Surgical Management of Permanent Bilateral Temporomandibular Joint Dislocation-A Case Report.

Abstract

Introduction: Chronic protracted mandibular dislocation (CPMD) in elderly patients poses unique treatment challenges due to age-related anatomical changes. This report details the successful management of bilateral CPMD in a geriatric patient.

Case report: A 69-year-old female presented with a 3-month history of inability to close her mouth following bilateral TMJ dislocation. Examination and imaging revealed thinning of the glenoid fossa and zygomatic root, along with pneumatization. Previous forceful reductions under general anesthesia had failed.

Intervention: A custom titanium modified bent L miniplate was surgically placed to act as a mechanical stop, preventing excessive anterior condylar translation while preserving hinge movement.

Outcomes: At follow-up, the patient reported no further dislocations, significant pain reduction, and improved mastication and speech. Postoperative mouth opening increased from 12 mm to 34 mm.

Conclusion: The custom miniplate technique offers a promising solution for managing chronic TMJ dislocations in elderly patients with compromised bone quality, providing mechanical stability without intra-articular intervention.