Dislocation of the temporomandibular joint (TMJ; see the image below) is a painful condition that occurs when the mandibular condyle. pada kasus Dislokasi mandibula dengan menggunakan modalitas Infrared, dan Kesimpulan:Infra Red dapat mengurangi nyeri pada dislokasi mandibula. The temporomandibular joint (TMJ) is an atypical synovial joint located between the condylar process of the mandible and the mandibular fossa and articular.
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Temporomandibular joint TMJ dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic.
Temporomandibular joint | Radiology Reference Article |
Acute TMJ dislocation is common in clinical practice and can be managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage.
In this article, we discuss the comprehensive review of the different treatment modalities in managing TMJ dislocation. The temporomandibular joint TMJ is a specialized joint between the mandible and the temporal bone of the skull. The condyle of the mandible articulates bilaterally in a concavity known as the glenoid fossa or the mandibular fossa.
Biomechanics of the TMJ is under neuromuscular control, comprising the muscles of mastication, the ligaments associated with it, and neural transmission carried by dislokxsi mandibular division of the trigeminal nerve. The pathophysiology of dislocation is the movement of the condylar process in front of the articular eminence and an inability to descend back to its normal position. It can be partial subluxation or complete luxationbilateral or unilateral, acute, and chronic protracted or chronic recurrent.
The other types such as medial, lateral, superior into the middle cranial fossa, and posterior are rare and are mostly associated with trauma. Dislocation of the TMJ is due to either imbalance in the neuromuscular function or structural deficit.
Alteration in the neuromuscular function occurs due to laxity of the articular disc and mandiibula capsular ligament, long-standing internal derangement, and spasm of the lateral pterygoid muscles. Structural deficit involves arthritic changes in the condyle, i. Some syndromes are also mandibulx with it such as the Ehlers-Danlos syndrome, orofacial dystonia, and the Mar fan syndrome.
The most common cislokasi symptom is the inability to close the oral cavity, i. In acute dislokaso, pain in the pre auricular region is present, but chronic recurrent dislocation is rarely associated with it. Usually bilateral and at times unilateral dislocation may lead to deviation of the chin to the contralateral side.
Palpation over the preauricular region may suggest emptiness in the joint space. The patient may look anxious. Clinical history and examination are the most important tools in diagnosing TMJ dislocation.
Other confirmatory diagnostic aids include plain and panoramic radiographies, showing the location of the condylar head anterior to the articular eminence. Three-dimensional computed tomography is the best in terms of its perfection to show this entity. On the basis of the clinico-radiological evaluation, Akinbami[ 17 ] classified TMJ dislocation into the following three types:. It is a very painful clinical condition, but easy to manage. The conservative methods in its manibula include symptomatic pain relief with analgesics and manual reduction.
The manual reduction method dislokasu performed by first pressing the mandible downward, then backward, and finally upward as described by Hippo crates. Then, the thumb should be pressed down on the occlusal surface of the lower molar teeth. At the same time, the chin should be elevated with the fingers and the entire mandible should be pushed posteriorly.
As the condition is very painful, it is always better to perform manual reduction under local anesthesia by giving auriculotemporal nerve block or local infiltration in the joint space. Role of the muscle relaxants in controlling the reflex muscle spasm is still debatable.
InAwang 20 manidbula another simple, safe, and rapid method in managing acute dislocation. According to him, induction of the gag reflex by probing the soft palate creates a reflex neuromuscular action that resulted in the reduction. If this condition is long-standing or recurrent, it poses a challenge to dislkasi treating clinician. The management is divided into two stages, the conservative methods mandibulq opted; if the results are not satisfactory, then we go for the surgical methods.
The conservative method includes the use of various sclerosing agents like alcohol, sodium dislokazi sulfate, sodium psylliate, morrhuate sodium, and platelet-rich plasma that has been injected into the joint space. The dislkoasi of autologous blood in recurrent dislocation was reported by Brachmann in and is very popular nowadays.
It is based on the principle to restrict mandibular movements by inducing fibrosis in the upper joint space, the pericapsular tissues, or both. To further enhance the fibrosis, restriction of the mandibular movement with a head bandage is required for the period of weeks. Previously, BTX-A was mandibulaa in the management of facial wrinkles, masseteric and temporalis muscle hypertrophies, strabismus, hyperhidrosis, hemifacial spasm, sialorrhea, and masticatory myalgia.
BTX injection therapy is also an option in those patients who suffer from recurrent dislocation of the TMJ as a result of impaired muscle coordination, secondary to oromandibular dystonia, neuroleptically-induced early and late dyskinesias, epilepsy, and brainstem stroke syndromes. It is contraindicated in a few conditions like hypersensitivity to BTX and myasthenia gravis in pregnant and lactating women. The surgical methods are indicated in those mandibupa where the patients have not responded well to the conservative methods.
InRowe and Killey used a bone hook that was passed over the sigmoid notch through a small incision below the angle of the mandible and downward traction was applied on the condyle.
Traction with wires was done by applying the wires through the holes drilled in the angle of the mandible. The tip of the elevator was used and strong force was applied in the downward and posterior directions. This method dislkoasi facilitates open reduction by extending the incision as used for the preauricular approach to the joint.
Various other methods like condylotomy, modified condylotomy, and myotomy had been tried. Condylotomy was used as a manxibula approach using a modified Kostecka approach and a Gigli saw. It is an open approach, usually using the preauricular route.
It limits the mandibular translation and allows only rotational movement of the condyle. InAdekeya et al. Few authors have suggested surgical procedures that either remove the mechanical obstacle in the condylar path or create a mechanical obstacle by augmenting the articular eminence. InMyrhaug first reported total eminectomy as a treatment for dislocation. The removal of the eminence will facilitate the return of the condyle without any interference into the glenoid fossa.
Initially inMayer described that downward displacement of the zygomatic arch acts by obstructing the path of the condylar translation. Later, Dautrey modified the technique in which the greenstick fracture was performed at the zygomaticotemporal suture and displaced the anterior dislokaai downward and inward to serve as a stop to the forward and the upward movements of the condyle head.
It cannot be performed in elderly people due to the brittleness of the bone; so, it is restricted to younger individuals. Fascia lata can be readily harvested and the treatment is cheaper but accompanied with postoperative pain, swelling, minor gait disturbance, and movement of the lower limb. Meniscoplasties and meniscectomies are relevant procedures done when the altered disc morphology dlslokasi the position cause dislocation or prevent self-reduction.
Total joint replacements should be considered when all the appropriate treatments fail in chronic protracted and chronic recurrent dislocations, especially those with associated degenerative joint diseases. The management of TMJ dislocation is customized as per the underlying cause. Hypermobility or subluxation can be managed by the use of autologous blood, sclerosing agents, and capsulorrhaphy.
Temporomandibular joint dislocation
Manual reduction is sufficient in case of acute dislocation. Chronic protracted and chronic recurrent dislocationsare among the most difficult to manage. Surgical intervention is required to treat these properly. National Center for Biotechnology InformationU. Natl J Maxillofac Surg. Author information Copyright and License information Disclaimer.
This article has been cited by other articles in PMC. Abstract Temporomandibular joint TMJ dislocation is an uncommon but debilitating condition of the facial skeleton. Dislocation, hypermobility, subluxation, temporomandibular joint. On the basis of the clinico-radiological evaluation, Akinbami[ 17 ] classified TMJ dislocation into the following three types: Type I – the head of the condyle is directly below the tip of the eminence.
Chronic dislocation If kandibula condition is long-standing or recurrent, it poses a challenge to the treating clinician. Chronic recurrent dislocation Subluxation The conservative method includes the use of various sclerosing agents like alcohol, sodium tetradecyl sulfate, sodium psylliate, morrhuate sodium, and platelet-rich plasma that has been injected into the joint space.
Chronic long standing dislocation The surgical methods are indicated in those cases where the patients have not responded well to the conservative methods. Footnotes Source of Support: Landes CA, Mandbiula R. Prospective evaluation of a pragmatic treatment rationale: Open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures.
Condyle and sub condylar mandibulq. Int J Oral Maxillofac Surg. Caminiti MF, Weinberg S. The role of dislomasi and surgical treatment. J Can Dent Assoc. Treatment of chronic mandibular dislocations: A comparison between eminectomy and mini plates. J Oral Maxillofac Surg. Traumatic chronic TMJ dislocation: Report of an unusual case and discussion of management.
Mandibular condyle dislocation into the middle cranial fossa: A case report and review of literature. Inappropriate treatments in temporomandibular joint chronic recurrent dislocation: A literature review presenting three particular cases.
Treatment of chronic mandibular dislocations by eminectomy: Follow-up of 10 dislokasu and literature review. Mandiula osteotomy and mmandibula grafting in the management of chronic recurrent dislocation and hypermobility of the temporomandibular joint.
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