Recurrent mandibular dislocation under neuroleptic drug therapy, treated by bilateral eminectomy

Acute mandibular dislocations caused by extrapyramidal syndromes under neuroleptic therapy have often been reported in the literature. However, the success of surgical therapy for recurrent mandibular dislocation in patients under long-term neuroleptic therapy has been discussed controversially. In our opinion, modifications in drug therapy--including the administration of so-called atypical neuroleptics--should be considered before advocating surgery. If the revised therapeutic approach proves to be unsuccessful because of psychotic relapse or persistence of extrapyramidal symptoms, good operative results may be achieved by bilateral eminectomy as reported on three psychiatric patients in this paper. In order to avoid postoperative subluxation and internal derangement due to increased muscular tension under chronic neuroleptic therapy, as much bone as possible should be removed when performing eminectomy.