Dislocation of jaw

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Dislocation of jaw
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Sagittal section of the articulation of the mandible.
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Dislocations occur when two bones that originally met at the joint detach. [1] Dislocations should not be confused with subluxation. Subluxation is when the joint is still partially attached to the bone. [2]

Contents

When a person has a dislocated jaw it is difficult to open and close the mouth. [3] Dislocation can occur following a series of events if the jaw locks while open or unable to close. If the jaw is dislocated, it may cause an extreme headache or inability to concentrate. When the muscle's alignment is out of sync, a pain will occur due to unwanted rotation of the jaw. [4]

If the pain remains constant, it may require surgery to realign the jaw. [5] Depending on the severity of the jaw's dislocation, pain relief such as paracetamol may assist to alleviate the initial chronic pain. If the pain relief is taken for an extended period of time, it may negatively affect the person while talking, eating, drinking, etc.

Symptoms

The symptoms can be numerous depending on the severity of the dislocation injury and how long the person is inflicted with the injury. Symptoms of a dislocated jaw include a bite that feels “off” or abnormal, difficulty talking or moving jaw, not able to close mouth completely, drooling due to not being able to shut mouth completely, teeth feel they are out of alignment, and excruciating pain [6]

The immediate symptom can be a loud crunch noise occurring right up against the eardrum. This is instantly followed by excruciating pain, particularly in the side where the dislocation occurred.[ citation needed ]

Short-term symptoms can range from mild to chronic headaches, muscle tension or pain in the face, jaw and neck.[ citation needed ]

Long-term symptoms can result in sleep deprivation, tiredness/lethargy, frustration, bursts of anger or short fuse, difficulty performing everyday tasks, depression, social issues relating to difficulty talking, hearing sensitivity (particularly to high pitched sounds), tinnitus and pain when seated associated with posture while at a computer and reading books from general pressure on the jaw and facial muscles when tilting head down or up. And possible causing subsequent facial asymmetry.[ citation needed ]

In contrast, symptoms of a fractured jaw include bleeding coming from the mouth, unable to open the mouth wide without pain, bruising and swelling of the face, difficulty eating due to the constant pain, loss of feeling in the face (more specifically the lower lip) and lacks full range of motion of the jaw. [6]

Anatomy

The joint involved with jaw dislocation is the temporomandibular joint (TMJ). This joint is located where the mandibular condyles and the temporal bone meet. [7] [8] Membranes that surround the bones help during the hinging and gliding of jaw movement. For the mouth to close it requires the following muscles: the masseter, temporalis, and medial pterygoid muscle. For the jaw to open it requires the lateral pterygoid muscle. [8]

Pathophysiology

Side view of the skull with anterior dislocation of jaw. Anterior Dislocation.jpeg
Side view of the skull with anterior dislocation of jaw.
Side view of the skull with posterior dislocation of jaw. Posterior Dislocation.jpeg
Side view of the skull with posterior dislocation of jaw.
Side view of the skull with superior dislocation of jaw. Superior Dislocation.jpeg
Side view of the skull with superior dislocation of jaw.
Front view of the skull with lateral dislocation of jaw. Lateral Dislocation.jpeg
Front view of the skull with lateral dislocation of jaw.

There are four different positions of jaw dislocation: posterior, anterior, superior and lateral. The most common position is anterior, while the other types are rare. Anterior dislocation shifts the lower jaw forward if the mouth excessively opens. This type of dislocation may happen bilaterally or unilaterally after yawning. The muscles that are affected during anterior jaw dislocation are the masseter and temporalis which pull up on the mandible and the lateral pterygoid which relaxes the mandibular condyle. The condyle can get locked in front of the articular eminence. Posterior dislocation is possible for people who get injured by being punched in the chin. This dislocation will push the jaw back affecting the alignment of the mandibular condyle and mastoid. The external auditory canal may be fractured. Superior dislocations occur after being punched below the mandibular ramus as the mouth remains half-open. Since great force occurs in a punch, the angle of the jaw will be forced upward moving towards the condylar head. This can result in a fracture of the glenoid fossa and displacement of the condyle into the middle cranial fossa, potentially injuring the facial and vestibulocochlear nerves and the temporal lobe. Lateral dislocations move the mandibular condyle away from the skull and are likely to happen together with jaw fractures. [8] [9]

Posterior, superior and lateral dislocations are uncommon injuries and usually result from high-energy trauma to the chin. By contrast, anterior dislocations are more often the result of low-energy trauma (e.g. tooth extraction) or secondary to a medical condition that affects the stability of the joint (e.g. seizures, ligamentous laxity, degeneration of joint capsule).[ citation needed ]

Diagnosis

As with other joint dislocations, clinical history and examination are crucial for diagnosis of a jaw dislocation. Commonly, plain and panoramic X-ray radiographies are used to determine the relative position of the mandibular condyle. If a complex or unusual injury is suspected, three-dimensional computed tomography is most reliable in diagnosing dislocation and possibly associated fractures or soft tissue injuries.[ citation needed ]

In case of dislocations resulting from high-energy trauma, attention must also be paid to possible other injuries, particularly blunt or indirect trauma to the skull and cervical spine. Acutely life-threatening conditions need to be ruled out or treated in first line. For superior jaw dislocation in particular, serious intracranial complications such as epidural hematoma are possible and must be recognized and managed to prevent disability or even death. Therefore, neurological status has to be examined in patients with complex dislocations involving temporal bone fractures. Hearing deficits on the injured side may indicate damage to structures of the ear. [10] [11]

Treatment

Most temporomandibular disorders (TMDs) are self-limiting and do not get worse. Simple treatment, involving self-care practices, rehabilitation aimed at eliminating muscle spasms, and restoring correct coordination, is all that is required. Nonsteroidal anti-inflammatory analgesics (NSAIDs) should be used on a short-term, regular basis and not on an as needed basis. On the other hand, treatment of chronic TMD can be difficult and the condition is best managed by a team approach; the team consists of a primary care physician, a dentist, a physiotherapist, a psychologist, a pharmacologist, and in small number of cases, a surgeon. The different modalities include patient education and self-care practices, medication, physical therapy, splints, psychological counseling, relaxation techniques, biofeedback, hypnotherapy, acupuncture, and arthrocentesis. [8]

As with most dislocated joints, a dislocated jaw can usually be successfully positioned into its normal position by a trained medical professional. Attempts to readjust the jaw without the assistance of a medical professional could result in worsening of the injury. The health care provider may be able to set it back into the correct position by manipulating the area back into its proper position. Numbing medications such as general anesthetics, muscle relaxants, or in some cases sedation, may be needed to relax the strong jaw muscle. In more severe cases, surgery may be needed to reposition the jaw, particularly if repeated jaw dislocations have occurred. [12]

Epidemiology

Jaw dislocation is common for people who are in car, motorcycle or related accidents and also sports related activities. This injury does not pin point specific ages or genders because it could happen to anybody. [13] People who dislocate their jaw do not usually seek emergency medical care. [13] In most cases, jaw dislocations are acute and can be altered by minor manipulations. [9] [14] It was reported from one study that over a seven-year period at an emergency medical site, with 100,000 yearly visits, there were only 37 patients that were seen for a dislocated jaw. [8]

See also

Related Research Articles

<span class="mw-page-title-main">Temporomandibular joint dysfunction</span> Medical condition

Temporomandibular joint dysfunction is an umbrella term covering pain and dysfunction of the muscles of mastication and the temporomandibular joints. The most important feature is pain, followed by restricted mandibular movement, and noises from the temporomandibular joints (TMJ) during jaw movement. Although TMD is not life-threatening, it can be detrimental to quality of life; this is because the symptoms can become chronic and difficult to manage.

A subluxation is an incomplete or partial dislocation of a joint or organ. According to the World Health Organization, a subluxation is a "significant structural displacement" and is therefore visible on static imaging studies, such as X-rays. Unlike real subluxations, the pseudoscientific concept of a chiropractic "vertebral subluxation" may or may not be visible on x-rays.

<span class="mw-page-title-main">Temporomandibular joint</span> Joints connecting the jawbone to the skull

In anatomy, the temporomandibular joints (TMJ) are the two joints connecting the jawbone to the skull. It is a bilateral synovial articulation between the temporal bone of the skull above and the mandible below; it is from these bones that its name is derived. This joint is unique in that it is a bilateral joint that functions as one unit. Since the TMJ is connected to the mandible, the right and left joints must function together and therefore are not independent of each other.

<span class="mw-page-title-main">Trismus</span> Condition of limited jaw mobility

Trismus is a condition of restricted opening of the mouth. The term was initially used in the setting of tetanus. Trismus may be caused by spasm of the muscles of mastication or a variety of other causes. Temporary trismus occurs much more frequently than permanent trismus. It is known to interfere with eating, speaking, and maintaining proper oral hygiene. This interference, specifically with an inability to swallow properly, results in an increased risk of aspiration. In some instances, trismus presents with altered facial appearance. The condition may be distressing and painful. Examination and treatments requiring access to the oral cavity can be limited, or in some cases impossible, due to the nature of the condition itself.

<span class="mw-page-title-main">Shoulder problem</span> Medical condition

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.

<span class="mw-page-title-main">Temporalis muscle</span> Muscle on the side of the head which aids in chewing

In anatomy, the temporalis muscle, also known as the temporal muscle, is one of the muscles of mastication (chewing). It is a broad, fan-shaped convergent muscle on each side of the head that fills the temporal fossa, superior to the zygomatic arch so it covers much of the temporal bone.Temporal refers to the head's temples.

<span class="mw-page-title-main">Joint dislocation</span> Medical injury

A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any major joint or minor joint. The most common joint dislocation is a shoulder dislocation.

<span class="mw-page-title-main">Lateral pterygoid muscle</span> Muscle of mastication

The lateral pterygoid muscle (or external pterygoid muscle) is a muscle of mastication. It has two heads. It lies superior to the medial pterygoid muscle. It is supplied by pterygoid branches of the maxillary artery, and the lateral pterygoid nerve (from the mandibular nerve, CN V3). It depresses and protrudes the mandible. When each muscle works independently, they can move the mandible side to side.

<span class="mw-page-title-main">Hip dislocation</span> Orthopedic injury

A hip dislocation is when the thighbone (femur) separates from the hip bone (pelvis). Specifically it is when the ball–shaped head of the femur separates from its cup–shaped socket in the hip bone, known as the acetabulum. The joint of the femur and pelvis is very stable, secured by both bony and soft-tissue constraints. With that, dislocation would require significant force which typically results from significant trauma such as from a motor vehicle collision or from a fall from elevation. Hip dislocations can also occur following a hip replacement or from a developmental abnormality known as hip dysplasia.

<span class="mw-page-title-main">Sphenomandibular ligament</span>

The sphenomandibular ligament is one of the three ligaments of the temporomandibular joint. It is situated medially to - and generally separate from - the articular capsule of the joint. Superiorly, it is attached to the spine of the sphenoid bone; inferiorly, it is attached to the lingula of mandible. The SML acts to limit inferior-ward movement of the mandible.

<span class="mw-page-title-main">Condyloid process</span>

The condyloid process or condylar process is the process on the human and other mammalian species' mandibles that ends in a condyle, the mandibular condyle. It is thicker than the coronoid process of the mandible and consists of two portions: the condyle and the constricted portion which supports it, the neck.

<span class="mw-page-title-main">Mandibular fossa</span> Depression in the temporal bone that articulates with the mandible

The mandibular fossa, also known as the glenoid fossa in some dental literature, is the depression in the temporal bone that articulates with the mandible.

<span class="mw-page-title-main">Occipital condyles</span> Undersurface protuberances of the occipital bone in vertebrates

The occipital condyles are undersurface protuberances of the occipital bone in vertebrates, which function in articulation with the superior facets of the atlas vertebra.

<span class="mw-page-title-main">Articular disk of the temporomandibular joint</span>

The articular disk of the temporomandibular joint is a thin, oval plate made of non-vascular fibrous connective tissue located between the mandible's condyloid process and the cranium's mandibular fossa.

Occlusion, in a dental context, means simply the contact between teeth. More technically, it is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

<span class="mw-page-title-main">Mandibular fracture</span> Medical condition

Mandibular fracture, also known as fracture of the jaw, is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums. Mandibular fractures occur most commonly among males in their 30s.

<span class="mw-page-title-main">Patellar dislocation</span> Medical condition

A patellar dislocation is a knee injury in which the patella (kneecap) slips out of its normal position. Often the knee is partly bent, painful and swollen. The patella is also often felt and seen out of place. Complications may include a patella fracture or arthritis.

Fibrous ankylosis is a condition that affects fibrous connective tissue causing a limited range of movement.

<span class="mw-page-title-main">Mandible</span> Lower jaw bone

In jawed vertebrates, the mandible, lower jaw, or jawbone is a bone that makes up the lower – and typically more mobile – component of the mouth.

<span class="mw-page-title-main">Condylar resorption</span> Medical condition

Condylar resorption, also called idiopathic condylar resorption, ICR, and condylysis, is a temporomandibular joint disorder in which one or both of the mandibular condyles are broken down in a bone resorption process. This disorder is nine times more likely to be present in females than males, and is more common among teenagers.

References

  1. ↑ MedlinePlus Encyclopedia : Dislocation
  2. ↑ WebMD (2009). "subluxation". Webster's New World Medical Dictionary (3rd ed.). Houghton Mifflin Harcourt. p. 405. ISBN   978-0-544-18897-6.
  3. ↑ Katzberg, Richard W.; Anderson, Quentin N.; Manzione, James V.; Helms, Clyde A.; Tallents, Ross; Hayakawa, Katsumi (1984). "Dislocation of jaws". Skeletal Radiology. 11 (1): 38–41. doi:10.1007/BF00361130. PMID   6710178. S2CID   23036632.
  4. ↑ Schwartz, A. J. (2000). "Dislocation of the mandible: A case report". AANA Journal. 68 (6): 507–13. PMID   11272957.
  5. ↑ Blake, J. B. (1918). "Recurrent Dislocation of the Lower Jaw". Annals of Surgery. 68 (2): 141–5. doi:10.1097/00000658-191808000-00005. PMC   1426866 . PMID   17863959.
  6. 1 2 "Jaw - Broken or Dislocated". The New York Times.
  7. ↑ Parida, Satyen; Allampalli, Varshad; Krishnappa, Sudeep (2011). "Catatonia and jaw dislocation in the postoperative period with epidural morphine". Indian Journal of Anaesthesia. 55 (2): 184–6. doi: 10.4103/0019-5049.79904 . PMC   3106396 . PMID   21712880.
  8. 1 2 3 4 5 Mandible Dislocation at eMedicine
  9. 1 2 Huang, I-Y.; Chen, C.-M.; Kao, Y.-H.; Chen, C.-M.; Wu, C.-W. (2011). "Management of long-standing mandibular dislocation". International Journal of Oral and Maxillofacial Surgery. 40 (8): 810–4. doi:10.1016/j.ijom.2011.02.031. PMID   21474286.
  10. ↑ Sharma, N. K., Singh, A. K., Pandey, A., Verma, V., & Singh, S. (2015). Temporomandibular joint dislocation. National Journal of Maxillofacial Surgery, 6(1), 16–20. http://doi.org/10.4103/0975-5950.168212
  11. ↑ "Management of Traumatic Dislocation of the Mandibular Condyle into the Middle Cranial Fossa" (PDF). www.cda-adc.ca. Retrieved 2018-03-23.
  12. ↑ MedlinePlus Encyclopedia : Jaw - broken or dislocated
  13. 1 2 "Dislocated jaw symptoms, diagnosis & treatment". Intuition Communication. Archived from the original on 2014-11-29. Retrieved 2012-02-09.
  14. ↑ Mayer, Leo (1933). "Recurrent dislocation of the jaw". The Journal of Bone and Joint Surgery. 15 (4): 889–96. Archived from the original on 2016-01-26.
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