Dislocation of the temporomandibular joint: types, treatment
Temporomandibular joint (TMJ) is a paired articular surfaces of the mandibular and temporal bone and is situated in the glenoid fossa where the head of the branches of the lower jaw in contact with the articular surface of the temporal bone. Dislocation of the temporal mandibular joint occurs when the displacement of the articular surface of the mandibular bone in relation to the glenoid fossa. While it may wholly or partially withdraw from the cavity of the glenoid fossa.
Dislocation or subluxation of the mandible may occur as a result of pronounced mechanical effects on the teeth: the bump or too much opening of the mouth, for example, when yawning, intense chewing during a meal or reception at the dentist. In addition, dislocation of the mandible can be induced by long-term pathological processes in the joints, for example, acute or chronic diseases such as deforming arthrosis or rheumatoid arthritis.
Classification of injury
You first need to make a distinction between dislocation and subluxation. In dislocation of the temporal mandibular joint, there is a complete release of the lower jaw head from the glenoid fossa and subluxation of the mandible is characterized by its partial loss.
Due to the weak ligaments and other structural features of the TMJ in women subluxation is more common than in men. But the subluxation can develop in a male patient, for example, in case of untimely treatment of traumatic dislocation or violation of the rehabilitation period, when the patient too soon removes restrictive bandage or expose the jaw heavy loads.
Depending on the mechanism of the origin of the dislocation of the jaw may be traumatic (acute) or habitual. The most common cause of traumatic dislocation is a punch in the chin area, and sometimes injury occurs as a result of excessively wide mouth opening while yawning, shouting, singing, biting or chewing food. Dislocation can occur in the process of various medical manipulations, for example, during bronchoscopy or intubation of the trachea. Habitual dislocation or subluxation develops in a strong stretching of the ligaments of the temporo mandibular joint and can occur even in the absence of pronounced physical effects.
The nature of injury sprains are divided into the following types:
As can be seen from the above classification, a dislocation or subluxation may occur on one or both sides of the jaw. Front, rear and side sprains differ in the direction of the displacement of the temporal mandibular joint: at the exit from the cavity of the glenoid fossa it can be placed in front of her, behind her or on the side.
Often in medical practice is found anterior bilateral dislocation of the jaw, the resulting trauma. Unilateral, posterior and lateral dislocations in the medical practice are considered quite a rare injury.
The symptoms of dislocation and subluxation of the jaw
Dislocation and subluxation of the jaw can have various symptoms depending on the mechanism of the origin and severity of the injury. Almost always they are accompanied by pain and impaired mobility of the jaw, however, each type of dislocation has a number of distinguishing features.
Bilateral anterior dislocation is diagnosed by the following symptoms:
- the lower jaw is stationary and displaced downward;
- the patient’s mouth is open and not closed;
- in the area of the jaw is pronounced pain;
- speech is impaired;
- observed profuse salivation.
Unilateral anterior dislocation is characterized by the following symptoms:
- her mouth was open;
- chin shifted down and to the intact side, whereby the face becomes asymmetrical;
- speech is impaired.
In posterior dislocation are observed the following characteristic symptoms:
- patient’s mouth is closed and cannot be opened.
- because of the displacement of language loss speech and breathing;
- a pronounced pain syndrome, including in the parotid region;
- the patient takes a forced sitting position and leaning her head forward;
- the patient may be signs of damage to the facial nerve.
- probably bleeding from the ears with one or two sides.
The usual symptoms of unilateral or bilateral dislocation and subluxation:
- in the joint you may experience clicking or crunching;
- jaw shifted to the side;
- in the region of the joint can be a pain.
The doctor detects the dislocation of the mandible by external examination and local examination of the affected area. But for complex injuries for diagnosis requires radiography of the TMJ, and in some cases required CT scan. When the anterior dislocation on the radiograph is determined by the empty glenoid fossa and the head displacement of the lower jaw in the forward direction from the articular tubercle. In posterior dislocation radiograph shows that the head joint is offset rearward and located below the lower wall of the osseous auditory canal.
Sometimes x-ray studies may be uninformative, as the ligaments and the articular disc are low density and well see them on radiographs impossible. So when the doctor should as accurately as possible to assess the condition of the ligaments and the articular disc, the patient is directed to magnetic resonance imaging (MRI).
If the doctor have any doubts about the correctness of the diagnosis, he may use additional diagnostic methods: axiography, dynamic magnetic resonance imaging or arthroscopy of the joint.
The actions of the doctor.
The treatment of dislocation and subluxation is carried out by reposition of the joint and fixation of the mandible to provide the joint quiet. In some cases, patients with these injuries may be appointed physiotherapy, anti-inflammatory therapy, massage and special exercises. In the treatment of habitual dislocation is sometimes used surgery.
Reduction of lower jaw with anterior dislocation can be carried out by a surgeon and a dentist. In posterior dislocation the patient must immediately deliver in the surgical Department, since in such cases the reduction of the temporal mandibular joint cannot be performed in a dental clinic.
Treatment of bilateral anterior dislocation is carried out as follows:
In the treatment of back sprain is applied other methods of reposition of the jaw and a longer rehabilitation period:
Treatment of habitual dislocations and subluxations
In some cases of habitual dislocation of the mandible may not require traditional treatment, as sometimes the patient can easily return to the joint in a natural position on their own, without the help of a doctor. But even if after the repositioning the jaw of the patient do not bother, often it still requires preventive treatment with the use of special orthodontic appliances.
In some situations, habitual dislocation or subluxation in adults cannot be cured without surgical intervention, as it may develop due to disturbed structures of the temporomandibular joint: increased extensibility of ligaments or insufficient height of the articular tubercle. Because of these pathologies, the head of the jaw joint is easy to leave a hole at the slightest exertion. To get rid of such disorders is possible only by surgery.
In patients childhood and adolescence, habitual dislocation of the mandible treated only with the use of conservative methods, which involve the limitation of the jaw and providing joint rest. To this end, the jaw is overlaid orthodontic appliances and devices, such as camera petrosova or bus Sound.
The most serious complications arise in cases where the treatment was carried out in a timely manner, that is, the joint was reduced during the first hours or days after the offset. The limitation of the jaw and its incorrect position can become permanent. In addition, the increased risk of habitual dislocation, as a result of the prolonged displacement of the temporal mandibular joint are stretched ligaments.
Complications can arise when the conditions of the rehabilitation period. After reposition of the jaw, the patient must wear a special bandage and to reduce the load on the jaw to a minimum. The time during which complied with these restrictions depends on the severity of the injury and can range from 5 days to 2-3 weeks. In case of violation of this regime, the patient may develop habitual dislocation of the mandible.
In difficult clinical cases, prevention of habitual dislocation requires a whole range of diagnostic and therapeutic measures. In particular, the patient must be examined by a surgeon, dentist and neurologist. After a complete examination, assigned to preventive treatment, which may include the use of orthodontic appliances, occlusal rehabilitation (presledovanie individual tooth), and dentures for the normalization of interaction between the elements of the temporomandibular joint.
During the entire period of preventive treatment, the patient must observe a certain mode, providing a minimum load on the TMJ. Patients who are not suffering from bruxism at night, it is recommended to fix the jaw with chin-parietal bandage, which allows to avoid excessive mobility of the jaw during sleep.
Orthodontic appliances or tires are selected or are made individually depending on the characteristics of the disease. It may be intraoral and extraoral devices mechanical action, as well as orthodontic devices, creating pressure on the mucous membrane in place of the coronoid process of the mandible and thereby reduce the breadth of the mouth opening. Sometimes instead they used actual dressing-limiter.
In addition to the listed methods of prevention of common dislocations and subluxations may include special exercises for the masticatory muscles (myogymnastics), and the presence of pain — physiotherapy treatment and medication.