Copyright @ 200 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. 8 A New Surgical Approach for the Treatment of Chronic Recurrent Temporomandibular Joint Dislocation Piero Cascone, MD, PhD, Claudio Ungari, MD, PhD, Francesco Paparo, MD, Tito Matteo Marianetti, MD, Valerio Ramieri, MS, MG Fatone, MD, PhD Rome, Italy Chronic recurrent temporomandibular joint (TMJ) dislocation is defined as the complete loss of articular relationships, during mouth-wide opening, between the articular fossa of the temporal bone and the condyle-disk complex. The most frequent pathoge- netic factors involved in chronic recurrent dislocation of the TMJ are supposed to be trauma, abnormal chewing movements, TMJ ligaments, capsule laxity, and masticatory muscles disorders. In fact, TMJ dislocation occurs more frequently in people with general joint laxity and in patients with internal derangement of the TMJ or with occlusal disturbance. Management of TMJ dislocation remains a chal- lenge. Eminectomy, whose validity has been demon- strated by several authors, acts on the bony obstacle, preventing condylar locking, but does not have a therapeutic effect on TMJ ligament and capsular laxity or masticatory muscle incoordination, which seem to be the real cause of TMJ dislocation in most cases. The authors present a mini-invasive modified technique of eminectomy, which aims to act on both the obstacle and the cause with respect and restoration of TMJ biomechanical constraints. Key Words: TMJ dislocation, eminectomy, reabsorb- able device, internal derangement T emporomandibular joint (TMJ) dislocation can be defined as the complete loss of articular relationships, during mouth wide opening, between the articular fossa of the temporal bone and the condyle-disk complex which is quite often locked in anterior abnormal position. 1,2 Temporomandibular joint dislocation can occur as sporadic, recurrent, or chronic recurrent. The latter consists on a temporary TMJ locking sensation that either stops spontaneously or can be reduced with manual self-manipulation and occurs at almost every mouth-wide opening. 1,2 The pathogenesis of chronic recurrent disloca- tion of the TMJ has been attributed to trauma, abnormal chewing movements, TMJ ligaments and capsule laxity, and masticatory muscles disorders. Even some drugs, such as fenotiazine 3 or neurologi- cal disorders causing muscular hyperactivity (e.g., Parkinson disease), have been considered as having a role in TMJ dislocation. 4 Temporomandibular joint dislocation can be found more frequently in people with general joint laxity and in patients with internal derangement of the TMJ or with occlusal disturbances. Management of chronic dislocation remains a challenge. Nevertheless, many surgical approaches have been proposed by international literature. 5Y10 The goals of treatment are either to restrict mandib- ular translation or to remove eminence obstacle, thus preventing mandibular dislocation and locking ante- rior to the articular eminence, such as eminectomy, which would be the most widely accepted tech- nique. 11 Nevertheless, TMJ function is controlled by a series of biomechanical constraints that guide and condition the joint. Thus, it would be necessary act either on biomechanical constraints to restore TMJ function for proper recurrent TMJ dislocation treatment. The authors propose a variation of the eminect- omy technique acting either on the obstacle or on disk, capsule, and ligament. CLINICAL REPORT A 21-year-old woman with a 2-month history of 21 consecutive dislocation of the TMJ requiring manual repositioning several times first came to our observation in January 2006. She had no history of 510 From the Cattedra di Chirurgia Maxillo-Facciale, University of Roma ‘‘La Sapienza,’’ Viale del Policlinico, Roma. Address correspondence and reprint requests to Francesco Paparo, MD, Viale Bruno Pelizzi, 21, 00173 Roma, Italy; E-mail: f.paparo@email.it