Chronic Bilateral Dislocation

8/13/2019 Chronic Bilateral Dislocation

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JM N UNIVERSITY OFSCIENCE ND TECHNOLOGY

Treatment Planning And Seminars

Anmar BasilThar Hayder


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43 years lady from Niger presented with inability to close

mouth or bring teeth together over the last 2 years.

OPG : both condyles were anterior to the articular

eminences


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Dislocation

Acute Chronic(persist >1month)


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Subluxation is self-reducing, patient is able to close hisor her mouth without assistance.

true dislocation(or luxation) is a condition in which ajoint is displaced from its articulations and requiresmanipulation by another individual.


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Chronic bilateral anterior dislocation

It is characterised by inability to close the mouth with or withoutpain

Dislocation can occur in any direction with anterior dislocation

being the commonest one

Trauma

Steep eminence

Habitual subluxation

Syndrome associated


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Ehler-danlos syndrome (EDS)

Is an inherited CT disorder with different presentations

that have been classified into several primary types

EDS is caused by the defect in the synthesis of collagen


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Types of EDS

Hypermobility

Classical

Vscular

Kyphoscoliosis

Arthrochalasia

Dermatosparaxis


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Hypermobility type

Joint hypermobility is the hallmark of this type , with less

severe skin manifestations.

Patients with the Hypermobility Type experience frequentjoint dislocation and subluxations

By ethnic i ty, JHM is observed in up to

3557% in A fr icans


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Treatment

Surgical (open)

Non Surgical (closed)


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surgical open reduction:

1968, Rowe and Killeybone hook which was passed over the Sigmoid Notch

through a small incision below the angle of mandible and

downward traction was applied on condyle


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1976, Adekeya et al

occlusion was restored by means of inverted L shaped

osteotomy of ramus.


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Bone grafts to be used in such

surgeries :

Iliac bone graft was seen to have resorption whereas in

case of the calvarial graft complication was seen in the

donor site with the occurrence of dural tears, arachnoidal

bleeding hematoma formation and scalp infections. Since

the iliac graft showed remarkable degree of resorption

bovine cartilages were tried. Cartilage were found to be

dimensionally stable in terms of resorption which was

further enhanced by their calcification.


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Lewis,1981technique in which the Bristows elevator was passed

through the temporal fascia as in Gillies technique ofelevation of depressed zygomatic bone. The tip of the

rowe elevator was used and force was applied in

downward and posterior direction. This method also

facilitates open reduction by extending the incision asused for preauricular approach to the joint


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Augmentation of the articular

eminence displacement of the zygomatic arch and obstructing the

path of the Condylar translation has been first described

by Mayer in 1933

it has been modified by Dautrey25 in which the green

stick fracture was performed at zygomaticotemporal

suture, which provides the rebound elasticity and provide

stability in the altered position. It cannot be performed in

elder people due to the brittleness of the bone;so i t isrestr ic ted to young indiv idual .


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eminectomy Myrhaug in 1951

Removal of eminence will facilitate the return of thecondyle without any interference into the glenoid fossa.

Although dislocation takes place, painless reduction will

occurs automatically


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Implants

Various other materials have also been used like L-

shaped pins, vitallium mesh implants, and mini implants to

enhance the eminence. Uses of these materials have

been reported with increase incidence of fracture and

loosening under functional loads. Silicon blocks used inthe shape of wedge has been reported to evoke immune

reaction and also showed displacement as a result of

functional movement.

Among al l di f ferent treatment modali t ies s tudied inthe l i terature, a rate of 95% o f cases w ithout

recurrence bo th after eminectom y and use of metal l ic

implant over the art icu lar em inence


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Closed

reduction

Avoid excessive

force

Sedation

Extraoral route


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Thank You

Documents

Chronic Bilateral Dislocation