a case report describing condylar dislocation is discussed

2. CONDYLAR
DISLOCATION
Shaik Irfan Ahamed
Department of oral and
maxilla facial surgery

3. INTRODUCTION Hypermobility disorders of TMJ are mainly in two forms
Dislocation
Subluxation
Dislocation refers the phenomenon in
which condyle is displaced out of
glenoid fossa and traverses in front of
the articular eminence
Subluxation is the condition in
which the dislocated condyle
can be reduced back in to
normal position by patient
themselves

4. ANATOMY

5. CLASSIFICATION

6. CLASSIFICATION
On the basis of the clinico-radiological evaluation,
Akinbami classified TMJ dislocation into the following
three types:
•Type I - the head of the condyle is directly below the
tip of the eminence
•Type II - the head of the condyle is in front of the tip
of the eminence
•Type III - the head of the condyle is high-up in front of
the base of the eminence.

7. ETIOLOGY
•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 the capsular ligament, long-standing internal derangement, and spasm
of the lateral pterygoid muscles.
• Structural deficit involves arthritic changes in the condyle, i.e., flattening or
narrowing, decrease in the height of the articular eminence, morphological
changes of the glenoid fossa, zygomatic arch, and squamo tympanic fissure.

8. ETIOLOGY
•Age and changes in the dentition also play definite role in dislocation.
•Other causes include over function, i.e., forceful wide opening of the mouth
while yawning, laughing, vomiting, or seizures, dental treatments like third
molar extractions or root canal treatments, or endotracheal intubation,
laryngoscopy, and trans oral fiber optic bronchoscopy.
•Certain antipsychotic medications may also lead to dislocation. Some
syndromes are also associated with it such as the Ehlers-Danlos syndrome,
orofacial dystonia, and the Mar fan syndrome.

9. CLINICAL FEATURES
•Pain in the pre auricular and surrounding
region
•Pre auricular depression/ hollowing
•Protruding chin
•Inability to close the mouth
•Drooling of saliva
•In ability to speak, swallow ,or masticate.
•Tense masticatory muscles are also a
characteristic feature
• Unilateral dislocation is associated with
deviation of chin towards contralateral side

10. INVESTIGATIONS

11. TREATMEN
T
PROTOCOL

12. CASE REPORT
Name –K. Venkatalakshmi
Age- 46/ female
Ip no- 2208020032
Chief complaint – Patient complains of pain and
sudden restricted movement of lower jaw after
patient had woke up from sleep , patient has
inability to close her mouth, speak and chew
since 2 days.
Medical history – no relevant medical history

13. PRE OP PROFILE

14. PRE OPERATIVE OPG

15. POST OPERATIVE PROFILE

16. POST OP OPG

17. CASE REPORT
Patient Name :- V. Yesu
Age / Gender :- 49 years / Male
Chief complaint :-complains of Pain and swelling
on the face.
History of Present illness :- Patient had history of
trauma due to road traffic accident.
No loss of consciousness at time of trauma.
Had inability to close the mouth after trauma.
With pain in the preauricular area
No relavant medical history.
No relavant history of habits.

18. CLINICAL FINDINGS

19. 3D CT FACIAL BONES

20. Reduction
Right condyle Left condyle Symphysis
region

21. POST OP OPG

22. POST OP PROFILE

23. DISCUSSION
•Dislocation recurring more than once is termed as chronic
recurrent dislocation.
•The term chronic protracted dislocation is used to describe
dislocation persisting for more than 1 month, while dislocation
present for more than 6 months is called extra-long-standing
dislocation.
•The incidence of TMJ dislocation is 3% of the dislocations
occurring in other joints of the body with female predilection.
•The reported incidence of TMJ dislocation is 7% with a
preponderance in people in the second and third decades

24. • Superolateral dislocation of the mandibular condyle is a rare event and
has been reported to be always combined with fractures near the
symphysis.
• Bilateral superolateral dislocation of condyles associated with anterior
mandible fracture had a age range of 15-50 years and with a male
predominance .
• In this case the mechanism of dislocation might be due to the sudden
high impact on the chin which was a common finding as seen by
laceration over the chin causing the fracture of the anterior mandible.
• This allows the rotation and outward movement of the ramus which
pushes the condyles laterally and superiorly over the zygomatic arch.

25. MANAGEMENT
Acute dislocation
•Following reduction, a Barton’s
bandage, chin strap, or
intermaxillary fixation is advised
for 3–6 weeks to prevent further
dislocation. Several reduction
techniques have been employed
with varying rates of success.

26. A. Hippocrates method
B. Wrist pivot method
C. Extraoral method
D. Combined method

27. MANAGEMENT OF CHRONIC
RECURRENT DISLOCATION
Minimally invasive
1. Injection of sclerosing
agents
2. Autologous blood
injection
3. Prolotherapy
4. Botulinum toxin injection
Conservative
1. Physiotherapy
2. Intermaxillary fixation
3. Barton’s bandage
4. Chin strips
5. Kinesio taping

28. MINIMAL INVASIVE METHODS

29. SURGICAL PROCEDURES
Capsulorrhapy

30. Dautrey’s
method
Gleno-temporal
osteotomy

31. Eminectomy
Condylectomy

32. Lateral pterygoid myotomy

33. CONCLUSION
•The nature of the dislocation should be directly addressed when formulating a
surgical plan, and an operation should be considered only after minimally
invasive management, such as injection of autologous blood, has been tried.
•The operation aims either to remove anything that obstructs the movement of
the condyle, or to prevent excessive movement of the condylar head.

34. REFERENCES
•Textbook of oral and maxillofacial surgery for clinician by Krishnamurthy Bonanthaya
Elavenil Panneerselvam.
•Sharma NK, Singh AK, Pandey A, Verma V, Singh S. Temporomandibular joint
dislocation. Natl J Maxillofac Surg. 2015 Jan-Jun;6(1):16-20.
•Nezafati S, Ashkhasi L, Ghavimi M. Treatment of Long-standing Condylar Dislocation
with Vertical Ramus Osteotomy: A Case Report. J Dent Res Dent Clin Dent Prospects.
2015 Winter;9(1):53-6.
•Tocaciu S, McCullough MJ, Dimitroulis G. Surgical management of recurrent
dislocation of the temporomandibular joint: a new treatment protocol. Br J Oral
Maxillofac Surg. 2018 Dec;56(10):936-940.
•Vasconcelos BC, Porto GG. Treatment of chronic mandibular dislocations: a
comparison between eminectomy and miniplates. J Oral Maxillofac Surg. 2009
Dec;67(12):2599-604.
•Balaji SM, Balaji P. Surgical management of chronic temporomandibular joint
dislocations. Indian J Dent Res. 2018 Jul-Aug;29(4):455-458.

35. THANK YOU