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Habitual dislocation of the mandible
Last reviewed: 04.07.2025
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[ What causes habitual jaw dislocation?
The cause of habitual dislocation of the lower jaw may be rheumatism, gout and other organic pathological lesions of the temporomandibular joints. Habitual dislocations are often observed in epileptics, as well as in people who have had encephalitis and suffer from clonic seizures. Habitual dislocation of the lower jaw may also occur as a result of improper treatment of acute dislocation of the lower jaw (lack of its immobilization for a certain time after reduction). As a result, there is a significant stretching of the joint capsule and ligamentous apparatus of the joint.
Outcomes of habitual dislocation of the lower jaw
Conservative treatment of habitual dislocation of the lower jaw is usually effective. If, despite conservative treatment of habitual dislocation of the lower jaw, the underlying disease progresses, it is necessary to resort to a surgical method of eliminating the dislocation (elevation of the articular tubercle).
Treatment of habitual dislocation of the lower jaw
Treatment of habitual dislocation of the lower jaw is conservative or surgical.
Conservative treatment of habitual dislocation of the lower jaw includes therapy for the underlying disease (rheumatism, gout, polyarthritis) and orthopedic treatment, such as wearing a special splint (on the upper jaw) with a pad that rests against the mucous membrane of the anterior edge of the lower jaw branch (K. S. Yadrova's splint), or Yu. A. Petrov's apparatus.
A very simple to manufacture and easy to use device for limiting the abduction of the lower jaw is proposed. Two stamped metal crowns are made on the premolars of the upper and lower jaws (and in their absence - on the molars or canines). A 3 mm long section of an injection needle with an internal diameter of 0.6-0.7 mm is soldered to the vestibular surface of each crown. The needle sections are soldered at an angle of about 45° in relation to the chewing surface. The finished dental crowns are cemented on the teeth. After melting one end of a 10-15 cm section of a monolithic polyamide thread of the appropriate diameter (0.6-0.7 mm) until a club-shaped expansion is formed, it is passed from back to front through the lower tube, and then from front to back through the upper tube. Having determined the required length of the thread, cut off its excess 3 mm in front of the posterior end of the upper tube with a heated button probe and transform the protruding section of the thread (with the same heated instrument) into a club-shaped expansion. If in the future it becomes necessary to reduce or increase the amplitude of the lower jaw movement, this can be easily accomplished by changing the length of the polyamide thread.
As a result of limiting mobility in the joint, the size of the joint capsule and ligamentous apparatus is reduced, the condition of the meniscus improves, and the joint is strengthened.
Surgical methods of treating habitual anterior dislocations involve either increasing the height of the articular tubercle, or deepening the mandibular fossa, or strengthening the ligament-capsular apparatus. For example, Lindemann increases the height of the articular tubercle by splitting it off and moving it downwards on the anterior pedicle; A. A. Kyandskiy forms a bone spur in front of the submandibular fossa, reinforced with cartilage (by transplanting cartilage under a small bone-periosteal flap). Konjetzny moves the articular disc from a horizontal to a vertical position in front of the head of the mandible.
Thanks to these techniques, the mandibular fossa deepens and an obstacle is formed in front of the condylar process.
Some surgeons remove the meniscus, strengthen it with sutures, reduce the size of the capsule, or strengthen it with a fascia graft.
However, the most effective and comparatively simple method is the articular tubercle elevation according to A. E. Rauer. In this case, an incision is made in the soft tissues in the area of the posterior part of the zygomatic arch and a piece of costal cartilage taken from the patient being operated on is inserted under the periosteum in the area of the articular tubercle; preserved allocartilage can also be used for this purpose, which further simplifies the operation.