Piracicaba Dental School, State University of Campinas, Brazil.
Med Oral Patol Oral Cir Bucal. 2010 Nov 1;15(6):e891-4. doi: 10.4317/medoral.15.e891.
Surgery of the temporomandibular joint is indicated for different clinical situations, including internal derangements, hypomobility, hypermobility, pathology and trauma. Mandibular dislocation is an acute painful condition that causes severe functional limitation. Manual reduction, with or without pharmacological assistance, is the treatment of choice and should be performed as early as possible. On rare situations mandibular dislocation may not be perceived by the patient and remain undiagnosed or misdiagnosed for a long period. This may include severe illness, neurological diseases and prolonged intensive care hospitalization with oral intubation and sedation. Treatment of prolonged mandibular dislocation is different. Morphological changes of the joint and associated structures will prevent successful manual reduction even with the patient under general anesthesia. Basically, two types of surgery may be indicated: elimination of the articular eminence (eminectomy) or reestablishment of a new condyle-ramus relationship, that can be achieved by condilotomy. This article reports a case of prolonged mandibular dislocation that was treated surgically with success. A review of the literature is performed by authors and advantages and disadvantages of each type of treatment are discussed.
颞下颌关节手术适用于多种临床情况，包括关节内紊乱、关节活动受限、关节活动过度、关节病变和创伤。下颌骨脱位是一种急性疼痛的病症，会导致严重的功能受限。手法复位，无论是否使用药物辅助，都是首选的治疗方法，应尽早进行。在极少数情况下，下颌骨脱位可能不会被患者察觉，从而导致长时间的漏诊或误诊。这种情况可能包括严重疾病、神经系统疾病以及长时间的重症监护住院治疗，包括经口插管和镇静。对于长时间的下颌骨脱位，治疗方法有所不同。关节和相关结构的形态变化会使即使在患者全身麻醉下也无法成功进行手法复位。基本上，可能需要两种手术类型：关节突切除术（关节突切除术）或重新建立新的髁突-升支关系，可以通过髁突切开术来实现。本文报告了一例成功手术治疗的长时间下颌骨脱位病例。作者对文献进行了回顾，并讨论了每种治疗类型的优缺点。
