Neglected Dislocation of the Temporomandibular Joint: A Case Report

    

    

    Figure 2: Results at 1 year post-surgery.
    

Discussion

Neglected TMJ dislocation is a rare and controversial condition in terms of definition, pathogenesis, clinical course, diagnosis and, above all, management.

There are many etiopathogenic factors which may favour the development of a TMJ luxation that have been widely described [2-7].

One of the primary issues with neglected TMJ dislocation is the variety of etiopathogenic factors that may contribute to its development. The condition can be triggered by a range of predisposing factors, which include myotonic and neurological disorders such as Huntington’s disease, epilepsy, Parkinson’s disease, and muscular dystrophies. These conditions interfere with normal muscle function and often lead to the prolonged dislocation of the TMJ. In addition, certain dystonias like Steinert’s disease or Meige’s syndrome, and even prolonged intubation during critical care, have been identified as contributing factors [2]. The resulting TMJ dislocation may initially present as an acute episode, but if left untreated, it can become recurrent or chronic over time.

The chronicity of the condition is exacerbated by the continuous dislocation of the TMJ, which leads to structural changes within the joint itself. The dislocated condyle causes muscle spasms and fibrotic changes in the surrounding soft tissue. Over time, this soft tissue can grow into the glenoid fossa, further complicating the reduction process [4].

As the dislocation persists, it becomes increasingly difficult to reposition the condyle into its correct anatomical position. During this time, a new mandibular fossa forms as the body adapts to the displaced condyle. This is precisely what occurred in our case, where the dislocation went untreated for an extended period.

Neglected dislocations are typically harder to diagnose because of the patient's ability to adapt, which may allow them to function with a displaced condyle without significant immediate pain or dysfunction. However, as the dislocation becomes chronic, the longer it remains untreated, the more difficult it becomes to reduce the condyle and restore normal joint function [1].

Chronic dislocation of the temporo-mandibular joint (TMJ) occurs when an acute dislocation is left untreated, in certain situations, including severe illness, neurologic or psychiatric diseases or prolonged oral intubation.Chronic TMJ dislocations are often the result of neglecting an acute dislocation or treating it inappropriately [8].

Neglected dislocations become progressively irreversible, often requiring surgical reduction [9].

surgical treatments include repositioning of the condyle by direct approach to the TMJ and glenoid evidentiation, resection of the temporal articular tubercle (Myrhaug technique), condylotomy,and condylectomy…[4].

The Dautrey procedure is a preventive procedure that aims to limit anterior displacement of the mandibular condyle by increasing the height of the temporal articular tubercle. It has been found to be very satisfactory in the treatment of recurrent dislocation, and it does not adversely affect joint function [6].

Proper fixation is important to prevent recurrence of longstanding dislocation especially for edentulous patients [4].

Conclusion

Neglected TMJ dislocation is a complex and multifaceted condition that remains challenging in terms of its definition, diagnosis, and management. Early recognition and proper management are crucial in minimizing long-term complications and improving outcomes, particularly for those with recurrent dislocations or edentulous patients.

References

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