What are the causes of a broken or dislocated jaw. How can you recognize the symptoms of a temporomandibular joint fracture. What diagnostic methods are used for jaw injuries. How are jaw fractures and dislocations treated. What is the recovery process for TMJ injuries.

Understanding Temporomandibular Joint (TMJ) Fractures and Dislocations

The temporomandibular joint (TMJ) is a crucial component of our facial structure, connecting the lower jawbone to the skull. When this joint is injured, it can result in a fracture or dislocation, leading to significant discomfort and functional impairment. These injuries can affect one or both TMJs, causing a range of symptoms that require immediate medical attention.

TMJ fractures occur when the jawbone breaks or cracks, while a dislocation involves the unhinging of the jaw joint from the skull. Both conditions can severely impact daily activities such as eating, speaking, and even breathing. Understanding the nature of these injuries is essential for proper treatment and recovery.

What exactly is the temporomandibular joint?

The temporomandibular joint is a complex hinge and gliding joint located on each side of the head, just in front of the ears. It allows for the opening and closing of the mouth, as well as side-to-side and forward movement of the lower jaw. This joint is essential for various functions, including:

• Chewing and grinding food
• Speaking clearly
• Yawning
• Facial expressions

Given its importance in daily life, any injury to the TMJ can have significant consequences on an individual’s quality of life.

Common Causes of TMJ Fractures and Dislocations

TMJ fractures and dislocations typically result from facial trauma. The extended structure of the jawbone, reaching from the chin to behind the ear, makes it vulnerable to various types of injuries. Some of the most common causes include:

1. Physical assault to the face
2. Sports-related injuries
3. Vehicle accidents
4. Accidental falls, particularly in the home
5. Industrial or workplace accidents

These incidents can apply significant force to the jaw area, leading to fractures or causing the joint to become dislocated from its normal position. The severity of the injury often depends on the force of impact and the angle at which it occurs.

Are certain individuals more prone to TMJ injuries?

While anyone can suffer a TMJ fracture or dislocation, some factors may increase the risk:

• Participation in contact sports without proper protective gear
• Occupations involving physical labor or high risk of falls
• Pre-existing TMJ disorders or weakened bone structure
• Age-related bone density loss
• Certain medical conditions affecting bone strength

Understanding these risk factors can help individuals take appropriate precautions to minimize the likelihood of TMJ injuries.

Recognizing the Symptoms of TMJ Fractures

Identifying a TMJ fracture promptly is crucial for proper treatment and recovery. The symptoms of a broken jaw can be quite distinct and often include:

• Intense pain in the jaw area
• Swelling, including facial inflammation
• Bleeding from the mouth
• Difficulty breathing
• Discomfort when chewing or speaking
• Jaw stiffness and limited mobility
• Numbness and bruising in the face
• Dental-related issues, such as gum numbness or loose teeth

Pain, swelling, and bleeding are typically the most immediate and noticeable symptoms. The entire face may swell, causing significant discomfort and stiffness in the jaw. Bleeding from the mouth can occur, potentially leading to breathing difficulties if blood obstructs the airways.

How does a TMJ fracture affect daily activities?

A TMJ fracture can significantly impact various aspects of daily life:

• Eating becomes challenging and painful
• Speaking may be difficult or uncomfortable
• Oral hygiene routines may need to be modified
• Sleeping positions might need adjustment to minimize discomfort
• Social interactions can be affected due to speech and appearance changes

These effects underscore the importance of seeking immediate medical attention when a TMJ fracture is suspected.

Identifying Signs of a Dislocated Jaw

While a dislocated jaw shares some symptoms with a fracture, there are distinct signs that set it apart. Recognizing these differences is crucial for proper diagnosis and treatment. The key indicators of a dislocated jaw include:

• Pain that worsens with jaw movement or body motion
• A noticeable overbite or jutting out of the jaw
• Misalignment of teeth and an abnormal bite
• Inability to close the mouth completely
• Drooling due to incomplete mouth closure
• Difficulty speaking clearly

The most distinguishing feature of a dislocated jaw is the visible change in the jaw’s position. The lower jaw may appear to protrude more than usual, creating an exaggerated overbite. This misalignment can prevent proper closure of the mouth, leading to issues with speech and saliva control.

Can a jaw dislocation occur without trauma?

While most jaw dislocations result from trauma, they can occasionally occur due to other factors:

• Excessive yawning or opening the mouth too wide
• Certain medical procedures, such as dental work or endoscopy
• Connective tissue disorders that affect joint stability
• Repetitive stress on the TMJ from habits like gum chewing or teeth grinding

Understanding these potential causes can help individuals be more aware of their jaw health and take preventive measures when necessary.

Diagnostic Procedures for TMJ Injuries

Accurate diagnosis of TMJ fractures and dislocations is crucial for effective treatment. Medical professionals employ various diagnostic methods to assess the extent and nature of the injury. The diagnostic process typically includes:

1. Patient history: The doctor will inquire about the circumstances of the injury and any pre-existing conditions.
2. Physical examination: A thorough examination of the jaw, face, and oral cavity is conducted to assess visible signs of injury and functional impairment.
3. Imaging studies: X-rays are the primary imaging tool used to visualize bone fractures and joint dislocations.

In some cases, additional imaging techniques may be employed for a more detailed assessment:

• CT (Computed Tomography) scans: Provide detailed 3D images of the bone structure
• MRI (Magnetic Resonance Imaging): Useful for evaluating soft tissue damage around the joint
• Arthrography: A specialized imaging technique that can reveal internal joint abnormalities

Why is a multidisciplinary approach often necessary for TMJ injuries?

TMJ injuries often require input from various medical specialists due to their complex nature:

• Emergency physicians for initial assessment and stabilization
• Oral and maxillofacial surgeons for surgical interventions
• Dentists for addressing dental complications
• Radiologists for interpreting imaging studies
• Physical therapists for rehabilitation

This collaborative approach ensures comprehensive care and optimal recovery outcomes for patients with TMJ fractures or dislocations.

Treatment Approaches for TMJ Fractures and Dislocations

The treatment of TMJ fractures and dislocations varies depending on the severity and type of injury. Medical professionals tailor the treatment approach to each patient’s specific condition and needs. Here are the primary treatment methods:

Treating a Dislocated Jaw

For a dislocated jaw, the primary goal is to reposition the joint correctly. This process, known as reduction, involves:

1. Administration of local anesthetics and muscle relaxants to minimize pain and facilitate manipulation
2. Manual manipulation of the jaw back into its proper position by a trained medical professional
3. In some cases, surgical intervention may be necessary if manual reduction is unsuccessful

Managing TMJ Fractures

The treatment approach for TMJ fractures depends on the fracture’s severity and location:

• Clean breaks may heal independently with jaw immobilization
• Multiple fractures or displaced breaks often require surgical repair
• Wiring the jaw shut is a common treatment method for both minor and severe fractures

What is the purpose of wiring a jaw shut?

Wiring the jaw serves several important purposes in TMJ fracture treatment:

• Immobilizes the jaw to promote proper healing
• Maintains correct bite alignment during the healing process
• Reduces the risk of further injury or displacement
• Allows for controlled healing in cases of multiple or complex fractures

Patients with wired jaws are typically provided with wire cutters for emergencies, such as choking or vomiting episodes.

Recovery and Rehabilitation After TMJ Injuries

Recovery from TMJ fractures and dislocations is a gradual process that requires patience and adherence to medical advice. The typical recovery timeline includes:

1. Initial immobilization period: Usually lasts about 6 weeks
2. Gradual reintroduction of jaw movement
3. Physical therapy to improve jaw strength and mobility
4. Dietary modifications to accommodate healing

During the recovery period, patients may experience:

• Limited ability to open the jaw
• Need for a liquid or soft food diet
• Discomfort and pain, managed with prescribed medications
• Potential weight loss due to dietary restrictions

How can patients support their recovery at home?

Patients can take several steps to facilitate their recovery:

• Strictly follow the prescribed liquid or soft food diet
• Maintain good oral hygiene, adapting techniques as necessary
• Avoid activities that could stress the healing jaw
• Attend all follow-up appointments and physical therapy sessions
• Report any unusual symptoms or concerns to their healthcare provider promptly

Adhering to these guidelines can significantly contribute to a smoother and more effective recovery process.

Long-Term Implications and Follow-Up Care for TMJ Injuries

While many patients recover fully from TMJ fractures and dislocations, some may experience long-term effects. Understanding these potential outcomes and the importance of follow-up care is crucial for optimal long-term health.

Potential Long-Term Effects

Some individuals may experience lasting effects from their TMJ injury, including:

• Chronic pain or discomfort in the jaw area
• Limited jaw mobility or range of motion
• Changes in bite alignment
• Increased susceptibility to TMJ disorders
• Arthritis in the affected joint

Why is ongoing follow-up care important after TMJ injuries?

Regular follow-up care serves several important purposes:

• Monitors the healing process and identifies any complications early
• Allows for timely adjustments to treatment plans if needed
• Helps manage any persistent symptoms or developing issues
• Provides an opportunity for patients to discuss concerns and receive guidance
• Ensures proper rehabilitation and return to normal jaw function

Maintaining a strong relationship with healthcare providers can significantly improve long-term outcomes for patients recovering from TMJ injuries.

In conclusion, TMJ fractures and dislocations are serious injuries that require prompt medical attention and comprehensive care. Understanding the causes, symptoms, diagnostic processes, and treatment options is crucial for both patients and healthcare providers. With proper management and dedicated follow-up care, many individuals can recover successfully from these injuries and regain normal jaw function. However, it’s important to remain vigilant about potential long-term effects and to seek ongoing care as needed to ensure the best possible outcomes.

Broken or Dislocated Jaw: Causes, Symptoms, and Diagnosis

What is a broken or dislocated jaw?

A broken or dislocated jaw is an injury to one or both of the joints that connect your lower jawbone to the skull. Each of these joints is called the temporomandibular joint (TMJ). The TMJ can break, crack, or become unhinged from the skull. The unhinging of the jaw joint is known as a dislocation.

A broken, fractured, or dislocated jaw can create problems with eating and breathing. Immediate medical attention is necessary to minimize complications and accelerate healing.

Experiencing facial trauma is the primary cause of a broken or dislocated jaw. The jawbone extends from your chin to behind your ear. Common types of injury that can cause fractures or dislocations in the jawbone are:

• physical assault in the face
• sports injuries
• vehicle accidents
• accidental falls in the home
• industrial or workplace accidents

Broken jaw

Symptoms of a broken jaw include:

• pain
• swelling, including facial swelling
• bleeding, including bleeding from the mouth
• breathing difficulties
• discomfort when chewing
• jaw stiffness
• numbness and bruising in the face
• dental-related discomfort, such as numbness in the gums or loosened teeth

Pain, swelling, and bleeding are the most immediate symptoms of a broken jaw. Your entire face can swell, making your jaw painful and stiff. Bleeding from the mouth can occur, causing breathing difficulties in some people. The blood flow can block your airways. You may experience the most pain and tenderness when chewing or speaking. If you have a severe jaw fracture, you might experience limited ability to move your jaw or be unable to move your jaw at all.

Numbness and bruising in the face and gums are also normal to have if your jaw is fractured or broken. Breaking the bone can cause other abnormalities with the shape of your face. You might notice that your jaw or face has a lumpy appearance. The impact of your injury could also cause loosened or lost teeth.

Dislocated jaw

The signs of a dislocated jaw can be different than those of a broken jaw. Pain is a factor, and it may become worse when you move your mouth or your body. Additional signs of a dislocated jaw include the following:

• Your jaw might appear to jut out too much, as in an overbite.
• You might notice that your teeth don’t line up as they usually do and your bite feels strange.
• An abnormal bite can prevent you from closing your mouth completely, and this might cause drooling.
• Speaking may be difficult.

Your doctor will diagnose a broken jaw or dislocation by asking you your history, doing a physical exam, and taking relevant X-rays. A simple dislocation could be treated by an oral surgeon or dentist. A serious fracture that requires surgery would need a specialist, such as a facial plastic and reconstructive surgeon, a head and neck surgeon, or an oral surgeon.

The Healthline FindCare tool can provide options in your area if you need help finding a specialist.

If you injure your jaw, it will most likely be treated as an emergency. While waiting for medical care, support your lower jaw to help stabilize it and keep your airway open.

Treating a dislocated jaw

A doctor must manipulate a dislocated jaw back into the correct position. Sometimes your doctor can do this manually. You’ll receive local anesthetics and muscle relaxants to minimize the pain and to help your jaw muscles loosen up enough to allow the manipulation. In some cases, surgery may be necessary to set the TMJ back into the normal position.

Treating a broken jaw

Treatment for a jaw fracture or break might also require surgery, depending on the extent of the injury. Clean breaks may heal on their own while your jaw is immobilized. Multiple fractures of the jawbone or displaced breaks in the part of the bone that’s pushed off to one side may require surgical repair.

Wiring your jaw shut

Broken and dislocated jaws are bandaged or wired shut during recovery.

Your doctor may treat your dislocation and minor fracture simply by wrapping a bandage around your head and under your chin to keep you from opening your jaw wide. Anti-inflammatory medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can dull the pain and reduce swelling.

Severe breaks might require wiring to promote healing. Wires and elastic bands keep your jaw closed and your bite in place. Keep a pair of scissors or wire cutters in your home during your recovery. The tools will allow you to open the wires if you experience vomiting or choking. If the wires need to be cut, notify your doctor so they can replace the wires as soon as possible.

Recovery from a jaw fracture or dislocation requires patience. You won’t be able to open your jaw very wide or at all for at least six weeks during treatment. Your doctor will prescribe painkillers and antibiotics to prevent infection. You’ll also be on a liquid diet to provide you with nutrition during this time while you’re unable to chew solid food.

You will need to follow a soft diet as you recover from a dislocated or broken jaw. Avoid foods that are crunchy or chewy if you have a dislocation or minor fracture that will heal on its own. Items such as fresh meats, raw produce, or crunchy snack foods can cause strain and pain to your healing jaw. A soft diet that includes the following can be easy to chew:

• canned meat
• well-cooked pasta
• well-cooked rice
• soup
• canned fruit

A wired jaw will need an even more drastic dietary change. Because you won’t be able to open and close your mouth, you’ll need to get your daily allowance of vitamins and minerals through a straw during your recovery. Getting enough calories can be a concern for some people with jaw injuries. Pureed foods prepared with whole milk or cream can help add calories when needed. Pureeing fruits, vegetables, and well-cooked meats can give you the protein and other nutrients you need to stay healthy. You can use oatmeal, cream of wheat, and other soft grains as the base for your meals.

Healthy eating while your jaw is wired means eating more frequently than you’re probably used to doing. Instead of eating three or four meals per day, aim for six to eight small meals. Eating small amounts throughout the day helps you meet your required calorie count. Smaller, more frequent meals can also provide a variety of flavors when you’re drinking eight smoothies each day.

Drink milk and juice to boost your calorie count. Cut back on water, coffee, tea, and diet soda. These beverages have no calories. They will not help you sustain your weight while you’re on a restrictive diet.

Eat lukewarm foods. Your teeth may be more sensitive than usual after your injury, and extreme temperatures on either side of the spectrum can hurt. Consider choosing baby food to accommodate your need for vitamins. Use water or milk to thin heavier soups, gravies, or jarred foods if their consistency is too thick to get through a straw.

The outlook is very good for most people who experience a broken or dislocated jaw. Dislocation and nonsurgical factures heal in four to eight weeks, whereas recovery from a surgical fracture could take up to several months. In most cases, the jaw heals successfully and there are few long-term effects.

However, you’re more likely to have recurring joint pain in your jaw after your injury. This is a condition called temporomandibular joint disorder, which is also referred to as TMJ disorder. People who have dislocated their jaw may have an increased risk of a future dislocation as well. Protect your jaw from future pain or injury by supporting your chin when you sneeze or yawn.

Temporomandibular Joint Trauma | Pocket Dentistry

Key points

• •

  Mandibular trauma with or without condylar fractures can affect the temporomandibular joint.

• •

  Almost all condylar fractures in children and most of them in adults can be managed with closed reduction with acceptable outcomes.

• •

  Recent data report better functional outcomes with open treatment of condylar fractures and concomitant soft tissue repair but at a low risk of facial nerve injury.

• •

  Severely displaced condylar fractures may be associated with soft tissue injuries that are in need of soft tissue repair.

Introduction

Maxillofacial trauma involves the mandible up to 50% of the time. Condylar fractures constitute 10% to 40% of mandibular fractures. Much of the literature on management of condylar fractures historically focused on treating the bony injury with closed or open approaches, overlooking soft tissue injuries within the temporomandibular joint (TMJ). Available data support closed treatment of almost all condylar fractures in children younger than 12 years because of their excellent remodeling capacity. Treatment of condylar fractures in adults remains controversial between proponents of open treatment versus closed treatment, with open treatment recently gaining more acceptance. Recent studies based on MRI and arthroscopy show objective evidence of injury to the capsule, meniscus, and ligaments in and around the TMJ. Based on these studies, we now know that mandibular trauma with or without fractures can be associated with injury to the soft and hard tissues of the TMJ. Improved long-term outcomes have been reported by some prospective studies with simultaneous soft tissue repair during open treatment of certain types of condylar fractures as opposed to closed treatment. Further knowledge on the role of soft tissue injury in healing of condylar fracture may pave the way for a major change in treatment protocols in the future. The current article focuses on treatment of injury to the TMJ region as a combination of soft tissue injury and condylar fractures.

Incidence and presentation of temporomandibular joint trauma

A recent 5-year data review by Alfrooz and colleagues in 2015 from the National Trauma Data Base (NTDB) with 13,142 patients found that condylar and subcondylar fractures constituted 14.8% and 12.6% of all mandibular fractures, respectively, in the United States. In the same study, the mechanism of injury most commonly causing condylar fractures were motor vehicle accidents and assaults. A traumatic injury that can result in mandibular trauma presumably also can cause direct or indirect TMJ trauma. MRI and arthroscopy studies have shown evidence of trauma to the soft tissues within the TMJ even without radiographic evidence of condylar fractures. Trauma to the TMJ with or without condylar fractures commonly manifests with facial swelling, malocclusion, and limitation in mandibular range of motion. The preauricular region may elicit ecchymosis and/or tenderness to palpation. In patients with displaced unilateral condylar or subcondylar fractures, occlusal examination may show premature contact on the ipsilateral side secondary to loss of ramus height with open bite on the anterior and contralateral posterior dentition. Patients who have hemarthrosis without a fracture in the condylar region may show open bite on the side of the injury ( Fig. 1 A, B ). Limited mandibular range of motion is consistent with injury to the muscles of mastication, with limited lateral excursions in the direction away from the side of fracture in unilateral cases. Bilateral condylar fractures commonly present with an anterior open bite with premature posterior contact ( Fig. 1 C). Presence of concomitant facial fractures in the rest of the maxillofacial region may mask or change the signs of malocclusion ( Fig.  1 D).

Fig. 1

( A ) Increased joint space result of possible hemarthrosis in the joint. Also noted is an intracapsular condylar fracture. ( B ) Patient in ( A ) with hemarthrosis on left TMJ shows mandibular midline deviation to the right side and left posterior open bite consistent with the trauma. ( C ) Anterior open bite CT scan of patient with bilateral subcondylar fracture with resultant decrease in posterior ramus height and subsequent anterior open bite. ( D ) Patient with pan-facial fracture. Only has left subcondylar fracture in the mandible, shows bilateral open bite due to concomitant mid-facial fractures.

Initial radiographic evaluation of maxillofacial trauma at most modern medical centers consists of orthopantomogram/plain skull films with or without computed tomography (CT) scans. CT scan evaluation is considered the gold standard in the diagnosis of maxillofacial fractures. Although CT scans may not be the best imaging to assess soft tissue structures, hemarthrosis or fluid buildup is often noted on CT scan, evident by an increase in the joint space (see Fig.  1 A). Although MRI scan is not standard of care in facial fractures and may not be feasible in an acute trauma setting, it is a reliable technique to assess soft tissues in the TMJ. Several investigators have studied acutely injured TMJs with MRI scans to assess the extent of soft tissue injuries. These studies show a high incidence of hemarthrosis, capsular tear, disc displacement, and perforation of the disc or bilaminar tissues ( Fig. 2 ). Patients who sustain severe condylar displacement show much worse soft tissue injuries. It is also found that the cases without bony fracture in the condyle also sustain significantly more injury than the ones that have evidence of condylar fractures, perhaps due to the amount of force transferred to the soft tissues. Arthroscopic studies showed hemarthrosis in the superior joint space in all cases of condylar injury, and in approximately 60% of the inferior joint spaces in patients with mandibular trauma with or without evidence of fracture.

Fig.  2

MRI of injured TMJ showing hemarthrosis in T2 view ( white arrow ).

( From Dwivedi A, Tripathi R, Gupta P, et al. Magnetic resonance imaging evaluation of temporomandibular joint and associated soft tissue changes following acute condylar injury. J Oral Maxillofac Surg. 2012;70(12):2829-34; with permission.)

Classification of temporomandibular joint trauma

Several classification systems involving the condylar fractures have been described over the past century, but none has been universally accepted. The varying nomenclature for types of condylar fractures has made this more challenging. A comprehensive classification system proposed by Lindahl is based on level of the bony fracture, dislocation of the fractured segment, and its relationship to the articular fossa. The level of fractures was classified into condylar head, neck, and subcondylar types ( Fig. 3 ). Although this classification is comprehensive, it is complex for practical application and does not involve possible treatment. A newer classification system proposed by Bhagol and colleagues for subcondylar fractures based on 2 known predictable variations that determine the type of treatment, including the degree of displacement and amount of reduction in ramus height, was validated with a prospective clinical study. Subcondylar fractures were classified into minimally displaced, moderately displaced, and severely displaced, and correlated with increasing loss of ramus height. Class I fractures are minimally displaced fractures and are treated closed, whereas class II fractures can be treated with open or closed and class III fractures are treated with open reduction. Unfortunately, none of the current classification systems include soft tissue injuries. Hence, the treating surgeon should consider trauma on a case-by-case basis considering type of condylar fractures, concomitant fractures, injury to the TMJ soft tissues, risk to the facial nerve, and patient-specific variables that prevent open or closed treatment.

Fig. 3

Levels of condylar fracture. ( A ) Intracapsular fracture or condylar head fracture. ( B ) Subcondylar fracture at the level of the sigmoid notch. ( C ) High condylar neck fracture usually seen in pediatric patients.

Management of temporomandibular joint trauma

Bony injury

Bony components of the TMJ include the condyle, eminence, and the glenoid fossa. Condylar fractures are commonly seen bony injuries in TMJ trauma with varying levels of displacement and resultant loss of ramus height. Glenoid fossa fractures are fortunately less common and could result in displacement of the condyle into the middle cranial fossa.

Condylar fractures

Up to 70% of condylar fractures, in general, are found to be associated with concomitant mandibular fractures in other regions of the mandible, most commonly the parasymphysis and body. Conventionally, condylar fractures have been treated with closed treatment approaches involving varying periods of immobilization of the jaws with maxillomandibular fixation (MMF) ranging from 2 to 6 weeks. MMF is performed with using arch bars and wires or MMF screws and wires or hybrid arch bars that are secured with screws interdentally ( Fig. 4 ). Closed treatment technique is easier, quicker, associated with fewer surgical risks, and does not require a steep learning curve that may be required for open treatment. Closed treatment of condylar fractures is based on the ability of the teeth, soft tissue, and bone in the condyles to adapt to the new position and still maintain form and function. Almost all condylar fractures in children can be treated with closed treatment due to the capability of bone to remodel over the growth years. In adults, nondisplaced or minimally displaced condylar or subcondylar fractures can be managed with short-term immobilization using maxillomandibular fixation for 1 to 2 weeks followed by rehabilitation using jaw exercises and guiding elastics to maintain occlusion.

Fig. 4

( A ) MMF for closed treatment of condylar fractures with application of MMF screws. The wires are applied across these screws to obtain MMF. ( B ) Arch bars placed on the maxillary arch with wires around the teeth, whereas hybrid arch bars are placed in the mandibular arch secured with inter-radicular screws. MMF can be transitioned to guiding elastics after 10 to 14 days to stabilize the occlusion. Prolonged MMF, especially for intracapsular fractures increases risk for ankylosis.

Open treatment versus closed treatment of condylar fractures

Closed treatment of condylar fractures in adults has been the mainstay for several decades. Although easier to perform and associated with fewer surgical risks, closed treatment has been shown to result in increased mandibular deviation, increased risk of malocclusion, and minimal anatomic changes in the displaced bone and soft tissues of the TMJ. Overall, the results from treatment of condylar fractures with closed treatment have been acceptable, if not ideal. The patient’s medical comorbidities and expectations always should be considered when choosing between open versus closed treatment in any type of condylar fracture. A proper informed consent with discussion of treatment options, risks involved, and patient expectations and their capability to handle MMF is crucial to make the correct decision. In 1983, Zide and Kent recommended absolute and relative indications for open treatment of condylar fractures, but the absolute indications are rare and relative indications are difficult to justify in all cases.

Multiple prospective randomized studies have shown acceptable outcomes with closed treatment while showing improved functionality with open treatment. A recent systematic review with meta-analysis comparing open versus closed treatment for condylar fractures by Al Morriasi and Ellis showed superiority of open treatment with regard to maximal mouth opening, malocclusion, lateral excursions, chin deviation, pain, and asymmetry. But some of the drawbacks of this systematic review were the inability to differentiate the types of fractures among the studies included, inclusion of bilateral condyle fractures with unilateral fractures, and variability and bias in the studies.

Open treatment of condylar fractures is gaining preference lately, with increasing knowledge of improved outcomes as well as improved fixation techniques. Open treatment provides the advantage of early function, better anatomic correction of displaced condyles, and the opportunity to assess and repair soft tissue injuries. It carries the risk of facial nerve injury and scar formation. Based on the level of condylar fracture, extraoral or intraoral surgical approaches to perform open reduction and internal fixation can be used. Extraoral approaches may include the preauricular approach, retroauricular approach, and retromandibular and submandibular approaches. Modification of these conventional approaches also has been described, such as the transmasseteric approach ( Fig. 5 ). Intraoral approaches with or without endoscopic assistance have been described to reduce the chance of facial nerve injury. Studies on surgical complications from open treatment of condylar fractures report a high incidence of transient facial nerve weakness but low incidence of permanent facial nerve injury. Endoscopic approaches also are reported to have an incidence of transient facial nerve injury. Because of the steep learning curve, special equipment required, and prolonged duration of the operation, endoscopic repair of condylar fracture has fallen out of favor. Other rare potential complications from open treatment of condylar fractures, although rare, include Frey syndrome, sialocele formation, infections, resorption of the condyle, and failure of hardware. Although open treatment may have better functional outcomes, surgical risks should be weighed against the benefits. Several factors should be considered before using an open approach, including type/location of fracture, displacement of the condyle, the patient’s ability to undergo surgery from a medical standpoint, the surgeon’s expertise with open approaches, risk for scar formation, and facial nerve injury.

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TMJ Dysfunction Treatment Center

The articular disc is oval in shape and is held by ligaments over the articular head of the lower jaw during any movement in the TMJ joint, providing cushioning when opening and closing the mouth.

How does a dislocation of a joint occur?

If there are problems at the level of the teeth or bones of the skull, the lower jaw can change its position in the temporomandibular joint, turn around or distalize (push back) within the joint capsule. In this case, the interarticular disc is subjected to pressure by the head of the mandible, and can be forced forward within the joint, which leads to dislocation of the TMJ disc.

This dislocation can occur every time the mouth is opened and closed, thus becoming chronic. The first symptoms of temporomandibular joint dislocation are the appearance of clicks, crunching or discomfort near the ear in the joint area.

The head of the lower jaw on one or both sides moves deep into the articular cavity, starting to compress the bilaminar zone of the joint, rich in vessels and nerves, which is no longer protected by an anteriorly dislocated disc. Pain appears.

What happens if a TMJ dislocation is not treated?

Every time you eat or talk, the TMJ joint moves. The same thing happens with swallowing. That is approximately every 60 seconds.

Thus, you can see that this is one of the most mobile and most involved joints in the body. When dysfunction occurs, the intra-articular disc again and again undergoes dislocation when the joint moves. The disk itself over the years, if the joint is not healed in time, begins to deform, fragment, and wear out. The ligament holding the disc may be torn and thinned. Next, there is a process of destruction of the articular surface of the head of the lower jaw, which will move without shock absorption and be damaged. At the same time, clicks are replaced by an unpleasant sensation of a “broken glass” crunch in the joint area when the mouth is opened.

TMJ symptoms

Thus, you can see that this is one of the most mobile and most involved joints in the body. When dysfunction, pain, clicks appear, the intraarticular disc again and again undergoes dislocation when the joint moves.

The compensatory response to an injury in a joint will be to tighten the masticatory muscles to hold the joint tightly in an attempt to limit its movement. There is a symptom of muscle hypertonic muscles on one or both sides. When the TMJ stops functioning normally, it affects every aspect of your daily life and becomes a constant source of pain and discomfort. Following the hypertonicity of the masticatory muscles, the sternocleidomastoid muscle, the trapezius, also becomes tense, which causes discomfort in the neck, shoulders, and gradually, in the entire spine. Outwardly, scoliosis of the spine begins to develop.

Don’t endure pain caused by TMJ dysfunction as something inevitable. Dysfunction can occur under the influence of various forces that cause overload of the TMJ. It is necessary to consider the nature of these forces in order to understand the cause of dysfunction.

Main causes of TMJ dysfunction

• Birth injury
• Injury of the skull before or after 12 years
• Malocclusion
• Scoliosis of the spine
• Missing posterior teeth
• Improper orthodontic treatment or prosthetics

Pathogenesis of TMJ dysfunction

1.

Birth trauma

The flexibility and plasticity of the baby’s skull is necessary for the physiological passage of the head through the birth canal. In this case, the child’s skull is subjected to strong pressure and distortion, which normally self-corrects in the first weeks of life. However, in many cases, distortions imposed on the skull at birth do not spontaneously correct over time.

Changes in the shape and symmetry of the structures of the skull, which are visible to the naked eye and the degree of which can be measured, can adversely affect the adaptive abilities of the body and the general health of the child. When deformed, the bones of the skull are clamped from one side or sides and lose their full mobility. Violation of the rhythmic movements of the bones of the skull entails membranous and fascial tensions in the head and body. Vertebral scoliosis in childhood often develops as a consequence of cranial (cranial) scoliosis that occurred at birth.

Also, when the skull is compressed, the child may experience the following diseases and symptoms:

Developmental delay – violation of liquorodynamics, compression of the skull.

Speech impairment and many other types of dysfunction.

When a child reaches 4 months of age, complete correction of cranial distortion becomes more and more difficult

With age, the body compensates for the distortion of the skull bones, malocclusion, discrepancy between the upper and lower jaws, scoliosis, forward position of the head and mouth breathing begin to develop. All these factors provoke the development of TMJ dysfunction. But the body tries to compensate and adapts to the existing birth trauma, however, any push from the outside will break this compensation.

Lifetime cranial injury, bumps, falls, postural problems, loss of teeth, incorrect orthodontic treatment, errors in dental prosthetics, all this will be a trigger factor for impaired compensation and the development of TMJ dysfunction.

2. Injury of the skull, received before or after 12 years

Cranial damage is usually the primary etiological factor that underlies various malocclusion pathologies. It is the trauma of the skull, albeit “insignificant” at first glance, that can lead to displacement of the bones of the skull, especially within the squamous sutures. At the same time, on x-ray images, we will not see any signs of a fracture or damage to bone structures. However, it happened.

As a result, the upper jaw, normally located strictly horizontally relative to the base of the skull, will become distorted in the three-dimensional space of the skull.

The correspondence between the occlusal plane of the maxilla and mandible will be disturbed. The muscles will react first. Compensatory, there will be an increase in the tone of the masticatory muscles, in an attempt to close a new bite during the act of eating, swallowing, talking. Excessive occlusion of the teeth on the low side of the maxilla will create heavy contact resulting in periodontal problems, recessions, tooth pain on that side. When such patients enter dental clinics, they unsuccessfully begin to heal possible causative teeth one after another, but the pain persists..

As a result, the discrepancy between the upper and lower jaws, hypertonicity of the masticatory muscles, problems in the oral cavity (abrasion or absence of teeth) will certainly lead to TMJ dysfunction.

However, cranial pathology can also occur under the influence of concomitant postural problems of the spine and pelvis, which affect the posture and muscle tone of the entire frame, being often the primary factors in the development of compensatory cranial dysfunctions, without trauma to the skull itself.

Scoliosis of the spine

However, cranial pathology can also occur under the influence of concomitant postural problems of the spine and pelvis, which affect the posture and muscle tone of the entire frame, being often the primary factors in the development of compensatory cranial dysfunctions.

Everything is interconnected in the human body. Changes in an area of ​​one organ will cause a cascade of reactions throughout the body, including musculoskeletal

Most practitioners do not look at the TMJ joint, but pay attention to pain that occurs in different parts of the body due to TMJ dysfunction. Ascending postural causes of temporomandibular joint dysfunction are often associated with pelvic or sacroiliac joint instability. system – posture. Thus, the postural instability of the body propagates upward, causing changes in the functioning of the TMJ – the temporomandibular joint. In addition, interactions at the level of the teeth also affect the functioning of the TMJ.

When treating a patient’s body with TMJ dysfunction and malocclusion, it is important to look at the whole system.

The pelvis is important for a balanced, stable position of the spine.

Inside the spinal column is the dura mater, which also lines the inside of the cranial cavity, and is a single inextensible high-density structure. It is extremely important for the formation of the relationship between the skull and the spine. The dura mater has features in the places of attachment to bone structures, however, we are especially interested in the sacrum and the occipital bone, in the area of ​​which the main fusion occurs. Thus, it is possible to trace the close relationship between the occipital bone and the sacrum, which normally should have synchronous movement. A dura mater stretched unnaturally as a result of scoliosis or pelvic pathology will directly lead to disruption of both the occipital bone and the sacrum. Dysfunction in the pelvis quickly rises, causing pain in the neck, thoracic region, lower back, and, finally, affecting the function of the TMJ.

There is also an ascending type of dysfunction, in which problems in the lower parts of the body cause dysfunction of the overlying parts. Now imagine that there is a leg injury or spasm in the sacroiliac joint on one side. What will the body do? It will shift the main load to the healthy side (leg, or side without pain and spasms).

The spine and the entire postural system of the body will adjust to the new center of gravity through body misalignment. The distortion of the body will occur with the help of the muscles, which will contract or relax in a “staggered” manner, under the command of the central nervous system. HER commands will be aimed at maintaining the balance of the body, because otherwise the person will simply fall on his side. This mechanism will also be reflected in the head, which, in order to maintain balance, will tilt in the opposite direction. Now consider the skull.

Intracranial pressure will automatically increase on the low side of the tilt and with a long head position, the skull will tend to equalize this pressure. The central nervous system will once again give a command to the muscles of the anterior-lateral surface of the neck, the masticatory group. They will contract in such a way as to turn the middle and anterior zones of the skull in the opposite direction, thus balancing the intracranial pressure. Also, with the help of muscles, other mechanisms are implemented that maintain balance and postural balance of the body.

There are 3 most powerful zones responsible for body balance:

1. Eyes
2. Vestibular apparatus
3. Feet

If one of these systems fails, the load will be distributed among the others. Now imagine that when the head is tilted due to the spasmodic muscles of the back group of the back (to maintain balance), the information from the horizontal planes of the vestibular apparatus and the eyes becomes incorrect. In an attempt to align the signals, the brain will also give a command, and the neck muscles will contract, trying to rotate the middle and anterior zones of the skull closer to the level of the horizon, i.e. align the eyes.

4. Incorrect bite

Pathology of bite can often be caused by:

• Violation of the relative position of the upper and lower jaw resulting from trauma.
• Improper orthodontic treatment or prosthetics
• Missing posterior teeth

The upper jaw relative to the skull can be located in a retroposition, be tilted to the right or left, have a turn of the entire body, or tilt in the anteroposterior direction. These pathological positions occur when the face or excessive compression of the child’s skull during childbirth (the degree of force that causes changes in the position of the upper jaw depends on the individual resistance of the body) There is a block of the upper jaw, accompanied by a violation of the movement of the incisive, maxillary and palatine bones relative to each other and the skull .

With the existing blockage of the upper jaw, the developing dentition can be very crowded due to the narrowing of the maxillary bones, and the emerging teeth simply do not fit in the dentition, and begin to erupt unevenly and out of the arch.

When the upper jaw is in retroposition, i.e. slightly posterior to its rightful place, there is a narrowing of the airway space of the nasopharynx. Subsequently, the lower jaw also moves backward, trying to close the teeth in forced occlusion. This position of the upper and lower jaw, in turn, limits the movement of other bones responsible for nasal breathing (vomer, ethmoid bone). The block of bones, in turn, provokes a violation at the tissue level. The compressed mucosa begins to swell, venous stasis develops, accumulation of lymphoid tissue, friability of the nasopharyngeal mucosa appears. In this case, a rather serious violation of nasal breathing occurs.

In children with this problem, mouth breathing begins to predominate. Adults develop sleep apnea and snoring. The body’s attempt to clear the upper airways results in an anterior position of the head relative to the body. Also, in the mucous membrane of the nasopharynx and oropharynx, lymphoid tissue grows – tonsils, nasal polyps increase, which further narrows the lumen of the respiratory tract. The reactivity of the mucosa to allergens also increases, first to local ones, in the form of polynoses, allergies to dust, then the general reactivity of the body becomes tense, a reaction to food and drug allergens appears.

5. Consequences of prosthetics or orthodontic treatment

Any inconsistencies and problems that arise, our body tries to solve and adapt to them. This process is constantly taking place, for example, even to regulate the temperature inside the body, during severe frosts in the environment. Moreover, the process of adaptation is activated when the mutual arrangement of the bones of the skull is disturbed. The body adapts as quickly as possible and changes are primarily reflected in the bite. Any dental intervention that does not take into account a possible global problem, but is directed only at the tooth in isolation, will inevitably break the body’s adaptation. The changed height of the teeth, bite, number of teeth will affect the whole body.

When the upper jaw is tilted, the side with the greatest load will give pain. There may be trigeminal neuritis of the maxillary branch, periodontal pockets on this side, increased tooth wear, the appearance of wedge-shaped defects and gum recessions. All this happens due to a change in the load vector on the tooth or a general overload (due to some pathology of the relative position of the bones, possibly injury) and the body receives eating, talking. Any turn, tilt, retroposition of the upper jaw will be accompanied by a turn, tilt and retroposition of the lower jaw. But, as we remember from the anatomy of the lower jaw, the heads of which are located strictly in accordance with the articular cavities of the temporal bones, the deviation of its position will harm the TMJ. Dysfunction of the joint sets in very quickly. The heads, being out of place, displace the articular disc and lead to its dislocation.

General syntax for the treatment of TMJ dysfunction. Cranio-mandibular disorders.

1. Stabilization of the TMJ by making an individual orthotic – splint therapy (neuromuscular, decompression, NTI-deprogrammer, etc.)
2. Correction of cranial disorders in 3 planes – Roll, Pitch, Yaw.
3. Neuro-muscular balance of the body and postural system.
4. Observation in dynamics. Asymptomatic period should be at least 4 months
5. Completion of treatment at the dentoalveolar level for the formation of a new occlusal relationship (prosthetics, orthodontics)

When the TMJ stops functioning normally, it affects every aspect of your daily life and becomes a constant source of pain and discomfort.

Following the hypertonicity of the masticatory muscles, the sternocleidomastoid muscle, the trapezius muscle, becomes tense, which causes discomfort in the neck, shoulders, and gradually, in the entire spine.

Outwardly, scoliosis of the spine begins to develop.

Also, there may be an increasing asymmetry of the face.

All about TMJ dysfunction – causes, symptoms, who treats

What should be done to diagnose and treat dysfunction of the temporomandibular joint ? To solve this problem, the first step for the patient is to make an appointment with the dentist. After the initial examination, the doctor may prescribe additional studies:

• Maxillofacial Surgeon Consultation
• MRI temporomandibular joint
• CT of the jaw.

Temporomandibular joint disorder (TMJ dysfunction) is a disorder that affects the movement of the jaw. Dysfunction can be caused by teeth grinding, age-related wear of the joint, a blow to the head or face, stress, uneven bite.

Symptoms of temporomandibular joint dysfunction

Signs of a TMJ disorder include:

• pain around the jaw, ear and temple
• Clicking, crackling or grinding sound when moving the jaw
• headache around the temples
• difficulty opening the mouth completely
• The jaw is locked when the mouth is opened.

Pain in the jaw may be aggravated by chewing and stress.

How a doctor diagnoses temporomandibular joint dysfunction

The patient should see a dentist or oral surgeon if they experience the following symptoms:

• cannot eat or drink
• Jaw pain affects daily life
• pain affects sleep
• joint pain and discomfort return on a regular basis.

Based on the results of the initial examination, the doctor may order an MRI of the temporomandibular joint.

Treatment of temporomandibular disorder at home

There are some simple ways to reduce jaw pain in TMD, for example:

• eat soft foods – pasta, omelettes and soups
• take painkillers – paracetamol or ibuprofen
• massage painful jaw muscles
• do not chew gum
• do not chew food with front teeth
• don’t yawn too wide
• do not bite your nails
• Do not rest your chin on your hand.

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Scientific sources:

1. Egorov P.M., Karapetyan I.S. Pain dysfunction of the temporomandibular joint. M.: Medicine, 1986. 128s.
2. Ivasenko P.I., Yakovlev V.M., Ignatiev Yu.T., Savchenko R.K., Kozhikhova N.P. Dysplastic-dependent pathology of the temporomandibular joint. // Dentistry 2001. – T.80, No. 4. – P.43-46.
3. Pautov I.Yu. Computed tomography in the diagnosis of internal disorders of the temporomandibular joint / / Abstract of the thesis. dis. .candidate med. Sciences.-M. 1995.- 15s.
4. Badanin V.V. Computed tomography study of the temporomandibular joint in orthopedic treatment of an improperly fused condylar process of the lower jaw. Clinical Dentistry. 1999. – No. 4. – P.55-57.
5. Kamalov I.I. The use of computed tomography in clinical practice: a review / I.I. Kamalov // Kazan, honey. magazine -1995.- T.76, No. 5. pp. 398-402.

Useful information

jaw fracture

What needs to be done to diagnose and treat a jaw fracture? To solve this problem, the first step for the patient is to make an appointment with a traumatologist. After the initial examination, the doctor may prescribe additional studies:

Consultation with a surgeon
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MRI of the temporomandibular joint
Orthopantomogram.

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jaw CT

CT scan of the jaw (full name is multislice computed tomography of the upper or lower jaw) is an X-ray examination of the lower face, which includes scanning of the jaws, teeth, jaw joints and soft tissues of the oral cavity.