Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Ankara, Ankara, Turkey.
J Craniomaxillofac Surg. 2019 Jun;47(6):945-950. doi: 10.1016/j.jcms.2019.02.013. Epub 2019 Mar 6.
The behavior and function of the condyle are not the same in every type of temporomandibular joint (TMJ) dislocation. Acute displacement or dislocation of the condyle is not a rare incident, and the treatment modalities have been well known by physicians for a long time. Chronic dislocation of the condyle is considered a relatively common entity for which treatment may indispensably be surgical intervention. Type of dislocation, duration and the number of episodes are taken into account while constructing the treatment plan. Chronic dislocation that has been left untreated for a long time is a relatively less often encountered type exhibiting difficult clinical conditions for treatment. This type of dislocation is usually seen in elderly patients with poor general health conditions and can be classified as "long-standing dislocation." In this clinical condition, after having some chronic dislocation episodes, the condyle leaves the original fossa, sits in the anterior part of the eminence permanently, creates a new fossa and never gets back to the original place again. Duration is the most important criterion in classifying long-standing dislocations and has a great effect on decisions regarding the type of management. The relevant literature includes few reports, most of which speculate upon "duration," which varies on a large scale ranging from 5 weeks to 33 years. There has been neither an agreement on time span within which long-standing dislocation develops, nor a universally accepted definition for what "long-standing" is indeed meant to be. On the other hand, in some cases, the condition has been named "true long-standing dislocation" due to some permanent pathological changes that the TMJ undergoes, such as pseudoarticulation/nearthrosis/false joint/neo-joint. In this paper, management of true long-standing/permanent dislocation in two patients, whose conditions lasted more than 1 year and resulted in permanent changes in TMJ anatomy, is presented. Due to the poor general health condition of the two elderly patients, they were treated in the most conservative way possible. In one of the patients, eminectomy and head-gear application were used to attain gradual relocation of the condyles. Rehabilitation of masticatory function of the other patient was improved prosthetically.
髁突的行为和功能在每种类型的颞下颌关节（TMJ）脱位中并不相同。急性移位或髁突脱位并不罕见，其治疗方法长期以来一直为医生所熟知。慢性髁突脱位被认为是一种相对常见的病症，可能需要手术干预。在制定治疗计划时，会考虑脱位类型、持续时间和发作次数。长期未经治疗的慢性脱位是一种相对较少见的类型，其治疗临床条件较为困难。这种类型的脱位通常见于身体状况较差的老年患者，可归类为“长期脱位”。在这种临床情况下，在经历了一些慢性脱位发作后，髁突离开原来的凹陷，永久性地坐在关节结节的前侧，形成一个新的凹陷，再也无法回到原来的位置。持续时间是分类长时性脱位的最重要标准，对管理类型的决策有很大影响。相关文献报道较少，其中大部分推测“持续时间”，范围从 5 周到 33 年不等。关于长时性脱位发展的时间范围，尚未达成一致意见，也没有一个普遍接受的定义来准确界定何为“长时性”。另一方面，在某些情况下，由于 TMJ 经历了一些永久性的病理变化，如假性关节/骨关节炎/假关节/新关节，这种情况被称为“真性长时性脱位”。本文介绍了两名患者的真性长时性/永久性脱位的治疗方法，其病情持续时间超过 1 年，导致 TMJ 解剖结构永久性改变。由于这两名老年患者身体状况不佳，他们采用了尽可能保守的治疗方法。其中一名患者采用了关节结节切除术和头帽应用，以实现髁突的逐渐复位。另一名患者的咀嚼功能通过修复来改善。
