Autologous blood injection for treatment of recurrent temporomandibular joint dislocation

doi:10.1067/moe.2001.116602

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 92, Issue 4, October 2001, Pages 390-393

https://doi.org/10.1067/moe.2001.116602 Get rights and content

Abstract

Objective: The purpose of this study was to reintroduce a rather simple, safe, minimally invasive, and rapid alternative procedure for the treatment of recurrent dislocation of the condyles. Study Design: Subjects were 3 patients (5 joints) who suffered from recurrent condyle dislocation. The technique consisted of visually identifying a line from tragus to the eye angle. Then the articular fossa point was identified in this line, 10 mm anteriorly to tragus and 2 mm below the line. A 19-gauge needle was inserted at the articular fossa point. After injection of saline in the superior compartment, 5 cc of autologous blood drawn from the cubital fossa was injected (4 cc in the superior compartment and 1 cc in the pericapsular tissue). After this an elastic bandage was applied and left for the first 24 hours. Patients were advised to constrain their mandibular motion and to eat only soft foods for a week. They received cephalosporin antibiotics and nonsteroidal anti-inflammatory drugs for 7 days. A week after the procedure, supervised physiotherapy was started and the patients were encouraged to increase their mandibular opening to 40 mm. Results: Postoperative recoveries were uneventful. Dislocation of condyles did not reoccur; however, patient no. 3 experienced an episode of unilateral subluxation. At follow-up all patients presented with normal mouth opening. Conclusion: Bleeding resulted from the introduction of a needle for injection in the pericapsular tissue. Blood coming from this wound, associated with autologous blood injected in the superior compartment, generates a bed for fibrous tissue formation in the region, creating a limitation of mandibular movement, thus ceasing dislocation of the condyles. Temporomandibular joint autologous blood injection is a simple procedure performed on an outpatient basis that we advise as an alternative treatment for patients with recurrent dislocation of the condyles. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:390-3)

Section snippets

Description of the technique

The technique may be applied while the patient is under local anesthesia, local anesthesia combined with sedation, or general anesthesia. After preparing the patient in the usual manner, the surgeon must visually identify a line from the tragus of the ear to the eye angle. The articular fossa point (AF) is found on this line, 10 mm anterior to the tragus of the ear and 2 mm inferior to the line. Local anesthesia of the auricular temporal nerve is applied to the patient, and a 19-gauge needle is

Case reports

All patients were treated in the Department of Oral and MaxilloFacial Surgery (OMFS) at the Barzilai Medical Center in Ashkelon, Israel. There were no complications after the procedure, and at follow-up all patients presented with normal mouth opening.

Discussion

Laughing, yawning, vomiting, and forced mandibular opening during dental treatment or some medical procedures, such as endoscopies and direct bronchoscopies, can cause the dislocation of the condyle. Once the mouth is forced open, excessive looseness of the mandibular and capsular ligaments occurs. This looseness may cause hypermobility of the mandible, which may lead to dislocation of the condyle.

Hypermobility is characterized by an excessively loose TMJ that permits excessive mandibular

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There are more references available in the full text version of this article.

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This report outlines the novel management of a 10 year old patient who presented with recurring temporomandibular joint (TMJ) dislocations. Given the age of the child, initial management was conservative and used guidance outlined in current paediatric literature. When dislocations continued, the patient was managed pharmaceutically and with guided botulinum toxin injections to the lateral pterygoid muscles. This treatment has proved successful. We therefore propose a revised protocol for the management of recurrent TMJ dislocations in children.
Current thinking about the management of dysfunction of the temporomandibular joint: a review
2017, British Journal of Oral and Maxillofacial Surgery
Increasingly the management of TMJ pathology is becoming a subspecialist interest. The number of patients having TMJ joint replacement had steadily increased over the last decade and there is now NICE guidance on this matter. Whilst the evidence of the management of TMJ disease is limited and there are few randomised controlled trials, the incidence of TMJ pathology has not changed and there is a requirement for guidance on the management. Whilst previously patients with TMJ pain were managed surgically, this is changing, and the vast bulk of initial management is non-surgical/medical. This paper will review the literature on TMD and provide guidance for management.
Stability of treatments for recurrent temporomandibular joint luxation: A systematic review
2016, International Journal of Oral and Maxillofacial Surgery
Temporomandibular joint luxation (TMJ) is the excessive anterior translation of the mandibular condyle out of its normal range of movement and away from the glenoid fossa. Once dislocation occurs, the abnormal condylar position generates reflex contractions of the masticatory muscles, which in turn hinder movement of the condyle back to its resting position. Frequent luxation episodes characterize a condition referred to as recurrent TMJ luxation. While there are several surgical and conservative therapeutic options available for recurrent TMJ luxation, a robust, evidence-based rationale for choosing one technique over another is missing. Thus, a systematic review based on the PRISMA statement was proposed in an attempt to determine which therapeutic option results in the longest time to relapse. There is no good quality evidence on which treatment options guarantee the long-term elimination of recurrent TMJ luxation. In cases of post-surgical relapse, eminectomy has often been used as a ‘rescue procedure’, which may mean that surgeons empirically consider this treatment to be the ‘gold standard’ for addressing recurrent TMJ luxation.
Autologous blood injection for the treatment of recurrent mandibular dislocation
2015, International Journal of Oral and Maxillofacial Surgery
The purpose of the present study was to evaluate the effectiveness of autologous blood injection in the treatment of recurrent temporomandibular joint dislocation. Eleven patients diagnosed with recurrent dislocation of the joint that could not be self-reduced, received bilateral injections of autologous blood in the superior joint compartment and pericapsular region. During a follow-up period ranging from 24 to 35 months (average 29.6 months), eight patients (72.7%) did not show new episodes of dislocation. The most advocated treatment for recurrent dislocation is eminectomy, which involves a skin incision, with the risk of damaging the facial nerve, requires general anaesthesia, and presents an average success rate of 85% according to the literature. Autologous blood injection is a simple, rapid, minimally invasive, and cost-effective technique, with a low possibility of complications, and is a feasible alternative treatment before surgical intervention.
Arthroscopic findings after autologous blood injection in the treatment of recurrent temporomandibular joint dislocation
2015, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Autologous blood injection into the temporomandibular joint (TMJ) has been shown to be an effective method for recurrent TMJ dislocation. However, the clinicopathological changes caused by this blood injection have not been clarified. A patient with recurrent TMJ dislocation was treated with autologous blood injection into the TMJ. When his superior joint space was observed by an arthroscope 3 months later, fibrous tissue formation was observed between the posterior slope of the articular eminence and disk surface, which was consistent with successful clinical results for TMJ dislocation. Since this procedure is accompanied by fibrous adhesion, long-time follow-up is required.
Analysis of MRI findings in minimum invasive treatment for habitual temporomandibular joint dislocation by autologous blood injection around the temporomandibular joint capsule
2014, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
In the future, we intend to investigate the prognosis and accumulate many more cases of minimally invasive treatment for habitual TMJ dislocation using ABI around the TMJ capsule in patients at high risk from surgical treatment. In another report, Hasson and Nahlieli (2001) mentioned that restraining mandibular movement is the key to the success of the procedure. The pain that follows the injections will also restrain mandibular movement, permitting the injected blood to settle and create fibrosis.
The aim of this study was to investigate magnetic resonance imaging (MRI) findings following autologous blood injection (ABI) for habitual temporomandibular joint (TMJ) dislocation. MRI was performed one hour and four and twelve weeks after ABI, revealing three types of significant findings. The first type was similar to hematoma and/or joint effusion in the articular capsule of the TMJ (type I). The second showed sporadic and diffuse T2 emphasis around the TMJ capsule (type II). The third involved a decreased range of condyle movement compared to before ABI (type III). Furthermore, we analyzed the three types of significant MRI findings.
At one hour after ABI, type I was Grade 0 in 0 of 14 patients, Grade 1 in 8, Grade 2 in 2, and Grade 3 in 4. Type II was seen in 9 of the 14 cases and type III in 8. After twelve weeks, all cases of type I were Grade 0, no type II cases were evident, and type III was seen in 11 cases. Injecting autologous blood into surrounding TMJ tissues is an important factor in ABI. Minimally invasive treatment for habitual TMJ dislocation using ABI around the TMJ capsule appears to represent a very effective and safe treatment.

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^*: Reprint requests: Oscar Hasson, DDS, Department of Oral and MaxilloFacial Surgery, Kaplan Medical Center, Rehovot, Israel 76100, [email protected]

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Oral and Maxillofacial SurgeryAutologous blood injection for treatment of recurrent temporomandibular joint dislocation*

Abstract

Section snippets

Description of the technique

Case reports

Discussion

Int J Oral Maxillofac Surgery

Int J Oral Surgery

J Am Dent Assoc

J Oral Maxillofac

Principles of oral and maxillofacial surgery

Oral and Maxillofacial Surgery
Autologous blood injection for treatment of recurrent temporomandibular joint dislocation*