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Reconstructive

Temporomandibular Joint Dislocation Surgery

Best Temporomandibular Joint Dislocation Surgery in India

TM joint dislocation describes the condition whereby the mandibular condyle slips out of its normal position, becoming displaced to the point of losing its articulation with the glenoid fossa - a smooth concave articular surface present around the anterior of the temporal bone. The mandibular condyle is simply a convex bony projection of the mandible. TM joint dislocation affects 7% of the global population and it is most prevalent among individuals between the ages of 20 - 40 years.

Classification         

TM joint dislocation can be classified based on the direction in which the mandibular condyle is displaced. Consequently, we can have:

  • Anterior TM joint dislocation: In this instance, the mandibular condyle is displaced to the front of the articular tubercle. This condition, which is sometimes referred to as open lock, is the most common type of TM joint dislocation, and it can be triggered by the use of the mouth to yawn, eat, or cackle. Anterior TM joint dislocation may also be exacerbated or sustained in the event of anatomical malformations that had been from birth.
  • Posterior TM Joint Dislocation: This rare dislocation occurs when the mandibular condyle is displaced towards the mastoid of the temporal bone. It is usually triggered by a blunt force or direct blow to the jaw.
  • Cranial TM Joint Dislocation: This is another less common type of mandibular condyle dislocation. In this case, the condyle displaces and projects towards the middle cranial fossa. It is often due to the delivery of an upward blow to the jaw.

Generally, TM joint dislocation can be unilateral or bilateral as per the location. Again, it can be either acute, chronic, or recurrent.

TM joint dislocation can occur traumatically as a result of vehicular accidents, physical assaults, and falls. However, specific non-traumatic activities like excessive opening of mouth while yawning, or doing certain dental surgeries - here is one of the reasons you should always seek the hands to handle such procedures - can also cause TM joint dislocation. Actions as simple as eating, singing, vomiting, or laughing can also cause the partial or complete dislocation of the mandibular condyle.

How Does TM Joint Dislocation Occur?

When the articular disc of the temporomandibular joint gets displaced, the posterior attachment is pulled into the joint thereby leading to mobility-induced compression and accompanying pain - which evolves as the integrity of the nerves and vessels of the retrodiscal pad is compromised. This sequence of events eventually reduces the mobility of the jaw and brings about a clicking as the displaced condyle protrudes towards the articular region. More so, the muscles of the jaw become markedly tight - a condition known as masseter muscle spasm - which causes the patients to experience excessive salivation.

Treatment of TM Joint Dislocation in India

It is highly important that you visit a top clinic nearby if you are having any symptoms of TM joint dislocation. Once you are at the clinic, you will first be taken through series of physical and digital imaging evaluations to assess and classify your condition. The observations from this exercise, coupled with a review of your medical history, will guide our surgeon into knowing the sort of reconstructive intervention that would be designed for you.

The most common methods of correcting TM joint dislocation are reduction techniques - which are non-surgical, and there are various types. The classic approach, however, involves the specialist administers analgesia and local anesthesia to the patients after having him/her sit in an upright position.

Having worn gloves, the specialist moves to methodically place his/her thumbs - the thumbs must have been wrapped with a gauze - on the inferior molars at both sides of the patient's mouth. With the other fingers aligning to beneath the lower jaw, downward and backward pressure is applied on the lower jaw with the aid of the thumbs even as the patient's mouth is slightly opened. By this, the chin is made to rotate upwardly while the lower jaw is pushed backward thus returning the condyle to its original position in the glenoid fossa. The reduction technique described here is also known as "Hippocratic reduction". Other reduction techniques used in treating TM joint dislocation include wrist pivot, gag technique, syringe technique, and extraoral technique.

However, in the instance whereby any of these reduction techniques will not result in a favorable outcome, surgical procedures are usually employed. The type of surgical approach selected will be dependent on the extent of changes that have taken their toll on the ligaments, muscles, and bony constituents/attachments of the temporomandibular joint. There is quite a broad range of surgical procedures to treat TM joint dislocation, and the team of surgeons, led by Dr. Debraj Shome, at The Esthetic Clinics is well updated on all these methods. Let us briefly look at some of these surgical procedures:

  • Arthroscopy: This involves the insertion of an arthroscope - which carries a light and a camera for visualization purpose - into a small thin tube that has been positioned in the joint space through an incision made on the skin just above the TM joint. The surgeon can then operate the TM joint area using small surgical tools.
  • Arthrocentesis: Arthrocentesis is a less invasive surgical technique and it is employed in treating cases of TM joint dislocation emanating from the presence of inflammatory substances. In this instance, fluid is injected into the joint, with the aid of inserted small needles, to flush out the inflammatory byproducts that have compromised the integrity of the TM joint.
  • Open-joint Surgery: This sort of surgical operation is normally directed at more complicated cases, such as those that involve joint immobility caused by bone and tissue defects. In performing this surgery, the specialist makes incision along the TM joint area to gain access to the joint itself. He/she thereafter carries out the necessary corrective measure.

It should be noted that there may be circumstances whereby a combination of methods will be required to effectively resolve the issue of TM joint dislocation. Each of the surgery described above is performed under local or general anesthesia, and the recovery time may greatly vary. For some of them, it may take you only a few weeks to regain the full functionality of your mouth while for others, the recovery process may take months. Irrespective of this, there are few things you should take cognizance of within the first week(s) after the initial operation.

  • You will need to design a meal plan loaded with soft foods and also take a lot of fluid. Solid or crispy foods will not be the best for the first 2 – 3 weeks after surgery as they can place stress on the joint/surgical area to the point of causing you more pain
  • You should regularly place a cold pack on the area that was operated on to check swelling. In some situations, however, you may need to apply warm heat to the spot. The surgeon will provide more guidelines on this.
  • You should also ensure that you use your prescriptions as and when due as instructed by the surgeon.
  • Do not let water reach the surgical dressing when bathing. You can have some watertight covering placed over it.

The surgeons at The Esthetic Clinics will be on hand to follow up on your case in order to further evaluate the recovery process and also ensure the sustenance of a favorable outcome. Cases of TM joint dislocation in Mumbai and its environs can be a thing of the past with sound therapeutic guidelines – during and after interventions – from the experts at our clinic.

When is surgical intervention necessary?

As you must have drawn from the discussion above, there are both surgical and non-surgical ways of treating TM joint dislocation, but then when exactly do you need surgery? You will need one if:

  • Opening or closing of the mouth is accompanied by markedly painful discomfort and/or difficulty.
  • There is an incidence of disease mandibular joint or when the structure of the joint has been compromised.
  • Pounced jaw pain is experienced while taking your meals, or using the mouth in some other ways.
  • Pain or stiffness in the jaw remains even after a non-surgical reduction had been performed.

How Much Does It Cost to Treat a TM Joint Dislocation in India?

A lot of things come into play when considering the cost of the treatment of TM joint dislocation. This is majorly due to the broadness of the disorder itself. For one, there is a need to run checks to see whether the case is a recurrent one or not, and then the severity of an individual's condition will be factored. So, there is no straightforward answer to the question on the cost of TM joint dislocation treatment. Summarily, the following are some of the factors that can significantly influence the cost:

  • The severity of the patient's TM joint dislocation
  • Method(s) selected in treating the dislocation
  • Type of diagnostic imaging
  • Type of anesthesia used
  • Surgeon fee
  • Location of clinic

The concern over the cost implication of the treatment of TM joint dislocation is quite understandable, and you can reach out to see how your insurance benefits may be helpful in this regard.

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About Doctor

Dr. Debraj Shome

Dr. Debraj Shome is Director and Co founder of The Esthetic Clinics. He has been rated amongst the top surgeons in India by multiple agencies. The Esthetic Clinics patients include many international and national celebrities who prefer to opt for facial cosmetic surgery and facial plastic surgery in Mumbai because The Esthetic Clinics has its headquarters there.



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