The ESTMJS (European Society of Temporomandibular Joint Surgeons) Consensus and Evidence-Based Recommendations on Management of Condylar Dislocation

Although condylar dislocation is not uncommon, terminology, diagnostics, and treatment concepts vary considerably worldwide. This study aims to present a consensus recommendation based on systematically reviewed literature and approved by the European Society of TMJ Surgeons (ESTMJS). Based on the template of the evidence-based German guideline (register # 007-063) the ESTMJS members voted on 30 draft recommendations regarding terminology, diagnostics, and treatment initially via a blinded modified Delphi procedure. After unblinding, a discussion and voting followed, using a structured consensus process in 2019. An independent moderator documented and evaluated voting results and alterations from the original draft. Although the results of the preliminary voting were very heterogenous and differed significantly from the German S3 guideline (p < 0.0005), a strong consensus was achieved in the final voting on terminology, diagnostics, and treatment. In this voting, multiple alterations, including adding and discarding recommendations, led to 24 final recommendations on assessment and management of TMJ dislocation. To our knowledge, the ESTMJS condylar dislocation recommendations are the first both evidence and consensus-based international recommendations in the field of TMJ surgery. We recommend they form the basis for clinical practice guidelines for the management of dislocations of the mandibular condyle.

1425 Surgical Management of a Long-Standing Temporomandibular Joint Dislocation: A Case Report

Background Temporomandibular joint (TMJ) dislocation is a common presentation to Oral & Maxillofacial Surgery. In most cases, the condylar head is displaced anterior to the articular eminence and can be relocated by closed reduction. Severe dislocation into the infratemporal fossa is uncommon. Long-standing dislocation is rare and makes closed reduction difficult to achieve. Presentation A 60-year-old female presented to the outpatient clinic with long-standing bilateral TMJ dislocation which onset months prior following a seizure. Both condylar heads could be palpated superior to the zygomatic arches and could not be reduced under local anaesthetic. Mandibular range of movement was severely limited and creating an oral seal was not possible, affecting speech function. There was a history of discomfort and declining oral intake. Computed tomography revealed both condyles were displaced into the infratemporal fossa. Management The patient and family expressed a desire to avoid risk of damage to the facial nerve and therefore surgery was limited to an intra-oral approach only. Closed reduction was impossible due to the degree of muscle fibrosis present. Bilateral coronoidectomies were performed under a short general anaesthetic which immediately improved range of movement. Full articulation and occlusion were achieved by performing bilateral condylotomies. Outcome The patient was reviewed by video consultation 2 weeks later and had recovered well. They reported good masticatory function and improved dietary intake. No additional physiotherapy or surgical input was required, and they have been discharged from further review.

Serial kasus berbagai metode perawatan dislokasi sendi temporomandibula berdasarkan jenis dislokasinyaCase series of various temporomandibular joint dislocation treatment methods based on the dislocation type

Pendahuluan: Dislokasi sendi temporomandibula (TMJ) merupakan suatu keadaan dimana kondilus keluar dari fosa glenoidalis ke arah superior, posterior atau anterior melewati eminentia artikularis dan seringkali disertai dengan spasme otot-otot pengunyahan. Penanganan yang terlambat dapat menimbulkan komplikasi berupa asimetri wajah dan menggangu pengunyahan. Tujuan penulisan kasus ini adalah menyampaikan serial kasus perawatan dislokasi sendi temporomandibular berdasarkan jenis dislokasinya. Laporan kasus: Empat tipe kasus dislokasi TMJ datang ke IGD dan Poli Bedah Mulut dan Maksilofasial Rumah Sakit Hasan Sadikin Bandung dengan riwayat dislokasi yang berbeda. Pasien berjenis kelamin dua laki-laki dan dua perempuan, berusia 33 hingga 66 tahun dengan faktor predisposisi menguap. Klasifikasi dislokasi yaitu akut dan kronis. Perawatan keempat kasus berupa reduksi manual, menggunakan metode Hippocrates dan wrist pivot, hingga pembedahan dengan miotomi. Simpulan: Keadaan dislokasi yang berbeda memerlukan perawatan yang berbeda. Kasus akut dapat segera dilakukan reduksi manual, sedangkan kasus kronis memerlukan pembedahan. Keterlambatan penanganan yang tepat dapat membuat keadaan menjadi lebih berat sehingga memerlukan penanganan yang lebih kompleks dan biaya yang lebih besar. ABSTRACTIntroduction: Temporomandibular joint (TMJ) dislocation is a condition in which the condyle exits the glenoid fossa superiorly, posteriorly, or anteriorly through the articular eminence and is often accompanied by mastication muscle spasm. Delayed treatment can cause complications in the form of facial asymmetry, thus interfere with mastication. The purpose of the case series was to present a case series of temporomandibular joint dislocations treatment based on the dislocation type. Case reports: Four different patients with four types of TMJ dislocation cases came to the ER and the Oral and Maxillofacial Surgery Clinic of Hasan Sadikin Hospital Bandung, with different dislocation histories. The patients were two males and two females, aged 33 to 66 years, with predisposing factors of yawning. Classifications of dislocations were acute and chronic. The four cases’ treatments were manual reduction, each using the Hippocrates method and wrist pivot, up to surgery with myotomy. Conclusions: Different dislocation conditions require different treatments. Acute cases can be directly reduced manually, while chronic cases require surgery. Delay in proper handling will severe the situation, requiring more complex treatment with higher costs.

Recurrent TMJ Dislocation in a Child: A Case Report and Discussion

Temporomandibular joint (TMJ) dislocation demonstrate a displacement of the mandibular condyle from it functional position within the glenoid fossa and articular eminence. TMJ dislocation is an acute episode can be transformed into chronic dislocation after multiple repeated episodes. Oral surgeon is frequently called for the management of recurrent TMJ dislocation in adults. In pediatric population, TMJ dislocation sometimes caused by trauma or other than trauma related to wide opening of the mouth during vomiting, yawning and dental procedures considerably under general anesthesia. A 3-year-old baby girl came to Emergency department with a complaint of open mouth for the last 6 hours. Initial examination was carried out and patient was sent for CT-Scan. CT-Scan reported an asymmetric soft tissue density mass in retropharyngeal area at the level of C1 and C2, showing more bulk on right side. Some subtle radiolucency are also identified within the mass. The possibility of a low-density foreign body or retropharyngeal abscess could not be entirely excluded. A quick examination under anesthesia (EUA)was performed to relieve the patient from the abscess/growth. During EUA, they did not find any growth or collection or pus. The patient was sent to oral and maxillofacial surgeon, on initial examination and previous CT Scan findings, TMJ dislocation was diagnosed. In order to completely examine the patient, reduction of the jaw was attempted on chair side. This was achieved by digital manipulation with little effort and the baby’s jaw was secured with Barton’s bandage to prevent repeated dislocation. She continued tablet baclofen for 6 months as prescribed by the pediatrician. KEYWORDS: Temporomandibular Joint (TMJ), Recurrent dislocation, pediatric

TMJ Replacement Following Pseudoarthrosis of Condylar Neck Fracture With Dislocation of the Condylar Neck Within the Infra-Temporal Fossa

Study Design: Case Report Objective: To present a patient with long-standing TMJ dislocation and pseudoarthrosis in the temporal bone treated with orthognathic surgery and unilateral joint replacement. Method: The patient, a 52-year-old female, came to our department to treat facial asymmetry and oral rehabilitation. The patient reported early facial trauma at 7 years old showing partial edentoulism, dental occlusion class III and a 19 mm mandibular midline deviation. Cone beam computed tomography showed the left TMJ in long-standing dislocation into the fossa temporalis, creating a new articular fossa in the temporal bone and adaptation of the hard and soft tissue. Results: Orthognathic surgery and TMJ replacement using a patient-specific implant and dental rehabilitation were planned; surgery was performed with no complications, and the 1-year follow-up showed that this treatment was a good option for long-standing TMJ dislocation. Conclusion: The long-term TMJ dislocation can be successfully treated by TMJ replacement using a patient-specific implant to obtain facial balance and oral function and avoid relapse.

Autologous blood injection as a modality of the treatment of temporomandibular joints dislocation: A case report

Many specific surgical procedures have been identified for treating the dislocation of chronic recurrent temporomandibular joints (TMJs). This article addresses an autologous blood injection (ABI) procedure for the TMJ diagnosis of chronic recurrent TMJ dislocation. A 22-year-old patient reported with chronic TMJ dislocation for 3 months. Autologous blood was injected into upper joint space and surrounding pericapsular tissue under local anesthesia. The patient was followed up regularly. The treatment was successful and the patient had no more dislocation of TMJ as inferred from favorable improvement in mouth opening. Autologous blood infusion (ABI) within the articular capsule and/or pericapsular space or joint depression, is one of the most negligibly intrusive treatments methodology for repetitive separations of TMJ, was as of now presented.

Telemedicine in Oral and Maxillo-Facial Surgery: An Effective Alternative in Post COVID-19 Pandemic

The aim of this work was to demonstrate the advantages of using telemedicine (TM) in the management of the outpatients with maxillofacial surgical pathologies during the COVID-19 pandemic. The study was conducted at the MaxilloFacial Surgery Unit of “Magna Graecia” University of Catanzaro, on two different groups of patients: a group of follow-up patients (A1: patients in oncological follow-up after surgical treatment performed before the COVID-19 pandemic; A2: suffering from chronic lesions such as precancerous lesions), and a group B of patients with first urgent visits (B1: patients with suspected oncological pathology; B2: patients with suspected urgent disease such as medication-related osteonecrosis of the jaws (MRONJ), odontogenic abscesses, temporomandibular joint (TMJ) dislocation, etc.). Participation in the study required possession of a smartphone with Internet access, e-mail and the use of a messaging service (WhatsApp or Telegram) to send photos and messages; completion by the patient of a COVID-19 screening questionnaire; submission of a satisfaction questionnaire by the doctors and patients. A total of 90 patients were included in this study. A high percentage of satisfaction emerged from the analysis of the satisfaction questionnaires of both patients and doctors.TM thus represents an excellent opportunity to improve accessibility to oncological and non-management activities, reducing the risk of Covid-19 dissemination and should be promoted and implemented in the post-pandemic era.

Conservative management of bilateral chronic protracted temporomandibular joint dislocation: a case report

<p>Temporomandibular joint (TMJ) dislocation is a condition in which the mandibular condyle is anteriorly displaced beyond the articular eminence, hence completely out of glenoid fossa which leaves the patient unable to close his/her mouth. Long standing TMJ dislocation persisting for more than a month are the most challenging to treat. The management varies widely, from closed reduction to complicated surgical procedures to reduce the dislocated condyle. Each case of dislocation presents with its own unique features. Since there are no standard rules or conventions for the ideal strategy in different circumstances till date, initial approach should be conservative, preserving surgical treatment for later if needed. This paper presents the experience of conservatively managing a case of long standing (one and half month old) TMJ dislocation under general anaesthesia with excellent outcome.</p><p> </p>