Unilateral mandible fracture with bilateral TMJ dislocation

Area of Science:

• Oral and Maxillofacial Surgery
• Orthodontics
• Radiology

Background:

• Temporomandibular joint (TMJ) dislocation involves the condylar head moving anterior to the articular eminence, potentially causing entrapment.
• Ligamentous stretching and muscle spasms frequently follow TMJ dislocation, leading to significant joint pain.
• Current management lacks standardization, though immediate reduction is considered the most effective treatment for acute TMJ dislocation.

Observation:

• A case study of a 42-year-old female patient with a unilateral mandible fracture and bilateral TMJ dislocation resulting from a motor vehicle accident.
• The mandible fracture was evident on radiographic imaging, but the bilateral TMJ dislocation was not identified until six weeks post-injury, after jaw wiring removal.
• Decreased range of motion initially suggested dislocation, which was later confirmed by Magnetic Resonance Imaging (MRI).

Findings:

• The delayed diagnosis of bilateral TMJ dislocation in this case resulted in prolonged conservative therapy.
• The patient ultimately required bilateral TMJ surgery to address the chronic condition.
• Chronic TMJ pain persisted despite surgical intervention.

Implications:

• This case highlights the critical importance of thorough clinical evaluation and appropriate imaging for diagnosing TMJ dislocations, even in the presence of other facial trauma.
• Delayed diagnosis and treatment of TMJ dislocation can lead to long-term complications, including chronic pain and the need for surgical intervention.
• Standardized diagnostic protocols and timely management are essential for improving outcomes in patients with TMJ dislocations.