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RECURRENT TMJ DISLOCATION

• OUTLINE  Introduction & definition  Epidemiology  Aetiology  Classification  Diagnosis  Investigation  Treatment  complication

cannot be reduced by patient or • Complete separation of articular surfaces with fixation of condyle in an abnormal position • Subluxation with excessive abnormal excursion of CH 2 to flaccidity & laxity of capsule or • Movt of the CH ant to eminence on wide opening of mouth. can be closed again quite easily [Pogrel 1987] – Habitual luxation .INTRODUCTION & DEFINITION • Displacement of condylar head completely out of glenoid fossa.

INTRODUCTION & DEFINITION • Recurrent dislocation xsed by CH sliding over the eminence. catching briefly beyond it & then returns to the fossa [Pogrel 1987] • Genuine (fixed ) luxation • RD assoc. with neurogenic dislocation increased tone of masticatory muscles .

masticatory movt to habitual rotational movt osteoarthrosis & atrophy of AE & a shallow GF . occurs in young women • Common in Yemen b/c of habitual qat chewingexcessive loading of TMJ. diagnosis excursive.EPIDEMIOLOGY • Uncommon condition.

under GA. RTA TMJ dx – osteoarthrosis.Angles class 2 div 1 . with systemic dx e.yawning Trauma.joint derangement Hypermobility assoc.dental & ENT TX.g Ehler’s Danlos syndrome.AETIOLOGY Extreme mouth opening.falls. CT disorders Malocclusion. int.

multiple sclerosis.g phenothiazine. antiemetic e. cos of alveolar bone resorption Ill-fitting denture Psychogenic & neurological disorders e.g Parkinson’s dx.g metoclopromide (extrapyramidal effects spasms of jaws & facial muscles Px with congenitally shallow GF or underdeveloped condyle .long term over-closure foll.AETIOLOGY Occlusal disharmony. Edentulism.tardive dyskinesia Neuroleptic drugs e.

palpable CH ant to AE. limited mouth opening. hollow ant to tragus.DIAGNOSIS • History of factors causing occlusal disharmony. pain in or around TMJ . ant open bite. familial hx of dislocation • Examination – check for mandibular prognathism. use of neuroleptic drugs. hyperextension of other joints. presence of psychogenic or neurological problems.

lat variant (moris & Hutton (1957) Posterior (Helmy 1957).CH moves ant to AE.CLASSIFICATION • Various exists Acute. assoc base of skull # or ant wall of bony meatus .movt of CH posteriorly. antero. chronic & recurrent (Rowe& Killey 1968) Anterior (Heslop 1956).

displacement of CH into middle cranial fossa ( assoc with # of GF) .CLASSIFICATION Lateral (Attery & Young 1969)-2 types: Type1 –lateral subluxation Type2 – complete dislocation with CH forced laterally & superiorly into temporal fossa ( assoc with parasymphyseal #) Superior (Zeccha 1977).

R & L oblique laterals • Conventional tomograms– orthopantomogram. reverse towne’s. others: PA . plain tomograms (lat) • Computerized tomograms-3D CT scans • MRI • Ultrasound .INVESTIGATION • Plain radiographs (TMJ views)– transcraniooblique.

Rest jaw 2-3wks Slow elastic traction with Erich pattern arch bars & post bite plane. Rest jaw for 2-3 weeks Chemical capsulorrhaphy using Na psylliate (Schultz 1949) 0. GA.5% 1ml soln of Na tetradecyl sulphate(STD) 3X 26wk interval  causes pericapsular fibrosis which limit CH excursion Injection of autologous blood into the joint Injection of botulinium toxin type A .TREATMENT-nonsurgical & surgical methods • Non-surgical methods Bimanual reduction with or without anxiolytics &/or LA.

tying a length of fascia lata or mersilene (Georgiade 1965) both to zygomatic arch & around condylar neck .SURGICAL METHODS • Restitution of ligaments & plication of capsule (surgical capsulorrhaphy). Suture line reinforced by turning down a flap of temporal fascia and securing this to both capsule & ligament • Limitation of forward movt by ligation of condyle.

vitallium mesh (Howe& Kent 1978). minimal donor site morbidity. low incidence of resorption. contain large amount of bone  Allele graft. etc.SURGICAL METHODS • Limitation of forward movt by augmentation of AE using:  bone graft from zygomatic arch.L-shaped SS pins (Findlay 1964).high quality. titallium miniplates (silastic implants . mastoid process. iliac crest & calvarium Calvarial graft.

slanting osteotomy • Elimination of dislocation by removal of AE (Myrrhaug (1951).px continues to dislocate but reduction by px is automatic & painlesscondylectomy(Reidel.SURGICAL METHODS • Down fracturing of zygomatic arch  Mayer (1933)  Leclerc & Girard (1943) vertical osteotomy  Dautrey & Gosserez (1964) post. condylotomy .

SURGICAL METHODS • Prevention of dislocation by removal of activating muscle Myotomy.lat pterygoid myotomy+/discectomy Temporalis myotomy (Laskin) .

COMPLICATIONS • • • • • • Relapse / recurrence Facial nerve palsy Limited mouth opening Infection Pseudoarthrosis Scar formation .