TMJ Disorders – Diagnosis And Treatment
Describe diagnostic features and treatment of temporomandibular joint dislocation.
Answer. A temporomandibular joint dislocation occurs when the condyle is displaced forcefully anteriorly out of the articular fossa but lies in the capsule of the joint.
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Diagnostic Features
- Clinical diagnosis: The patient complains of difficulty in swallowing. Saliva is seen drooling over the chin. Severe pain is present in the area over the temporal fossa. In the place where the condylar head is normally placed, at that area depression is seen. There is also the presence of an anterior open bite along with gagging of molar teeth.
- Radiographical diagnosis: Due to dislocation of the condyle articular fossa space appears to be empty.
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Diagnostic Treatment
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Nonsurgical treatment:
- Acute dislocation: It is done within 72 hours. Manual reduction can be done.
- It can be done with or without the use of anesthesia.
- The patient should be sitting upright in the chair.
- Clinicians should wear gloves.
- The thumbs of the clinician are positioned over the lower molar teeth bilaterally.
- Index figures are placed under the inferior border of the mandible. The posterior aspect of the mandible is depressed inferiorly to depress the condyle.
- While the chin is elevated anteriorly and the entire mandible is pushed backward with the palm.
- The mandible is moved downwards, backward, and upward, manipulating the condyle back in position.
- Chronic dislocation: Manual reduction is done under general anesthesia.
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Surgical Treatment:
- Alteration of ligaments:
- By injecting the sclerosing agent into the capsular space of the TMJ.
- Strengthening ligaments by surgically exposing the temporal fascia and suturing the flap of fascia on the capsular ligament.
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- Alteration of musculature:
- By closed condylectomy: A Gigli saw is used to intraorally bisect the condylar neck.
- Ligation of the coronoid process to the zygomatic arch anterior to the articular tubercle
- Alteration of bony structure:
- By colectomy
- Laminectomy, i.e., reduction of height of eminences.
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