Conservative Management of Unilateral TMJ Fracture - A Case Report Download PDF

Journal Name : SunText Review of Dental Sciences

DOI : 10.51737/2766-4996.2021.145

Article Type : Case Report

Authors : Shunmugavelu K

Keywords : TMJ fracture; Case report; Conservative management

Abstract

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.


Introduction

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. 

  1. 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.


Provisional Diagnosis of TMJ Fracture was Given Clinically Investigations

Computed tomography was done.