AJMAN UNIVERSITY OF SCIENCE AND TECHNOLOGY

Treatment Planning And Seminars

Anmar Basil Thar Hayder

 43 years lady from Niger presented with inability to close

mouth or bring teeth together over the last 2 years.

OPG : both condyles were anterior to the articular

eminences

Dislocation

Acute

Chronic
(persist >1month)

Subluxation is self-reducing, patient is able to close his

or her mouth without assistance.

A true dislocation (or luxation) is a condition in which a

joint is displaced from its articulations and requires manipulation by another individual.

Chronic bilateral anterior dislocation

It is characterised by inability to close the mouth with or without

pain
Dislocation can occur in any direction with anterior dislocation

being the commonest one

Trauma Steep eminence Habitual subluxation Syndrome associated

Ehler-danlos syndrome (EDS)

Is an inherited CT disorder with different presentations

that have been classified into several primary types

EDS is caused by the defect in the synthesis of collagen

Types of EDS
Hypermobility

Classical
Vscular Kyphoscoliosis Arthrochalasia Dermatosparaxis

Hypermobility type
Joint hypermobility is the hallmark of this type , with less

severe skin manifestations.

Patients with the Hypermobility Type experience frequent

joint dislocation and subluxations

By ethnicity, JHM is observed in up to

3557% in Africans

Treatment
Surgical (open)
Non Surgical (closed)

surgical open reduction: 1968, Rowe and Killey

bone hook which was passed over the Sigmoid Notch through a small incision below the angle of mandible and downward traction was applied on condyle

1976, Adekeya et al
occlusion was restored by means of inverted L shaped osteotomy of ramus.

Bone grafts to be used in such surgeries :

Iliac bone graft was seen to have resorption whereas in case of the calvarial graft complication was seen in the donor site with the occurrence of dural tears, arachnoidal bleeding hematoma formation and scalp infections. Since the iliac graft showed remarkable degree of resorption bovine cartilages were tried. Cartilage were found to be dimensionally stable in terms of resorption which was further enhanced by their calcification.

Lewis,1981
technique in which the Bristows elevator was passed through the temporal fascia as in Gillies technique of elevation of depressed zygomatic bone. The tip of the rowe elevator was used and force was applied in downward and posterior direction. This method also facilitates open reduction by extending the incision as used for preauricular approach to the joint

 Augmentation of the articular

eminence

displacement of the zygomatic arch and obstructing the path of the Condylar translation has been first described by Mayer in 1933 it has been modified by Dautrey25 in which the green stick fracture was performed at zygomaticotemporal suture, which provides the rebound elasticity and provide stability in the altered position. It cannot be performed in elder people due to the brittleness of the bone; so it is restricted to young individual.

 eminectomy

Myrhaug in 1951

Removal of eminence will facilitate the return of the condyle without any interference into the glenoid fossa. Although dislocation takes place, painless reduction will occurs automatically

 Implants
Various other materials have also been used like Lshaped pins, vitallium mesh implants, and mini implants to enhance the eminence. Uses of these materials have been reported with increase incidence of fracture and loosening under functional loads. Silicon blocks used in the shape of wedge has been reported to evoke immune reaction and also showed displacement as a result of functional movement. Among all different treatment modalities studied in the literature, a rate of 95% of cases without recurrence both after eminectomy and use of metallic implant over the articular eminence

Closed reduction
Avoid excessive

force
Sedation Extraoral route

Thank You