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DISLOCATION
BY DR. MANISHA MISHRA
TMJ
The temporomandibular joint (TMJ) is the
articulation of the temporal and mandibular bones
TMJ dislocation occurs when the condyle travels
anteriorly along the articular eminence and
becomes locked in the anterior superior aspect of
the eminence, preventing closure of the mouth.
This results in stretching of the ligaments, and is
associated with severe spasm of the muscles that
open and close the mouth (ie, the masseter,
internal pterygoid, and temporalis) .
The resultant trismus prevents the condyle from
returning to the mandibular fossa
Causes:
Deep yawning
Prolong Dental procedures
Airway manipulation particularly in an
anaesthetised patient.
Dislocation can occur during laryngoscopy,
transoral fiberoptic bronchoscopy and
intubation.
Clinical
features:
TMJ dislocation may occur with trauma, but most
often follows extreme opening of the mouth
during yawning, laughing, singing, vomiting, or
dental treatment .
Dislocation also can result from dystonic reactions
to drugs .
Symmetric mandibular dislocation is most
common, but unilateral dislocation with the jaw
deviating to the opposite side also can occur.
TMJ dislocation is painful and frightening for the
patient.
On
examination
:
Diagnosis:
The dentist bases the diagnosis on the position
of the jaw and the person's inability to close his
or her mouth.
Radiographs of the TMJ are not always
necessary, but should be obtained to exclude
condylar fracture if the dislocation is related to
trauma
The problem remains until the joint is moved
back into place. However, the area can be tender
for a few days.
Treatment :
The muscles surrounding the temporomandibular joint
need to relax so that the condyle can return to its normal
position.
Many people can have their dislocated jaw corrected
without local anesthetics or muscled relaxants. However,
some people need an injection of local anesthesia in the
jaw joint, followed by a muscle relaxant to relax the
spasms.
The muscle relaxant is given intravenously (into a vein in
the arm). Rarely, someone may need a general anesthetic
in the operating room to have the dislocation corrected.
In this case, it may be necessary to wire the jaws shut or
use elastics between the top and bottom teeth to limit the
movement of the jaw.
Prognosis:
The outlook is excellent for returning the
dislocated ball of the joint to the socket.
However, in some people, the joint may continue
to become dislocated , If this happens, needs
surgery.