Mini Review
Volume 3 Issue 2 - 2015
Non Surgical Treatment of TMJ Dislocation
Essam Soussa1* and Magued Fahmy2
1Department of Oral Biology, Dental College, Mansoura University, Egypt
2Department of Oral Surgery, Dental College, Alexandria University, Egypt
*Corresponding Author: Essam Soussa, Department of Oral Biology, Dental College, Mansoura University, Egypt.
Received: September 28, 2015; Published: November 18, 2015
Citation: Essam Soussa and Magued Fahmy. “Non Surgical Treatment of TMJ Dislocation”. EC Dental Science 3.2 (2015): 496-500.
Abstract
Temporomandibular joint is a unique type of joints because it is diarthroidal joint that allows a wide range of movements, but it is controlled by the masticatory muscles, ligaments and a specialized dense fibrous capsule. Any impairment for this structure is considered as tempromandibular disorder. Temporomandibular disorders (TMDs) are that group of pathologies that affect the joint. It is usually manifested by one or more symptoms such as pain, tenderness of the joint, joint sounds, muscle tenderness and or limitation of jaw movements. TMJ dislocation is considered one of the most serious disorders when the condyle travels down and anterior to the articular eminence. It occurs unilateral or bilateral, non-reducible (acute form) or reducible (chronic or habitual form). Many modalities have been described for treatment of chronic TMJ dislocation, either surgical or non-surgical procedures. The conservative methods include restriction of mouth opening combined with soft diets, muscle relaxants, occlusal splints, injection of botulinum toxin into muscles of mastication and injection of sclerosing agents. Conservative treatment methods are not always successful; therefore, multiple surgical interventions were developed including eminectomy, capsular plication, temporalis tendon scarification, lateral pterygoidmyotomy, reduction or augmentation of the articular eminenceand condylectomy
Injection of autologous blood into the temporomandibular joint as a non-surgical treatment modality for chronic recurrent temporomandibular dislocation is considered as a safe and successful technique.
Keywords: TMJ; TMJ dislocation; Non-surgical treatment; Autologous blood injection
Review
Tempromandibular joint (TMJ) is located in front of the ear. It is a unique type of joints because it is diarthroidal joint that allows a wide range of movements, but it is controlled by the masticatory muscles, ligaments and a specialized dense fibrous capsule. Any impairment for this structure is considered as tempromandibular disorder [1].
An articular disc composed of dense fibrous tissue is located between the temporal bone and the mandible, dividing the articular space into an upper and lower compartment. Gliding movements occur primarily in the upper compartment, while the lower compartment primarily functions as a hinge joint [2].
Mandibular movements
Free or empty movements are defined as those occurring without food in the oral cavity. These movements are contrasted with the masticatory movements of the jaw, which are those associated with the incision and chewing of food [2].
The free movements of the mandible, combining rotation and translation, include:
  1. Opening and closing.
  2. Protrusion and retrusion (symmetrical forward and backward movements), and Lateral shifts of the mandible.
The extreme or outer limits of the various combinations of these movements define what have been called the border movements of the mandible [40-41].
TMJ disorder, more recently known as TMDS (temporomandibular disorders) is the correct term defining the complex, multi-faceted medical problem affecting the jaw joint [3-4].
TMDs are classified into non-articular and articular disorders that may range from a little tempromandibular dysfunction to complete TMJ dislocation [6].
TMJ dislocation is considered one of the most serious TMJ disorders when the condyle travels down and anterior to the articular eminence; it may be unilateral or bilateral, non-reducible (acute form) or reducible (chronic or habitual form) [7].
Because of that articular cartilage is estrogen sensitive; TMD affects one in five adult Americans, 80% of whom are women. In fibrous joints, such as the Temporomandibular joints, estrogen stimulating chemicals have been demonstrated to accelerate degenerative joint disease (DJD) and estrogen repressors to slow the process [8].
TMD can produce arthritis, jaw and facial pain, headache, earaches and restricted jaw movement. The function of the TMJ is extremely complicated; it allows the jaw to move, up and down, side to side (lateral) forward and back (protrusion) and also in many unique combinations, as a person speaks, bites, chews, yawns, etc [9].
It is an exquisite network of ligaments, muscles and nerves, common symptoms range from popping and clicking of the joint to severe and sometimes debilitating pain and dysfunction [9].
The American Academy of Orofacial Pain has classified TMD as shown in Table 1 [5].
Temporomandibular Disorders [5].
  1. Congenital or developmental
  2. Disk-derangement disorders
  3. Degenerative joint disorders
  4. Trauma
  5. TMJ hypermobility
  6. TMJ hypomobility
  7. Infection
  8. Neoplasia
TMDs are classified into non-articular and articular disorders that may range from a little tempromandibular dysfunction to complete TMJ dislocation [6].
TMJ dislocation is considered one of the most serious TMJ disorders when the condyle travels down and anterior to the articular eminence; it may be unilateral or bilateral, non-reducible (acute form) or reducible (chronic or habitual form) [7].
Hypermobility can be divided into three inter- related clinical entities:
Hyper-translation: refers to movements of the condyle in front and above the articular eminence during the opening of the mouth. This is probably a normal state for many individuals [8].
Subluxation: it is considered as an incomplete dislocation of the condyle, where articular surfaces preserve partial contact. At maximum opening, the condyle moves anteriorly towards the articular eminence, and is able to re-take the fossa either through manipulation or spontaneous reduction [11].
Spontaneous dislocation (blocked opening): this is the final stage of TMJ hyper-mobility development. It happens when the condyle moves towards an anterior position with respect to the articular eminence. This position cannot be voluntarily reduced [12-13-14].
Signs and symptoms of acute and chronic dislocation are the same and include: inability to close the mouth, preauricular depression of the skin, excessive salivation, tense spasmatic muscles of mastication, and severe pain of the TMJ [15].
Many modalities have been described for treatment of chronic TMJ dislocation, either surgical or non-surgical procedures. The conservative methods include restriction of mouth opening combined with soft diets, muscle relaxants, occlusal splints, injection of botulinum toxin into muscles of mastication and injection of sclerosing agents [16].
Conservative treatment methods are not always successful; therefore, multiple surgical interventions were developed including eminectomy, capsular plication, temporalis tendon scarification, lateral pterygoidmyotomy, reduction or augmentation of the articular eminence and condylectomy [17].
Autologous Blood Injection (ABI)is a procedure that involves the injection of a patient’s own (autologous) blood into an area of the body to promote healing.
Autologous blood injection to the TMJ as treatment was first reported by Brachmann [18] in 1964, followed by Schultz [19] in 1973. The therapy is based on the principle to restrict mandibular movements by inducing fibrosis in upper joint space, pericapsular tissues or both.
Blood injections into the TMJ follow the pathophysiology of bleeding in joints elsewhere in the body, creating a bed of loose fibrous tissue in the TMJ area. Hence, the TMJ becomes stiff and is not easy to be dislocated [20].
In addition to red and white blood cells, blood contains platelets, which are rich in substances called growth factors. The growth factors promote normal healing in soft tissues, particularly by facilitating the deposition of new fibrous tissue. In tendons and ligaments, the fibrous tissue may then transform or remodel into collagen, restoring the architecture and strength of the damaged tissue. The amount of growth factor deposited into tendons by ABI is thought to be considerably higher than that brought to the tissues by the body’s normal attempts at healing [21].
Study method
The surgical procedure was done under aseptic conditions, using a butterfly cannula; a vascular access to the pinna vein was done to allow aspiration of blood until 1.5 ml was obtained. 1 ml of blood was injected into the superior joint space; 0.5 ml of blood was injected into the peri-capsular tissues. Fixation of the mandible was done by external ligature elastics and left with his mouth closed for 24 hours after injection. Immediately after the surgical procedure, intramuscular injection of Gentamicin to prevent infection. The elastic ring was removed after 24 hours, fed with soft diet consisting.
After one and two weeks, histological evaluation revealed slight decrease in cell number and thickness of condylar cartilage, in addition to increase in fibrous layer as compared with the control. No apparent increase in fibrous tissue collagen fibers as encountered with trichrome stain. The cartilage zone shows regenerative changes with new cartilage formation and the fibrous layer is nearly the same thickness as that of the control after two months. The bone region is similar to the control with areas of new bone formation.
Conclusion
This study is to evaluate the histopathological features with autologous blood injections as a treatment for chronic recurrent TMJ dislocation.
The surgical procedure was done under complete aseptic conditions. Autologous blood was aspirated from pinna vein and re-injected into the superior joint space and peri-capsular area, followed by external ligature elastic for fixation, intra muscular injection of antibiotic and analgesic to alleviate post-operative pain and infection.
Advantages of autologous blood injection is that its application is minimally traumatic, It is very simple and does not require hospital admission or general anaesthesia and could be performed in the outpatient clinic under local anaesthesia, It has reduced risk for immune-mediated rejection. It is simple to acquire and prepare and inexpensive.
Bibliography
  1. DuBrul EL. “Sicher’s oral anatomy”. 7th edn. St. Louis (MO): CV Mosby (1980): 146-161, 174-209.
  2. Hylander WL. Functional anatomy. In: Sarnat BG, Laskin DM (eds). The temporomandibular joint: A biological basis for clinical practice. 4th ed. Philadelphia: W. B. Saunders Company (1992) 60-80.
  3. Posselt U. “Physiology of occlusion and rehabilitation”. Oxford, Edinburgh: Blackwell Scientific Publications (1968).
  4. Ramfjord SP and Ash MM. “Occlusion”. Philadelphia: W.B. Saunders, (1971).
  5. De Leeuw R. “Orofacial pain: guidelines for classification, assessment, and management”. 4th ed. Chicago: Quintessence Publ. Co., 2008.
  6. De Bont LG., et al. “Epidemiology and natural progression of articular temporomandibular disorders”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology 83.1 (1997): 72-76.
  7. Hasson O and Nahlieli O. “Autologous blood injection for treatment of recurrent temporomandibular joint dislocation”. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology 109.1 (2001): 390-393.
  8. Undt G., et al. “Treatment of recurrent mandibular dislocation. Part I Leclerc blocking procedure”. International Journal of Oral and Maxillofacial Surgery 26.2 (1997): 92-97.
  9. Rosner IA., et al. “Estradiol and Tamoxifen stimulation of Lapine articular chondrocyte prostaglandin synthesis”. Prostaglandins 26.1 (1983): 123-138.
  10. Isberg A. “Temporomandibular joint dysfunction: A practitioner’s guide”. Isis Medical Media Ltd, (2001): 7-33.
  11. Okeson LP. “Management of Temporomandibular disorders and occlusion”. 3rd edn. Sto Louis (MI): Mosby Year (1993).
  12. Myrhaug H. “A new method of operation for habitual dislocation of the mandible.  review of former methods of treatment”. Acta Odontologica Scandinavica 9.3-4 (1951): 247-261.
  13. Oatis G and Baker D. “The bilateral eminectomy as definitive treatment”. Journal of Oral and Maxillofacial Surgery 13.4 (1984): 294-298.
  14. Dingman RO and Moorman W. “Meniscectomy in the treatment of lesions of the temporomandibular joint”. Journal of Oral and Maxillofacial Surgery 9.3 (1951): 214-224.
  15. Lovely FW and Copeland RA. “Reduction eminoplasty for chronic recurrent luxation of the temporomandibular joint”. Journal (Canadian Dental Association) 47.3 (1981): 179-184.
  16. Matsushita K., et al. “Sclerotherapy for recurrent dislocation of the temporomandibular joint in elderly patients”. British Journal of Oral and Maxillofacial Surgery 45.6 (2007): 511-515.
  17. Miller GA and Murphy EJ. “External pterygoidmyotomy for recurrentmandibular dislocation”. Review of the literature and report of a case”. Oral Surgery, Oral Medicine, Oral Pathology 42.6 (1976): 705-716.
  18. Brachmann F. Eigen blutinjektionen bei rezidivierenden, nicht fixiert en Kiefergelenk luxationen. Zahnarztl 1964; 15: 97.
  19. Miller GA and Murphy EJ. “External pterygoidmyotomy for recurrentmandibular dislocation. Review of the literature and report of a case. Oral Surg Oral Med Oral Pathol 1976;42:705-716.
  20. Lewis JES. “A simple technique for long – standing dislocation of the Mandible”. British Journal of Oral and Maxillofacial Surgery 19.1 (1981): 52-56.
  21. Pinto AS., et al. “The use of autologous blood and adjunctive “face lift” bandage in the management of recurrent TMJ dislocation”. British Journal of Oral and Maxillofacial Surgery 47.4 (2009): 323-324.
Copyright: © 2015 Essam Soussa and Magued Fahmy. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


August Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the August issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for September Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the September issue of respective journals. Submissions are accepted on/before August 15, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk