Chronic Temporomandibular Joint Dislocation: A Case Series and Literature Review

Temporomandibular joint (TMJ) dislocation is characterized by displacement of the mandibular condyle from the glenoid fossa¹.  Dislocation of the temporomandibular joints is most frequently managed in the acute setting and can often be recurrent.  Chronic or longstanding TMJ dislocation is an uncommon condition rarely encountered by a maxillofacial surgeon.   Management of longstanding TMJ dislocation is different from acute dislocation, and can require difficult and invasive surgical intervention to be successful.  The consequences of prolonged dislocation, including radiographic changes and potential long term complications are poorly described in the literature.  

The purpose of this study is to present three cases of chronic TMJ dislocation recently treated and to review the literature related to the management of this rare condition.  The authors describe a case of two month bilateral TMJ dislocation that occurred after intubation for acute respiratory failure, a six month bilateral TMJ dislocation after a medication related seizure, and a five month right TMJ dislocation sustained during intubation after head trauma.  Relevant radiographic findings are discussed.

Management of chronic TMJ dislocation consists of an initial attempt at closed manual reduction of the joint, followed by progressively more invasive surgical procedures, including open reduction, eminectomy, coronoidectomy, condylectomy, or TMJ replacement².  Long term dysfunction can occur after reduction, leading to possible TMJ replacement.

The cases described illustrate the importance of early recognition and treatment of TMJ dislocation.  Failure to promptly identify and treat dislocation of the TMJ can lead to significant patient morbidity, increased difficulty in management, and long term TMJ dysfunction.

1. Baur DA, Jannuzzi JR, Mercan U, Quereshy FA. Treatment of long term anterior dislocation of the TMJ. Int J Oral Maxillofac Surg. 2013 Aug;42(8):1030-3.

2. Huang IY, Chen CM, Kao YH, Chen CM, Wu CW. Management of long-standing mandibular dislocation. Int J Oral Maxillofac Surg. 2011 Aug;40(8):810-4.