The experience of chronic protracted mandibular dislocation treatment: manual vs. surgical reduction

Temporomandibular joint dislocation is a common challenge in dental care, but it can be promptly addressed through manual realignment, making it standard procedure in the realm of oral health. Nonetheless, effectively preventing and treating chronic protracted mandibular dislocation (CPMD), characterized by prolonged dislocation, remains a significant challenge. Hence, a retrospective analysis was conducted on the clinical data of 10 patients diagnosed with chronic protracted mandibular dislocation (CPMD), encompassing diagnosis, treatment, and prognosis details. CPMD tends to be more prevalent among the elderly population, with an average age of 67.2±11.9 years and a male-to-female ratio of 1:9. All diagnosed patients presented with bilateral anterior dislocation, each requiring diverse pre-treatment approaches. The most significant risk factor contributing to CPMD was unconsciousness resulting from nervous system injury, which delayed the perception of symptoms associated with temporomandibular joint dislocation. 90% of CPMD patients experienced successful treatment through manual reduction, while a refractory CPMD cohort, resistant to manual reduction, necessitated surgical intervention for resolution. All patients underwent treatment involving elastic intermaxillary traction, which served as the primary means of achieving reduction. Subsequent analysis of CT data revealed that condylar displacement beyond the zygomatic arch served as an indication for surgical reduction. Consequently, manual reduction under general anesthesia combined with elastic intermaxillary traction proved effective for managing CPMD cases. However, cases displaying excessive vertical displacement beyond the zygomatic arch should be considered for surgical intervention based on CT findings.