Article Type : Case Report
Authors : Shunmugavelu K
Keywords : TMJ fracture; Case report; Conservative management
Background: The treatment of TMJ fracture remains a
controversy in maxillofacial surgery. Despite mandibular fracture is a more
commonly encountered fracture it is still a debate to approach the fracture
surgical or conservative.
Case report: An interesting case of trauma on the left side
of face with TMJ fracture reported to the clinic. Proper clinical examination
and adequate investigations were done. We performed a conservative approach of
TMJ fracture management on a 41 year old patient and followed up for 6 months.
Patient had no signs of postoperative complications, patient was reviewed for 3
consecutive weeks and followed up after 6 months and found to be normal and
healthy. This is suggestive of successful management of TMJ fracture.
Conclusion: To conclude conservative management cannot be an
alternative to surgical management but in certain cases conservative management
can be administered. Case selection criteria and severity of fracture
determines the selection of treatment methods.
Maxillofacial trauma constitutes nearly 10% to 40% of the mandibular fractures [1]. Historically, temporomandibular joint fractures were conservative method with various forms of immobilization or maxillomandibular fixation, with largely favourable results [2,3]. Various complications concerning trauma affecting TMJ may be seen both in surgical and conservative management [4]. Such complications include disrupted occlusal function, internal derangement of the TMJ, facial asymmetry, nerve injury, Intra alveolar and Extra-Articular Ankylosis and limited jaw movement. The choice between two treatment modalities- surgical and controversial remains highly controversial [5]. This article aims to contribute to conservative management of TMJ fractures.
Case Report
A
41 year old male patient reported to the hospital due to trauma while working.
The patient was well built and nourished, he was conscious and well oriented to
time and place. The patient had no history of vomiting. Patient written consent
was obtained.
On examination
Temporomandibular
joint fracture is usually associated with complications. Immediate detection of
TMJ fracture and management of the above by either conservative or surgical
method can have drastic consequences in limiting complications. Clinical
features of TMJ fracture includes swelling, facial asymmetry, haemorrhage from
ear on that side, haematoma on the involved site, ecchymosis of skin just below
the mastoid process. On current visit, extra oral examination reveals left side
asymmetry face, no bleeding from ears and nose was evident. Hemotympanum and
hearing loss was not evident in this patient. There was a pre auricular
swelling with a size 3 x 3cm, soft in consistency, tender on palpation, and the
surface was warm, black blue spot suggestive of ecchymosis. Intra oral
examination revealed reduced mouth opening due to blockage of coronoid process.
Partially edentulousness in relation to 31, generalised attrition was evident,
dental caries in relation to 16, 26 and Generalised chronic periodontitis. Patient
was alright a few days after the trauma, he was conscious with pain and
swelling when brought to the hospital. Facial nerve examination was done and
was normal for the patient. No contributing past medical history and family
history was evident.
Computed tomography was done.