A Case of Habitual Temporomandibular Joint Dislocation in an Older Patient with Dementia Treated by Invasive Treatment

Abstract

　We experienced a case of habitual temporomandibular joint dislocation in an older patient with dementia in whom open treatment was effective. The patient was an 84-year-old woman. Her medical history included right thalamic hemorrhagic dementia and hypertension. In late August 2022, she was diagnosed with a dislocated temporomandibular joint and was admitted to our department for a thorough examination and treatment. Imaging examination showed that both mandibular condyles were located anterosuperior to the articular tuberosity, indicating anterior temporomandibular joint dislocation. No obvious abnormal findings in bone morphology were observed.

　Manual reduction was performed. The reduction was easy, and the hospital staff and family were instructed to restrict her mouth with an elastic bandage for 2 weeks. The day after the reduction, the patient removed the bandage and re-dislocated the joint. She visited our department again and underwent manual reduction. She returned to the facility, and on the same day, she removed the bandage by herself in the evening. As she repeatedly dislocated the joint, she was rushed to our hospital and was hospitalized for nutritional management as oral intake was difficult for her. In consultation with facility staff and her family, an eminectomy under general anesthesia was scheduled.

　Postoperatively, she had no temporomandibular joint dislocation and was able to achieve sufficient oral intake. In the future, as the number of older patients with dementia increases, it is predicted that the number of patients with temporomandibular joint dislocation will also increase, but when choosing a treatment method, it is necessary to take into account the patientʼs general condition, a thorough examination of the clinical condition, and social background.

　Dentists play a central role and through interprofessional work, we are able to provide an environment where patients can return to their facilities or homes as soon as possible.