Delayed Diagnosis of Temporomandibular Joint Dislocation in Severe Stroke Patients

A 79-year-old woman with a history of left cerebral infarction developed altered consciousness and left hemiplegia. CT of the head revealed a putaminal hemorrhage. She underwent tracheal intubation followed by a tracheostomy for long-term airway management. Despite improved consciousness, the patient continued to experience dysphagia and was fed via a nasal tube. Subsequent axial CT and 3D CT scans revealed an empty glenoid fossa in both temporomandibular joints (TMJs) with the condyles positioned anteriorly, consistent with chronic bilateral anterior TMJ dislocation. After an unsuccessful attempt at manual reduction, closed manual reduction was successfully performed under general anesthesia with muscle relaxants, allowing the patient to resume oral feeding. This case underscores the importance of considering TMJ dislocation in stroke patients with persistent dysphagia. Early diagnosis and timely intervention are crucial for improving patient outcomes in such cases.