Temporomandibular Joint Dislocation After Long-Term Mechanical Ventilation.

Abstract

Introduction: Dislocations of the temporomandibular joints (TMJ) are relatively common and occur in as many as 7% of the entire population at some point in their lives. Anterior dislocations are the most common and are defined as the excessive forward movement of the mandibular condyle out of the glenoid fossa beyond the articular eminence with complete separation of the articular surfaces. However, anterior bilateral TMJ dislocation after intubation described in this case report, is a very uncommon complication.

Case description: A 43-year-old woman with an unremarkable medical history presented to the emergency department with respiratory distress. She was admitted to the intensive care unit for non-invasive ventilation and intubated on the same day. After 10 days she was extubated. Post-extubation, the patient was unable to close her mouth, speak, or swallow, causing severe drooling. A computed tomography scan revealed a bilateral dislocation of the TMJ. An ear, nose and throat specialist successfully and easily repositioned the mandible under 5 ml of propofol, restoring normal jaw anatomy and function.

Discussion: Endotracheal intubation is a predisposing factor for TMJ dislocation. Other risk factors include female sex, interincisal distance, and age. Early recognition and management are imperative, since delay scan cause difficult repositioning due to muscle spasms. Longer delays can cause long-lasting dysfunctions and pain.

Conclusion: Bilateral anterior TMJ dislocation is a known but rare complication of endotracheal intubation. Swift recognition and treatment are imperative in order to prevent long-lasting anatomical and functional defects.

Learning points: Bilateral temporomandibular dislocation is a rare complication after intubation.Swift repositioning of anatomical structures is important to prevent long term complications.Long-term complications of prolonged dislocation of the temporomandibular joint include persistent disfunction and/or pain.