Recurrent mandibular dislocation
Since the days of Hippocrates, repositioning of the dislocated mandible has been an important topic in medicine and dentistry, and the first surgical techniques for the prevention of recurrent mandibular dislocation and for the treatment of long standing luxation were described in the late 1800s.
Dislocation of the mandible is usually bilateral. The symptoms are open mouth, protruding chin, tense masticatory muscles, salivation, speech difficulties, and pain. In unilateral cases, the mandible deviates toward the opposite side from the dislocated condyle. On manual palpation, the glenoid fossa is empty, and the condylar head can be palpated anterior to the eminence.
Some investigators have defined normal maximum translation of the condyle as the point at which the greatest convexity of the condyle meets the greatest convexity of the articular eminence. About 60% of normal subjects translate more anterior to that point without any symptoms. Subluxation occurs when the condyle translates anterior to its normal range, and the patient exhibits a temporary locking or sticking sensation that either abates spontaneously or can be reduced with self-manipulation ( Fig. 1 ). Dislocation is a more advanced hypertranslation in which the condyle locks anterior to the eminence in a position that cannot be self-reduced because the condyle is fixed in that position by muscular spasm ( Fig. 2 ). This state requires medical assistance to relocate the condyle in its normal position. In some cases, periarticular application of local anesthetics or tranquillizer premedication is necessary before manual reduction of the mandible is possible.