Temporomandibular joint dislocation in an epileptic and mentally retarded patient: a case report.

Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of articular surfaces and fixation in that position.' Theories regarding the pathogenesis of TMJ dislocation propose laxity of TMJ ligaments or capsule, excessive activity of the lateral pterygoid muscle (LPM)and erosion of the eminence'. TMJ dislocation can occur in an anterior, posterior, lateral and superior direction'. Clinical presentation of dislocated TMJ includes inability to close the mouth, deviation of the mandible away from the affected side in unilateral cases, hollowing in front of the tragus, spasm of muscles of mastication and severe pain of the TMt Radiographs show an empty condylar fossa with the condylar head located anterior to the articular eminence. Anterior TMJ dislocation usually follows excessive mouth opening during yawning, laughing, eclamptic fit and motor vehicle accident (MVA)'. Iatrogenic causes of TMJ dislocation are excessive mouth opening during dental treatment, intubation, and otorhinolaryngological procedures Some drugs are associated with TMJ dislocation, these include antiemetics such as metoclopramide and compazine which produce extrapyramidal effects' and neuroleptic drugs". Systemic connective diseases like Ehlers-Danlos and Marfan syndromes have also been implicated in TMJ dislocations The purpose of this article is to report management challenges of an epileptic and mentally retarded patient with recurrent TMJ dislocation

Pterygomandibular ankylosis : a report on two cases

Pseudo-ankylosis of the temporo-mandibular joint (TMJ) refers to a persistent restricted mandibular hypomobility resulting from a pathologic condition outside the TMJ. Ankyloses may be acquired or congenital. Most congenital ankyloses are extracapsular (pseudo- ankyloses), while most of the acquired ankyloses (true ankyloses) are intracapsular. An extremely rare form of extracapsular ankylosis is bony pterygomandibular fusion, few cases having been reported in the literature. To our knowledge, a case with two separate ipsilateral extracapsular ankylosis sites together with bilateral intracapsular ankylosis has never been reported. This paper considers the case of a 24 year-old patient who had been unable to open his mouth for six years. There was neither a history of trauma nor one of recurrent infection. The patient presented with a slight facial asymmetry with deviation of the mandible towards the right. CT scans confirmed the diagnosis of a complex pseudoankylosis, characterised by unilateral bony fusions between the lateral pterygoid plate and the medial aspect of the ramus, coronoid process and zygoma together with bilateral intracapsular ankyloses. The patient underwent surgery for ostectomy of the pterygomandibular fusion and a bilateral coronoidectomy. Comments on a paediatric case with bilateral bony pterygomandibular fusions are also included.http://www.sada.co.zaam201

Spontaneous regression of congenital epulis: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Congenital epulis is a rare lesion found on the alveolar process of a newborn child, diagnosed soon after birth. The lesion has a site predilection for the anterior maxillary alveolar process and a 9:1 sex predilection for females. Once diagnosed the traditional management of the lesion has been surgical excision under general anesthesia.</p> <p>Case presentation</p> <p>The purpose of this case report is to describe spontaneous regression of congenital epulis in a three week old healthy African American female child. She presented with a 1.5 cm bilobed sessile nodular lesion in the region of the right maxillary cuspid. The clinical impression was congenital epulis. Since the lesion was not interfering with feeding and respiration, a conservative approach was taken. The child was followed-up for 18 months, during which the lesion progressively regressed.</p> <p>Conclusions</p> <p>Conservative management prevented unnecessary surgery and anesthesia exposure in a neonate.</p

Facial asymmetry: A long-term complication of otitis media: A case report

Introduction: Facial asymmetry is a condition that may be congenital or acquired. The most common cause of acquired facial asymmetry is unilateral TMJ ankylosis which occurs following trauma, infection and chronic inflammatory diseases. Otitis media is one of local causes of temporomandibular joint (TMJ) associated complications such as suppurative arthritis and ankylosis.We report a case with history of chronic otitis media that resulted in restricted growth of the mandible, atresia of the external auditory meatus and facial asymmetry. Methods: A case report. Case: We report an 11 year old patient with history of recurrent otitis media on the left ear at 8 months. This was followed by pus draining from both the left ear canal and the preauricular area.The patient presented with facial asymmetry which was characterised by deviation of the mandible towards the left. The mouth opening was good, with interincisal distance of 45mm. There was complete atresia of the left external auditory meatus (EAC). The pinna of the ear and the preauricular area were scarred. Computated tomography (CT) scans showed complete opacification of the left external auditory canal, destruction of the bony wall of the bony EAC with several fragments of bone. The CT scan also showed unequal height of the condyles and degenerative changes in the left TMJ. This case demonstrates that restricted growth of the condyle, despite normal function can lead to facial asymmetry