Management of Chronic TMJ Dislocation
For chronic TMJ dislocation, begin with conservative closed reduction techniques using posterior bite blocks and elastic traction for 2-3 weeks, reserving open surgical reduction only for cases that fail conservative management. 1, 2
Initial Conservative Management (First-Line)
Conservative approaches should always be attempted first before considering surgical intervention. 1, 2
- Apply posterior acrylic bite blocks combined with elastic traction to gradually reduce the dislocated condyles over 2-3 weeks 1
- Manual reduction should be attempted initially, though it frequently fails in chronic cases (>2 months duration) 1
- Muscle relaxants may help overcome severe muscle spasm that prevents reduction 3
- NSAIDs should be used for pain relief and to reduce inflammation during the reduction process 3, 4
When Conservative Management Fails
If closed reduction techniques are unsuccessful after 2-3 weeks, proceed to open surgical reduction. 5, 2
Surgical Approach Options:
- Open reduction involving release of masseter, temporalis, and medial pterygoid muscles is required for severe chronic dislocations, particularly when condyles are displaced into the infratemporal fossa 5
- Post-surgical management includes scissors mouth props, Erich arch bars, and elastic traction to maintain reduction 5
- Arthroscopy may be considered for internal joint assessment in selected cases 3, 6
Post-Reduction Management
After successful reduction (conservative or surgical), implement measures to prevent recurrence:
- Patient education about avoiding wide mouth opening, yawning, and other aggravating activities 3, 4
- Soft diet maintenance during healing phase 3
- Jaw exercises and stretching once acute phase resolves to restore normal function 3, 6
- Manual trigger point therapy to address muscle tension and spasm 3, 6
Critical Pitfalls to Avoid
- Never delay diagnosis - chronic dislocations discovered weeks after injury (as late as 6 weeks) lead to long-term TMJ surgery requirements and chronic pain 7
- Do not rush to surgery - every case of prolonged dislocation has unique features, and conservative approaches should be exhausted first 1, 2
- Avoid combining NSAIDs with opioids due to increased risks without additional benefit 3, 4
- Do not perform irreversible procedures like discectomy without clear structural indication 3, 6
Treatment Algorithm
Immediate attempt (Day 1): Manual reduction with muscle relaxants and NSAIDs 1, 2
If manual reduction fails (Days 1-21): Posterior acrylic bite blocks with elastic traction 1
If conservative fails (After 2-3 weeks): Open surgical reduction with muscle release, followed by arch bars and elastic traction 5, 2
Post-reduction (Weeks 3-12): Jaw exercises, trigger point therapy, patient education, and activity modification 3, 6
The evidence strongly supports a stepwise approach, with the 2015 case series demonstrating successful conservative management in chronic cases (2 months duration) using bite blocks and traction 1, while surgical literature confirms that open reduction becomes necessary only when these methods fail 5, 2.