Surgical correction and osteoplasty for forward dislocation of temporomandibular joint

Surgical correction and osteoplasty were carried out in one case of prolonged and three cases of recurrent forward dislocation of the temporomandibular joint, two of the patients in the latter cases having mental disorders and one having a cerebral lesion. A hockey-stick-shaped preauricular incision was made, ending in the hair-bearing part of the temple. Then, the temporal fascia and muscle were divided anteriorly from the temporal bone. In two aged patients, a fragment of the zygomatic arch was pushed out and down, joining under the articular tubercle. In two younger patients, the cortical bone of the mandible was separated by sagittal split-ramus osteotomy for mandibular prognathism, and two graft blocks removed from the iliac bone were implanted between the root of the posterior zygomatic arch and the anterior cut-edge of the articular tubercle. In 3 of the 4 patients, the fragments or grafts were fixed by means of ligation using wire so as to make contact with the root of the posterior zygomatic arch. There was no recurrence of dislocation during a period of 2-5 years after surgery.