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Home All issues Volume 28 / No 1 (2022) J Oral Med Oral Surg, 28 1 (2022) 10 Full HTML
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J Oral Med Oral Surg
Volume 28, Number 1, 2022
Article Number 10
Number of page(s) 6
DOI https://doi.org/10.1051/mbcb/2021053
Published online 21 February 2022

© The authors, 2022

Licence Creative CommonsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Temporomandibular dislocation is a dislodgement of the head of the mandibular condyle from its normal position in the glenoid fossa [1]. Temporomandibular dislocations can be classified into different types depending on the direction taken by the condyles out of the glenoid cavity [2]. There are 4 groups of temporomandibular dislocation: anterior, posterior, superior and lateral [3]. They mainly occur during mandibular trauma with high kinetics [2]. The present study focuses entirely on post-traumatic superolateral temporomandibular dislocation (SLTMD) with intact condyle wich is very rare [2]. Indeed, Srinath et al. had recorded, from 1969 to 2016, a total of 17 publications documenting only 28 cases of superolateral dislocation of the intact condyle [4]. Several classifications have been proposed. However, the one which seems to be the most exhaustive is that proposed by Sharma et al. (Tab. I) [5]. The international literature of the past 10 years, explored for the development of this study, revealed that no publication on this subject has been identified in South Saharan Africa (Tab. II) [6]. This study reports 3 cases of TMSLD with intact condyle. This work, will allow to shed light on the explanatory factors and the clinical and therapeutic particularities of this pathology in an underdeveloped country.

Table I

Classification of supero-lateral temporomandibular dislocations with intact condyle.

Table II

Review of the littérature of superolateral temporo-mandibular dislocation with intact condyle.

Materials and method

This was a retrospective study that included. The case series was collected from patients admitted to maxillofacial trauma emergencies. This study was carried out in compliance with the conditions laid down in the Declaration of Helsinki. A literature review was performed using the keywords “superolateral, dislocation and temporomandibular”. Google Scholar and HINARI databases were used. The literature review covered a period from January 2011 to December 2020 and the data collection period was from January 2021 to July 2021. All patients with superolateral temporomandibular dislocation with intact condyle following a maxillofacial trauma were included in the study. The data collected were epidemiological (place, year, age, sex), clinical (trauma, type of dislocation) and therapeutic (type of reduction and evolution after treatment).

Results

Case series

Observation 1

A 33-year-old man, a motorcyclist not wearing a helmet, was admitted with maxillofacial trauma following a road traffic accident. He reportedly fell from a motorcycle he was riding and landed face down. Clinical examination revealed painful bilateral swelling of the pretragial regions and a linear wound measuring 5 cm in length in the chin area. There was also pain associated with abnormal mobility of the mandible with retained labial-chin tenderness. Maxillofacial CT (computed tomography) scan revealed a complex fracture of the mandibular symphysis with a third fragment associated with bilateral superior condylar dislocations. Both condyles were below the zygomatic arch (Fig. 1). It was a Type II A of classification of SLTMD with intact condyle. On the 7th of hospitalization, a reduction in temporomandibular dislocations was performed by external bi-manual pressure under general anesthesia. But this reduction was unstable. The condyles were therefore maintained in their glenoid cavity by an assistant while the osteosynthesis of the mandibular symphysis by a mini plate and a maxi plate was performed. An intermaxillary fixation using rubber band was performed for 10 days. The patient presented a mouth opening limitation of 10 mm, which was improved by mechanotherapy until a mouth opening of 30 mm was achieved after one week. The patient was seen 6 months later and presented no functional complaints.

thumbnail Fig. 1

CT scan of patient one showing Bilateral superolateral dislocations (yelow arrow) with intact condyle and zygomatic arch.

Observation 2

A 35-year-old man, motorcyclist patient not wearing a helmet, suffered a maxillofacial trauma following a road traffic accident. He would have fallen from the bike he was riding and landed face down. Clinical examination revealed painful unilateral right pretrageal swelling, a linear chin wound measuring 2 cm, abnormal mobility of the mandible (Fig. 2). The maxillofacial CT scan performed revealed a fracture of the mandibular symphysis associated with a right unilateral superolateral dislocation of the mandible with intact condyle. The condyle was impacted above the zygomatic arch which was intact (Fig. 2). It was a type II B of classification of SLTMD with intact condyle. On the 9th days of hospitalization, reduction of the TM dislocation was attempted by an external maneuver, under general anesthesia. It was unsuccessful. An open reduction by preauricular approach was therefore performed (Fig. 3). An osteosynthesis of the mandibular symphysis by mini plate was also made. The control scanner showed a good reduction of the dislocation (Fig. 3). An intermaxillary fixation using metal wire was performed for 10 days and then rubber band for 20 days. The patient had a mouth opening of 30 mm was achieved after 3 weeks. The patient was seen 6 months later and no functional complaints were observed.

thumbnail Fig. 2

CT scan and clinical picture of patient 2 showing right superolateral temporomandibular dislocation (yelow arrow), mandibular retrusion (red and white arrow) and chin wound (blue arrow).
thumbnail Fig. 3

Operative pretragial approach and CT scan of patient 2 showing right mandibular condyle dislocation with articular capsule ruptured (yelow arrow) and post operative condyle position after reduction (white arrow).

Observation 3

A 27-year-old man, a motorcyclist not wearing a helmet, was admitted for craniofacial trauma following a traffic road accident. He reportedly fell from the bike he was riding with landing face down. Clinical examination noted global swelling of the face, a transfixing wound of the lower lip and chin, with exposure and abnormal mobility of the mandible. The CT scan performed revealed a right superolateral temporomandibular dislocation with intact condyle. This dislocation was associated with a fracture of the mandibular symphysis with overlapping displacement, a Lefort I fracture and a fracture of the left zygomatic bone (Fig. 4). It was a type II B of classification of SLTMD with intact condyle. The patient, having no health insurance, could not afford the costs for the surgery. He therefore left against medical advice.

thumbnail Fig. 4

CT scan of patient 3 showing right superolateral temporomandibular dislocation with complexe maxillofacial fractures.

Literature review

Of the 16 publications reviewed, 12 (75%) were Indian (Tab. II) [1,3–17]. 30 patients were involved with a mean age of 31.87 years. In 15 cases (50%), the dislocations were bilateral. Out of a total of 45 dislocations, 26 (57.78%) were on the left side and type II of the TMSLD classification (Tab. I) was observed 34 times (75.55%). The average treatment time was 11.78 days (Tab. II) [1,3–17].

Discussion

The existence of chin wounds in 2 cases and chin associated to lower lip in one case gives an idea of ​​the site of facial landing. This seems to correspond to the injury scenario proposed by Debelmas et al. This scenario suggests an open parasymphyseal fracture leading to a widening of the transverse dimension of the mandible allowing lateral displacement of the two condyles [2]. However Sharma et al., in her work described a case of lateral dislocation in which there was no associated mandible fracture [5]. Most of the cases identified have been in industrialized countries where road traffic is denser. Our environment is renowned for the frequency of motorcycle accidents in which users are characterized by an absolute disregard for individual road safety measures such as wearing helmet [18]. The temporal bone's articular surface and the head of the mandible, enclosed in a fibrous capsule which is one of the elements of stability of tempomandibular Joints (TMJ). In addition, this stability is also ensured by three major ligaments, temporomandibular, stylomandibular, and sphenomandibular ligaments.Trauma or abuse can cause inflammation or injuries of the synovial tissues (synovitis) and the capsular ligament (capsulitis). With the consequence of an alteration of the stability of TMJ [19]. This pathophysiological presentation sheds light the importance of the capsular ligament condition in the instability of reductions in superolateral dislocation. These reduction difficulties in our cases could be also explained by the time taken to care of more than 7 days in both cases. These delays in care are relatively frequent due to limited local financial resources [18]. However, failures of reductions have also been reported in the literature [17]. Early mobilization of the temporomandibular joint and mechanotherapy seemed to provide good results in the 2 operated cases. This therapeutic attitude is shared by Debelmas et al. who tend to use early rehabilitation rather than prolonged rigid maxillo-mandibular blockage [2]. Therapeutic care would also have been a new challenge for local surgeons. However, the socio-economic conditions of the patient led him to leave against medical advice.

Conclusion

Superolateral temporomandibular dislocation with intact condyle is rare. Therapeutic management is not codified and calls for the creativity of the maxillofacial surgeons. These surgical experiences are valuable to the scientific community. This is the place to raise awareness of local authorities in order to deepen their actions in the direction of better social security, especially for the most disadvantaged patients.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This research did not receive any specific funding.

Ethical commitee approval

The authors declare that Ethical approval not required.

Informed consent

This article does not contain any studies involving human subjects.

Author's contributions

GE Crezoit: Conceptualization, Methodology, EM Djémi: Writing original draft. PIJ Bérété: Visualization, Investigation. ARE Yapo: Visualization, Investigation. B Illi: Supervision. NEK Zegbeh: Writing- Reviewing and Editing.

Acknowledgements

Thank you to Professor Konsem Tarcissus.

References

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All Tables

Table I

Classification of supero-lateral temporomandibular dislocations with intact condyle.

In the text
Table II

Review of the littérature of superolateral temporo-mandibular dislocation with intact condyle.

In the text

All Figures

thumbnail Fig. 1

CT scan of patient one showing Bilateral superolateral dislocations (yelow arrow) with intact condyle and zygomatic arch.
In the text
thumbnail Fig. 2

CT scan and clinical picture of patient 2 showing right superolateral temporomandibular dislocation (yelow arrow), mandibular retrusion (red and white arrow) and chin wound (blue arrow).
In the text
thumbnail Fig. 3

Operative pretragial approach and CT scan of patient 2 showing right mandibular condyle dislocation with articular capsule ruptured (yelow arrow) and post operative condyle position after reduction (white arrow).

In the text
thumbnail Fig. 4

CT scan of patient 3 showing right superolateral temporomandibular dislocation with complexe maxillofacial fractures.

In the text

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