Temporomandibular joint dislocation
The temporomandibular joint (TMJ) is formed by the articulation of the mandible and the temporal bone of the skull. It is located anterior to the tragus of the ear, on the side of the face. It participates in the action of opening and closing the mouth.
When the mouth opens wide, the condyle moves forward, and when the mouth closes, it returns to its original position. Dislocation of the temporomandibular joint occurs when the condyle moves too far forward and locks in front of a bony protrusion called the articular eminence.
In this position, the condyle can no longer move. This most often happens when the ligaments that normally hold the condyle in place are damaged, allowing the condyle to move beyond the articular eminence. The surrounding muscles may spasm and thus hold the condyle in the dislocated position.
TMJ dislocation can result from many reasons, but some of the most common include: wide mouth opening, trauma from a fall, after a dental procedure, work accident, car accident, sports or recreational injuries.
If you think you may have a dislocated joint, here are some of the symptoms that may occur:
The jaw is locked in an open position
Jaw moved forward
Stiffness and difficulty closing the mouth
Pain in the face and/or jaw
Salivary problems caused by inability to close the mouth
Temporomandibular joint dislocation (TMJ) is a condition that occurs when the temporomandibular joint (which connects the jaw to the temporal bone of the skull) is displaced or blocked. It can cause facial pain, difficulty opening the mouth, joint noises, ear pain or headaches.
The temporomandibular joint is located anterior and inferior to the ear, bilaterally and allows the jaw to perform functional movements.
It is a joint made up of the ascending arm of the mandibular bone, specifically the condyle and elements of the temporal bone, a fixed bone belonging to the neurocranium.
The particularity of this joint is that it is covered by fibrous cartilage, which allows it to be mobile and contribute to the movements of the oral cavity.
All the other joints in the human body are covered with hyaline cartilage, which is like glass and makes them immobile.
During the opening movement, the condyle rolls posteriorly on the inferior surface of the disc with slight anterior translation.
When the mouth closes, the condyle retracts to its original position.
When the condyle exceeds the area of displacement and advances further than the neighboring articular surfaces allow, it will remain stuck at the joint eminence and will not be able to return to the posterior position of Closing.
This causes dislocation of the mandible.
The condyle is surrounded by ligaments which have the role of directing its movement.
Symptoms of mandibular dislocation
The mandible remains blocked and the patient will no longer be able to close his mouth. When the condyle jumps out of its limits, it may return, making sounds as it passes the articular eminence, or it may remain locked.
Pain – the patient feels the inability of the condyle to return to its physiological limits.
Muscle contraction – the muscles are affected by this non-functional movement and will react by spasm, by sudden contraction.
The doctor will easily make the diagnosis based on clinical signs, i.e. the patient’s inability to close his oral cavity.
This phenomenon lasts until the mandible is repositioned and the condyle is in its normal place. Sensitivity can last up to several days after the problem has been corrected.
How can we prevent and treat temporomandibular joint dislocation in predisposed patients?
Preventing TMJ dislocation can include avoiding excessive stress, avoiding excessive chewing, maintaining correct posture and a balanced diet, and avoiding trauma to the face or head.
It is important that people with persistent symptoms consult a specialist in this area to receive a correct diagnosis and appropriate treatment.
Dislocation of the temporomandibular joint occurs in patients with exaggerated laxity of the ligaments surrounding the condyle.
To prevent joint dislocation from occurring, the patient must self-limit their jaw movements.
Care must be taken not to open the mouth too wide when shouting at someone or eating.
A useful method is to place the fist under the chin to control the amplitude of the opening.
Drug treatment consists of intraligamentary injections of substances to reduce ligament laxity.
In other more severe cases, when self-limitation of the mandibular opening does not prevent dislocation, surgical treatment is used to remove the joint eminence. The condyle will then no longer be blocked beyond this protrusion during mouth opening.
A dislocation of the temporomandibular joint requires an emergency visit to the dentist or general practitioner.
He or she will reposition the mandible and urge a predominantly liquid diet in the following days to minimize mandibular movements during chewing.
In most cases, repositioning the dislocated mandible is a one-off event and a therapeutic success.
However, in more severe situations, in patients in whom dislocations occur frequently, other therapeutic, medicinal or even surgical options may be considered.
The causes of this condition can be varied, including trauma, arthritis, certain dental conditions or excessive chewing. Treatment may include the use of non-steroidal anti-inflammatory drugs, physiotherapy and occupational therapy. In severe or chronic cases, surgery may be required
The causes of TMJ dislocation can be varied, including trauma to the face or head, arthritis, certain dental conditions or excessive chewing. It can also be caused by tension or emotional stress.
Symptoms of TMJ dislocation may include facial pain, difficulty opening the mouth, joint noises, ear pain or headaches. Other symptoms may include difficulty chewing, difficulty speaking and sensitivity to touch or pressure in the joint.
Treatment of TMJ dislocation may include the use of non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation, physiotherapy to improve joint and muscle flexibility, and occupational therapy to learn relaxation techniques and avoid activities that may worsen symptoms.
In severe or chronic cases, surgery may be needed to repair or replace the affected joint.
It is important for patients with persistent symptoms to consult a medical specialist who can determine the cause of the condition and recommend appropriate treatment.
Preventing TMJ dislocation may include avoiding excessive stress, avoiding excessive chewing or chewing hard objects, maintaining proper posture and a balanced diet, and avoiding trauma to the face or head.
In summary, temporomandibular joint (TMJ) dislocation is a condition that can cause facial pain, difficulty opening the mouth, joint noises, ear pain or headaches.
It is common to experience discomfort and pain in the face or jaw until the joint returns to the correct position. However, even after the joint returns to its original position, the area may be tender for up to several weeks.
Before the TMJ can be put back into its normal position, the muscles around it must relax. To achieve this, the area will be locally anesthetized and after this, if still needed, a myorelaxant is given to stop any muscle spasm.
When the jaw muscles are sufficiently relaxed, the doctor can move the condyle back into the correct position. He will pull the lower jaw down and tilt the chin up to release the condyle. Once free, the ball will be guided back into its correct position. In some cases, a bandage is recommended to prevent the mouth opening too wide.
It is best to follow a liquid and semi-liquid diet for several weeks. Eating liquid or easy-to-chew foods reduces the movement of the jaw and decreases the stress it is under, so the surrounding muscles can recover.
Unfortunately, if the ligaments holding your joint in place no longer have the strength to hold it in place; TMJ dislocation can continue to happen. If you find yourself in this position, the best way to keep your jaw from dislocating too often is to limit your range of motion.
If dislocation continues to be a serious problem, talk to your dentist about conservative surgical treatments that can help you treat the problem. When you experience a TMJ dislocation, it’s important to stay calm and seek professional help.