracheal
intubation in relation to different types of surgery. They assessed
pre- and postoperative TMJ-related clinical manifestations in order
to investigate the risk factors associated with TMJ dysfunction
following intubation. Lipp et al. [18] described a controlled
prospective study in which 50 patients underwent surgery with
general anaesthesia and orotracheal intubation and another
50 with locoregional anaesthesia (control group), and all were
examined postoperatively to assess possible intubation-related
TMJ damage. Rodrigues et al. [2] conducted a prospective study of
100 patients with no previous TMJ disorder, assessing disturbances
to this joint following tracheal intubation for different types of
surgery. They recorded the patients’ clinical and demographic
variables postoperatively in order to study new onset development
of joint disorders following intubation.
4. Discussion
It would appear to have been established that forcing mouth
opening can cause TMJ complications [3,19–22], the most frequent
in this joint being anterior dislocation [10,22,23], although the TMJ
accounts for only 3% of joint dislocations in the entire body
[22]. However, there is little information on the incidence of this
peri-anaesthesia complication [4,7,24]. The symptoms of TMJ
dislocation can range from a serious acute clinical picture with
severe pre-auricular pain and inability to close the mouth to a
subacute picture of less obvious pain and partial mouth closure,
but both are associated with difficulty in speaking and present a
depression in the pre-auricular area on palpation [22]. In contrast,
subluxation involves spontaneous reduction of the joint [8]. Several
authors [3,7,8,10,11,14,22,25] mentioned TMJ condyle (sub)luxa-
tions related to orotracheal intubation manoeuvres under general
anaesthetic with hypnotic and neuromuscular blocking drugs. In
these cases, the mere drop in muscle tone and loss of defensive
reflexes caused by general anaesthesia, together with laryngo-
scope traction for intubation, were sufficient for this phenomenon
to occur [10–12,21,26,27].
Patel et al. [12] and Avidan et al. [20] referred to cases of TMJ
dislocation following the induction of anaesthesia before invasive
airway control had been effected: a few spontaneous actions (such
Anaesthetic Results
technique
GA with 8% disc displacement (female to male ratio 7:1)
intubation 19% joint sounds (female to male ratio 4:1)
GA with Advanced age, female gender and low interincisal distance are risk
intubation factors for TMJ pain
Greater risk if prior TMJ disorder
No relationship between intubation time and TMJ symptoms
66% of the patients who underwent general anaesthesia presented
intubation/LRA up to 35% reduction of maximum mouth opening
GA with 13% presented some type of TMJ dysfunction prior to surgery.
intubation Of these, 44% worsened after intubation
5% of patients developed new onset TMJ dysfunction
GA Of the 27 claims, 11 were for joint dislocation and 16 for isolated pain
30% presented discomfort due to previous joint disorders
as yawning) were enough to dislocate the condyle. In the same
way, Unnikrishnan et al. [27] described a case of condyle
dislocation associated with yawning during the induction of
anaesthesia in a tracheostomy tube wearer. In these cases,
moreover, neuromuscular blocking drugs had not yet been
administered. Similarly, Gambling et al. [19] published an
analogous case of condyle dislocation after anaesthesia had been
induced with hypnotic and neuromuscular blocking drugs but
prior to intubation manoeuvres. As in the previous cases, joint
reduction under sedation was required after this early diagnosis of
condyle subluxation.
Other manoeuvres associated with invasive airway manage-
ment which do not require excessive opening, such as intubation
with a fibrescope or lighted stylet, have also been described as
possible joint dislocation triggers. Rastogi et al. [4] described a
case of TMJ condyle dislocation following intubation with a
fibrescope and the administration of general anaesthesia with
neuromuscular blocking drugs. The same authors also reported
a case of condyle dislocation in a patient with orotracheal
intubation with a lighted stylet following induction of anaes-
thesia with hypnotic and neuromuscular blocking drugs. Direct
laryngoscopy manoeuvres had not been performed in either
of these two cases, but their mouths were sufficiently open to
carry out the airway management procedure. Following the
intervention, their respective joints were repositioned under
sedation.
Although most dislocations occur during intubation manoeu-
vres while inducing anaesthesia, Wang et al. [23] reported a case of
condyle dislocation in a 35-year-old patient in relation to excessive
oral opening during orotracheal extubation.
Cases of mandibular dislocation during laryngeal mask inser-
tion have also begun to be reported, even in patients with no
previous history of TMJ disorders [6,21,24]. The reason is that head
tilt and chin lift manoeuvres tend to be used to position these
airways, causing passive wide opening of the mouth, which
together with the low muscle tone induced by the general
anaesthesia predisposes to joint dislocation [6].
Other studies report disc dislocation with locking but no
condyle dislocation. Gould et al. [9] described two such cases. In
one, the jaw locked even before laryngoscopy manoeuvres had
begun. Small et al. [28] and Roze des Ordons et al. [29] described
similar cases. In the case reported by Small et al. [28], the disk
dislocation reduced spontaneously. In these cases, difficult airway
management situations arose that required special intubation
techniques. Knibbe et al. [3] and Iguchi et al. [26] also reported
cases of disk displacement with locking.
Cases of condyle resorption in which malocclusion and facial
deviation developed several months after performing difficult
 J. Talaván-Serna et al. / J Stomatol Oral Maxillofac Surg 118 (2017) 40–44
orotracheal intubations have also been described. These could be
related to infectious, autoimmune, endocrine, cardiovascular,
metabolic or traumatic factors [5].
Consequently, it could be argued that temporomandibular
dysfunction following laryngoscopy and intubation or the inser-
tion of a laryngeal mask does not imply failings in these
techniques, as the structure of the TMJ and the wide range of
movements it can perform [23] make this joint quite susceptible to
instability and it may even dislocate when no external force has
been applied [25,27]. At all events, spontaneous dislocation of the
temporomandibular joint and TMJ disorders arising as a result of
general anaesthesia have not yet been clarified sufficiently [6] and
probably have a multifactorial origin.
It would be advisable to assess TMJ status preoperatively in
order to plan the intubation accordingly [1–4,7,10,13,28], as
recommended by the American Society of Anesthesiology [22], and
to proceed cautiously [6] during induction and intubation,
checking the occlusion in the event of any suspicion of joint
dislocation [30]. The patient should also be warned of the risk of
such complications, which could even be triggered de novo
following airway manipulation in the context of general anaes-
thesia [2–4]. In severe cases, postponement of surgery might even
be considered until the TMJ disorder has been resolved [3].
It would also be advisable for the anaesthetist to be conscious of
these complications [19], to be as careful as possible [6], to check
during the application of anaesthesia and perianaesthetically that
TMJ disorders are absent, and to be able to diagnose and treat them
[3,7,10,14,25,30], especially in the case of dislocation, where
delayed diagnosis can lead to greater difficulty in correcting the
problem [6,20].
Diagnosing TMJ complications in patients with intubation can
be complex, owing to communication difficulties as a result of the
general anaesthesia, analgesic medication prescribed perioperati-
vely, which can mask TMJ pain, and a lack of familiarity with joint
dislocation among healthcare staff [22]. As a result, the condition is
often not diagnosed until the patient recovers full consciousness
and is able to communicate the feeling of pain and the inability to
move the mouth [4,6,23]. Prolonged unconsciousness, such as may
occur in intensive care patients, can therefore entail a considerable
delay in diagnosis. For instance, Rattan and Arora [30] describe the
case of a 22-year-old man whose prolonged orotracheal intubation
was followed by late diagnosis of TMJ condyle dislocation, which
required surgical reduction as closed reduction was no longer
possible. On occasion, the diagnosis may be still tardier, even
occurring weeks or months after the patient’s postoperative
discharge [3].
According to Martin et al. [1], the patient’s ability to open
the mouth preoperatively is correlated with the Mallampati
score, although the latter is not a good predictor of TMJ
dysfunction. They also consider that low interincisal distance,
female gender and increasing age are correlated with TMJ pain
following intubation and that previously experience of TMJ
symptoms is the best predictive factor for post-intubation
symptoms, even up to two weeks after this procedure. A greater
or lesser duration of intubation appears not to be related to TMJ
symptoms [1].
It seems to have been established that TMJ dysfunction can be
aggravated by intubation manoeuvres. For instance, Agrò et al.
[13] reported that up to 13% of the population presents symptoms,
which suggest TMJ dysfunction prior to general anaesthesia, and
the symptoms of 44% of these worsened following intubation.
Moreover, up to 5% of patients developed new onset TMJ
dysfunction. In the prospective study conducted by Gould et al.
[9], 35 of the 15 patients who underwent intubation presented
TMJ disorders, albeit temporary, and two cases presented disc
displacement with locking. Lipp et al. [18] reported up to 66% of
43
minor TMJ incidents following intubation in a series of
50 patients.
Domino et al. [17] found that 10% of the claims for airway
trauma (27 out of 266) were for TMJ damage, in all cases associated
with ordinary tracheal intubation in ASA I–II patients. Out of this
total, 85% of the claims were made by women and 96% by persons
aged under 60 years. Of the 27 TMJ trauma claims, 11 were for joint
dislocation and 16 were for pain. 30% of the cases had a previous
history of TMJ disorders.
Certain conditions, such as some autoimmune diseases that
affect joints; diseases that cause hyperlaxity and fragile connective
tissues; malocclusion problems; retrognathism; algodystrophic
TMJ syndromes; a previous history of joint dislocation favoured by
flatness of the articular eminence; muscle hypotonia; or even
psychogenic factors, can favour TMJ disorder development in the
course of airway control manoeuvres during anaesthesia, as the
loss of muscle tone is combined with forced manoeuvres with a
susceptible joint [4,6–8,13,14,19,22,23,25,27,28]. However, it
would also appear that not achieving adequate neuromuscular
relaxation could make laryngoscopy manoeuvres more difficult
and oblige the anaesthetist to increase the force applied to the
adjacent tissues and to the TMJ itself, predisposing this joint to
greater damage [9]. Moreover, slow induction of general anaes-
thesia is also a risk factor for TMJ disorders [7,24] as it makes it
necessary to extend the duration of airway control manoeuvres,
which are one of the risk factors for joint disorders. In the same
way, a difficult airway adds to the difficulties and using more
aggressive manoeuvres increases the risk of joint dislocation
[3,8,28].
The main limitation of this review is that few studies have been
published on TMJ disorders related to general anaesthetic and
sedation techniques and most of those published are case or case
series reports of isolated instances encountered while applying
these procedures. This means that the evidence they provide is of a
low standard. A higher standard of evidence was provided by some
authors [1,2,13,17,18], although the fact that their number is very
small and the variables analysed by each of them were highly
disparate makes them difficult to analyse with a view to arriving at
definite conclusions.
Despite the few studies found, we may conclude that intubation
can cause TMJ disorders, although their percentage is small. The
most frequent is condyle dislocation followed by disc locking. A
record of TMJ problems is a risk factor for postoperative joint
complications. More studies of higher evidence quality need to be
conducted on TMJ disorders in relation to general anaesthetic and
sedation procedures.
Contributions
Conception and design of study: J. Talaván-Serna, J.M. Montiel-
Company.
Acquisition of data: J. Talaván-Serna, J.M. Montiel-Company,
C. Bellot-Arcis, J.M. Almerich-Silla.
Analysis and/or interpretation of data: J. Talaván-Serna, J.M.
Montiel-Company, C. Bellot-Arcis.
Drafting the manuscript: J. Talaván-Serna, J.M. Montiel-
Company, C. Bellot-Arcis.
Revising the manuscript critically for important intellectual
content: J. Talaván-Serna, J.M. Montiel-Company, C. Bellot-Arcis.
Approval of the version of the manuscript to be published:
J. Talaván-Serna, J.M. Montiel-Company C. Bellot-Arcis, J.M.
Almerich-Silla.
Disclosure of interest
The authors declare that they have no competing interest.
44 J. Talaván-Serna et al. / J Stomatol Oral Maxillofac Surg 118 (2017) 40–44
Acknowledgements
Mary Georgina Hardinge translated the manuscript into
English.
References
[1] Martin MD, Wilson KJ, Ross BK, Souter K. Intubation risk factors for temporo-
mandibular joint/facial pain. Anesth Prog 2007;54:109–14.
[2] Rodrigues ET, Suazo IC, Guimaraes AS. Temporomandibular joint sounds and
disc dislocation incidence after orotracheal intubation. J Clin Cosm Investig
Dent 2009;8:71–3.
[3] Knibbe MA, Carter BJ, Frokjer GM. Postanesthetic temporomandibular joint
dysfunction. Anesth Prog 1989;36:21–5.
[4] Rastogi NK, Vakharia N, Hung OR. Perioperative anterior dislocation of the
temporomandibular joint. Anesth Analg 1997;84:924–6.
[5] Mareque-Bueno J, Fernández-Barriales M, Morey-Mas MA, Hernández-Alfaro
F. Progressive mandibular midline deviation after difficult tracheal intubation.
Anaesthesia 2013;68:770–2.
[6] Sia SL, Chang YL, Lee TM, Lai YY. Temporomandibular joint dislocation after
laryngeal mask airway insertion. Acta Anaesthesiol Taiwan 2008;46:82–5.
[7] Quessard A, Barrière P, Levy F, Steib A, Dupeyron P. Luxation de l’articulation
temporomandibulaire diagnostiquée au décours d’une anesthésie générale.
Ann Fr Anesth Reanim 2008;27:846–9.
[8] Schwartz AJ. Dislocation of the mandible: a case report. J Am Assoc Nurse
Anesth 2000;68:507–13.
[9] Gould DB, Banes CH. Iatrogenic disruptions of right temporomandibular joints
during orotracheal intubation causing permanent closed lock of the jaw.
Anesth Analg 1995;81:191–4.
[10] Oofuvong M. Bilateral temporomandibular joint dislocations during induction
of anesthesia and orotracheal intubation. J Med Assoc 2005;88:695–7.
[11] Bellman MH, Babu KV. Jaw dislocation during anaesthesia. Anaesthesia
1978;33:844.
[12] Patel A. Jaw dislocation during anaesthesia. Anaesthesia 1979;34:376.
[13] Agrò F, Salvinelli F, Casale M, Antonelli S. Temporomandibular joint assess-
ment in anaesthetic practice. Br J Anaesth 2003;90:707–8.
[14] Sriganesh K, Farooq S, Byrappa V. Temporomandibular joint dislocation during
tracheal intubation in a patient with Sjogren syndrome. J Neurosurg Anes-
thesiol 2015;27:82–3.
[15] Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The
PRISMA statement for reporting systematic reviews and meta-analyses of
studies that evaluate health care interventions: explanation and elaboration.
PLoS Med 2009;21(6):e1000100 [Epub 2009 Jul 21].
[16] Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 statement:
updated guidelines for reporting parallel group randomised trials. BMC Med
2010;24(8):18. doi:10.1186/1741-7015-8-18.
[17] Domino KB, Posner KL, Caplan RA, Cheney FW. Airway injury during anesthe-
sia: a closed claims analysis. Anesthesiology 1999;91:1703–11.
[18] Lipp M, von Domarus H, Daubländer M, Leyser KH, Dick W. Auswirkungen
der intubationsnarkose auf die kiefergelenke. Anaesthesist 1987;36:
442–5.
[19] Gambling DR, Ross PLE. Temporomandibular joint subluxation on induction of
anesthesia. Anesth Analg 1988;67:91–2.
[20] Avidan A. Dislocation of the temporomandibular joint due to forceful yawning
during induction with propofol. J Clin Anesth 2002;14:159–60.
[21] Ting J. Temporomandibular joint dislocation after use of a laryngeal mask
airway. Anaesthesia 2006;61:201.
[22] Pillai S, Konia MR. Unrecognized bilateral temporomandibular joint disloca-
tion after general anesthesia with a delay in diagnosis and management: a case
report. J Med Case Rep 2013;18:243.
[23] Wang LK, Lin MC, Yeh FC, Chen YH. Temporomandibular joint dislocation
during orotracheal extubation. Acta Anaesthesiol Taiwan 2009;47:200–3.
[24] Michot JB, Compère V, Hardy H, Dureuil B. Luxation mandibulaire survenant à
l’ablation d’un masque laryngé. Ann Fr Anesth Reanim 2010;29:738–9.
[25] Sosis M, Lazar S. Jaw dislocation during general anaesthesia. Can J Anesth
1987;34:407–8.
[26] Iguchi N, Fukumitsu K, Kinouchi K, Kawaraguchi Y, Yamanishi T. Lockjaw
caused by induction of anesthesia in a volunteer bone marrow donor. Masui
2004;53:306–8.
[27] Unnikrishnan KP, Sinha PK, Rao S. Mandibular dislocation from yawning
during induction of anesthesia. Can J Anesth 2006;53:1164–5.
[28] Small RH, Ganzberg SI, Schuster AW. Unsuspected temporomandibular joint
pathology leading to a difficult endotracheal intubation. Anesth Analg
2004;99:383–5.
[29] Roze des Ordons A, Townsend DR. Trachlight management of succinylcholine-
induced subluxation of the temporomandibular joint: a case report and review
of the literature. Can J Anesth 2008;55:616–21.
[30] Rattan V, Arora S. Prolonged temporomandibular joint dislocation in
an unconscious patient after airway manipulation. Anesth Analg 2006;
102:1294.