Acute Temporomandibular Joint Dislocation Immediately Following Mandibular First Molar Extraction: A Case Report and Review of Clinical Management

Introduction: Temporomandibular joint (TMJ) dislocation is an uncommon but potentially distressing complication that may occur during dental treatment as a result of prolonged mouth opening, excessive mandibular translation, or predisposing joint laxity. Although frequently reported following lengthy dental procedures and third-molar surgeries, acute TMJ dislocation after a routine extraction is infrequently described in the dental literature.¹˒⁷ Prompt recognition and chairside management are essential to prevent patient discomfort, muscle spasm, and the need for emergency intervention.
Case Presentation: A 26-year-old healthy female presented for extraction of the mandibular right first molar (#30) due to extensive dental caries with pulpal involvement, cracked tooth syndrome, dental pain, and associated periapical abscess. Medical history was noncontributory, and the patient denied previous surgeries, tobacco use, or a history of temporomandibular joint disorders. Local anesthesia was achieved with one carpule of 4% articaine with 1:100,000 epinephrine administered by infiltration and one carpule of 2% lidocaine with 1:100,000 epinephrine administered as an inferior alveolar nerve block. Extraction was completed uneventfully using elevators and forceps, and hemostasis was achieved. Immediately following the procedure, the patient developed an inability to close her mouth consistent with acute mandibular dislocation. Manual reduction was performed chairside using downward and posterior mandibular pressure, resulting in immediate restoration of mandibular function and symptomatic relief. Postoperative instructions focused on avoiding excessive mouth opening and minimizing the risk of recurrence.
Discussion: Acute TMJ dislocation during dental treatment is uncommon but may occur even during routine procedures requiring sustained mouth opening.¹˒⁷˒¹⁰ Risk factors include prolonged mandibular depression, ligamentous laxity, previous episodes of dislocation, and excessive opening during treatment.⁷˒¹¹ Early recognition and immediate manual reduction remain the cornerstone of management.⁷˒¹⁰ Dentists should be familiar with the clinical presentation and reduction techniques to ensure prompt intervention and prevent complications.
Conclusion: This case highlights an uncommon complication occurring after routine mandibular molar extraction and demonstrates successful chairside management through immediate manual reduction. Awareness of TMJ dislocation, its predisposing factors, and appropriate management strategies is essential for all dental practitioners.

Temporomandibular joint dislocation, mandibular dislocation, tooth extraction, dental complications, lockjaw, chairside management, case report

1. Brachmann A, Kamal M, Schwenzer K, et al. Temporomandibular joint dislocation: review of current treatment strategies. J Oral Maxillofac Surg. 2022;80(7):1225-1234. [Google Scholar] [Crossref]

2. Hegab AF. Management of acute and chronic temporomandibular joint dislocation: a review. Int J Oral Maxillofac Surg. 2013;42(4):397-404. [Google Scholar] [Crossref]

3. Akinbami BO. Evaluation of the mechanism and principles of management of temporomandibular joint dislocation: systematic review of literature and a proposed new classification. Head Face Med. 2011;7:10. [Google Scholar] [Crossref]

4. Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015;91(6):378-386. [Google Scholar] [Crossref]

5. Dimitroulis G. Temporomandibular disorders: a clinical update. BMJ. 1998;317:190-194. [Google Scholar] [Crossref]

6. Okeson JP. Management of Temporomandibular Disorders and Occlusion. 8th ed. St Louis, MO: Elsevier; 2019. [Google Scholar] [Crossref]

7. Sharma NK, Singh AK, Pandey A. Acute temporomandibular joint dislocation following dental treatment: case report and review of management strategies. J Clin Diagn Res. 2016;10(5):ZD01-ZD03. [Google Scholar] [Crossref]

8. de Santana Santos T, Cabral MG, Antunes AA, et al. Manual reduction techniques for acute temporomandibular joint dislocation: review of the literature. Med Oral Patol Oral Cir Bucal. 2011;16(4):e589-e593. [Google Scholar] [Crossref]

9. Martins WD, Ribas MO, Bisinelli J, França BH. Chronic recurrent temporomandibular joint dislocation: literature review and management considerations. Int J Dent. 2014;2014:1-8. [Google Scholar] [Crossref]

10. Vasconcelos BCE, Porto GG, Bessa-Nogueira RV. Treatment of chronic mandibular dislocations by eminectomy: follow-up of 10 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(1):e8-e12. [Google Scholar] [Crossref]

11. Adekeye EO, Shamia RI. Condylar dislocation: a review of twenty-nine cases. Int J Oral Surg. 1978;7(1):50-54. [Google Scholar] [Crossref]

12. Ugboko VI, Oginni FO, Esan TA. Management of temporomandibular joint dislocation: a review of literature. Niger Postgrad Med J. 2008;15(1):29-35. [Google Scholar] [Crossref]

13. Ugboko VI, Oginni FO, Ajike SO, Olasoji HO, Arotiba GT. A survey of temporomandibular joint dislocation in a Nigerian tertiary healthcare center. Niger J Clin Pract. 2005;8(1):31-35. [Google Scholar] [Crossref]

14. Fonseca RJ, Barber HD, Powers MP, Frost DE. Oral and Maxillofacial Trauma. 4th ed. St Louis, MO: Elsevier; 2013 [Google Scholar] [Crossref]