Abstract
Rationale:
Dislocation of the mandibular component after total temporomandibular joint replacement (TMJR) is uncommon but can be difficult to manage because manual reduction may fail, and recurrence can occur.
Patient concerns:
A 25-year-old woman with bilateral condylar resorption, mandibular retrognathia, class II malocclusion, and severe obstructive sleep apnea underwent bilateral stock TMJR and concomitant orthognathic surgery.
Diagnoses:
Posterior dislocation of the left mandibular component occurred intraoperatively and was manually reduced. Posterior dislocation recurred on postoperative day 1 and again on postoperative day 37.
Interventions:
After unsuccessful manual reduction, revision surgery was performed to reposition the left mandibular component. Following the recurrence on postoperative day 37, continuous class II elastic traction was applied for 22 days.
Outcomes:
Class II elastic traction restored satisfactory occlusion and mandibular position without the need for further surgery. At the 6-month follow-up, the patient maintained stable occlusion and facial profile, a maximum mouth opening of 35 mm, and stable condyle-fossa prosthesis positioning on imaging. The literature review identified 10 publications involving 57 patients with perioperative prosthesis dislocation; 64.3% of the dislocations were detected intraoperatively and 35.7% postoperatively.
Lessons:
Recurrent dislocation may occur after TMJR, particularly following extensive mandibular repositioning and postoperative muscular instability. Prompt recognition, appropriate prosthesis repositioning, and postoperative elastic traction may reduce the risk of recurrence and avoid additional surgery.