Vol. 89 No.
6 June 2000
REVIEW ARTICLE
Dislocation of the temporomandibular joint
Christopher W. Shorey, DDS, a and John H. Campbell, DDS, MS, b Indianapolis, Ind
INDIANAUNIVERSITY
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:662-8)
Dislocation of the temporomandibular joint (TMJ)
occurs when the mandibular condyle is displaced ante-
riorly beyond the articular eminence. There are
multiple causes for its occurrence, and treatments
range from relatively conservative methods to complex
surgical intervention. Although "success" rates and
length of follow-up for the available treatments are
highly variable, this article will assess interventions
reported in the English literature in an attempt to
provide the clinician with a clearer understanding of
outcomes and potential complications.
In 1832, Sir Astley Cooper proposed principles for
diagnosis and treatment of dislocation of the lower
j a w ) He introduced the terms complete dislocation
(luxation) and imperfect dislocation (subluxation),
and other authors have further delineated the 2 condi-
tions. 2-6 Subluxation is generally defined as a
displacement of the condyle out of the glenoid fossa
and anterosuperior to the articular eminence, which
can be reduced by the patient (self-reduced). Clinical
and radiographic analysis have indicated that approxi-
mately 70% of the population can subluxate the TMJ. 7
In contrast, dislocation is a similar displacement of the
condyle, which cannot be self-reduced. Whatever the
underlying cause, with each successive dislocation,
further episodes tend to occur more easily. 8 When
dislocation in a patient becomes more frequent and
progressively worse, the condition is referred to as
habitual or recurrent dislocation. 9
aFellow, Department of Oral Surgery, Medicine, and Pathology,
Indiana University.
bAssistant Professor, Department of Oral Surgery, Medicine, and
Pathology, Indiana University.
Received for publication April 29, 1999; returned for revision July
15, 1999; acceptedfor publication Feb 10, 2000.
Copyright© 2000 by Mosby,Inc.
1079-2104/2000/$12.00 + 0 7/12/106693
doi:10.1067/moe.2000.106693
662
Dislocation of the TMJ represents 3% of all reported
dislocated joints in the body. 10 However, most authors
regard recurrent dislocation as a rare entity. As with
other temporomandibular disorders, the highest inci-
dence of recurrent dislocation is reported among female
subjects, although the reasons for this are not well
understood) 1 Signs and symptoms of acute and chronic
dislocation are the same and include (1) inability to
close the mouth, (2) preauricular depression of the skin,
(3) excessive salivation, (4) tense, spasmatic muscles of
mastication, and (5) severe pain of the TMJ.l°
PRECIPITATING FACTORS
Some factors associated with the onset of habitual
dislocation include, but are not limited to, yawning,
singing, sleeping with the head resting on the forearm,
manipulation of the mandible while patient is under
general anesthesia, excessive tooth abrasion, severe
malocclusion, loss of dentition (leading to overclosure),
and trauma.6,12,13 Patients undergoing psychiatric or
psychological chemotherapy can also experience recur-
rent dislocation as a side effect of certain medications. 14
Several authors have proposed that abnormalities in
the stability factors of the TMJ may be associated with
dislocation.l,6,8A1,15-17 The stability of any joint
depends on 3 factors: (1) the integrity of the ligaments
associated with the joint, (2) the activity of the muscu-
lature acting on the joint, and (3) the bony architecture
of the joint surfaces. 15
Myrhaug related the bony architecture to disloca-
tion. 11 He observed that a deep overbite was frequently
associated with a deep glenoid fossa and a steep artic-
ular eminence, which he surmised to be conducive to
dislocation. Other authors have postulated that chronic
stretching of the capsular and lateral ligaments, known
in earlier literature as "lax ligaments," predispose the
TMJ to dislocation. 6,13 Abnormalities of the neuro-
muscular mechanisms controlling muscles of mastica-
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
Volume 89, Number 6
tion have also been associated with dislocation. 1 Bell 16
implied that a period of critical importance exists when
the condyle reduces from a subluxated position. If a
spasm of the musculature occurs when the condyle
approaches the crest of the articular eminence on its
return to the glenoid fossa, then dislocation is a highly
probable outcome. Finally, some authors have specu-
lated on a combined ligamentous/muscular cause, that
is, the disk-condyle relationship and TMJ dislocation.
The relative position of the anterior band of the disk to
the condyle may, in some instances, cause a mechan-
ical block, thus precipitating dislocation.8a 7
THERAPY
The treatments of recurrent dislocation may be orga-
nized according to the stability factors into (1) alter-
ation of the ligaments, (2) alteration of the associated
musculature, and (3) alteration of the bony anatomy.25
Each will be addressed in turn.
Ligament alteration
One treatment modality affecting ligament function is
the introduction of a sclerosing agent into the capsular
space of the TMJ. The therapeutic intent is to cause
fibrosis with resultant tightening of the capsule. 6,13,18In
effect, this procedure could prevent or limit exaggerated
condylar movement. Alcohol, Rivanol (aethacridin),
5% sodium psylliate (Sylnasol), sodium morrhuate, 3%
sodium tetradecyl sulfate, and autologous blood have
been used individually as sclerosing agents. 13a5.18-20
The reviewed literature reported 135 patients treated by
intracapsular injection of one of these substances, with
a cumulative cure rate of 72%. Length of follow-up
ranged from 0 to 18 months, with no long-term out-
comes reported.
According to Schultz, 13 several hundred patients
were treated by sclerosis under his direction without
any complications or deleterious effects; however, no
record of patient selection, length of follow-up, and
type of follow-up was documented. The administration
of sclerosing agents is associated with side effects,
which may include pain, muscle tenderness, occlusal
disharmony or malocclusion, temporary nerve paresis,
and excessive salivation. 6.15 Some authors reasoned
that the stronger the reaction of the body to the scle-
rosant, the more effective the treatment. 6 However, in
order to maintain freedom from dislocation, multiple
treatments are often necessary) 3 Exaggerated mouth
opening (eg, yawning) may threaten the integrity of the
fibrosis and release the limitation achieved, resulting in
recurrent dislocation or subluxation. 13 For this reason,
sclerosing agents may be considered reversible and
may best be limited to patients with "lax" capsular
ligaments in whom surgery would be hazardous.6,15
Shorey and Campbell 663
Immobilization of the mandible by maxillomandibular
fixation (MMF) may be used by itself or in concert with
other treatment modalities for habitual dislocation. As
the sole therapy, immobilization has been recommended
for a period of 3 to 6 weeks to facilitate healing of the
presumably damaged ligament(s)) 1 As an adjunctive
treatment to sclerosing agents, it may aid the develop-
ment of a mature fibrosis within the joint capsule. 18
However, MMF alone or with concomitant use of scle-
rosing agents has typically failed to achieve permanent
satisfactory results.6,9,11,21.22 In addition, compliance in
maintenance of MMF for the prescribed period has
proven challenging for some individuals. 23
The suboptimal efficacy of these relatively conserva-
tive treatments led to the concept of "strengthening"
the ligaments by surgical intervention. This particular
procedure has been advocated for people with exces-
sive overclosure caused by loss of the dentition,
followed by chronic subluxation that later progressed
into recurrent dislocation. Attempts to strengthen the
capsular ligament were initially accomplished by sur-
gically exposing the fascia of the temporalis muscle
and suturing a flap of fascia onto the capsular liga-
ment. u Others have advocated capsular plication. 24-26
In 1945, Hudson 25 described this technique that used a
preauricular approach to the capsular ligament, fol-
lowed by an incision vertically through the body of the
ligament. The incision margins were then overlapped
and sutured. A disadvantage to this therapy is violation
of the intracapsular space, which can produce compli-
cations such as hemarthrosis, degenerative changes to
the joint, or both. 27 This problem may be circumvented
by simply placing silk sutures along the inferior aspect
of the ligament, with a short subsequent period of
MME 24 If additional tightening of the joint capsule is
needed, then the procedure may further be modified to
incorporate ligamentorrhaphy. Ligamentorrhaphy
involves the surgical fixation (or anchoring) of the
lateral ligament of the capsule to the periosteum of the
overlying zygomatic arch, followed by MMF for 1
week. Fabrication of a prosthesis to reestablish proper
vertical dimension of occlusion has been recom-
mended to reduce recurrence. 12 We found only 12
capsular plications reported in the English literature.
All 12 operations proved "successful," with reported
follow-up periods ranging from 4 months to 5 years,
except for 1 case, which was followed for 11 years. 12,24
Its true efficacy awaits the report of a larger series with
long-term follow-up.
Muscle alteration
The second classification of treatment involves the
alteration of TMJ-associated musculature. Active phys-
ical therapy has been advocated for patients afflicted
664 Shorey and Campbell
with habitual dislocation. 9 Strengthening the supra-
hyoid muscles to counterbalance the action of the
lateral pterygoid muscles could theoretically reduce the
likelihood of dislocation. The equipment to perform
this type of physiotherapy, however, is elaborate and
involves considerable compliance by the patient.
A more recently reported treatment modality for
alteration of the musculature is the use of type A botu-
linum toxin (BTA). Botulinum toxin is derived from
the anaerobic, gram-positive rod clostridium botu-
linum, and type A is 1 of 8 types currently recog-
nized. 28 An extraoral preauricular transcutaneous
approach to injection (similar to the administration of
sclerosing agents) is recommended. The site of injec-
tion is approximately 1 cm anterior to the condyle in a
slightly opened-mouth position. Electromyogram
monitors facilitate-the location of the needle into the
lateral pterygoid~muscle. Once the tip of the needle is
in position and is aspirated to ensure no blood vessel
penetration, an appropriate amount of BTA (usually up
to 500 mouse units [MU]) is injected. The intended
effect of the BTA is to weaken the lateral pterygoid
muscles sufficiently to prevent dislocations, while
producing only slight impairment to maximal opening.
It does not appear to have an immediate effect,
requiring 4 to 5 days after administration before onset
of relief. BTA is a temporary and completely reversible
treatment for recurrent dislocation. Multiple injections,
given every 2 to 4 months (maximum 1013MU each),
may be necessary to achieve long-term effects. For
obvious reasons this therapy is contraindicated in
patients with diseases that impair neuromuscular func-
tion (eg, myasthenia gravis). It has been reported that
treating oromandibular dystonia with BTA injected
into the lateral pterygoid muscle resulted in a transient
dysphagia in 8% of the patients. 28 Only one case report
has been documented in regard to the treatment of
recurrent dislocation; a controlled clinical trial has yet
to prove evidence of its efficacy.28
Alteration of the jaw opening musculature can also
be performed surgically, either by a direct or an indi-
rect approach. Indirect approaches involve ligating the
mandible to the craniofacial complex to limit the extent
of muscular movement. 29 The ligation of the coronoid
process to the zygomatic arch with either wire or
animal tendon of slow absorbability has been
reported. 11 In 1965, Georgiade29 modified the proce-
dure by drilling small holes into the extracapsular
portion of the condylar neck and through the zygo-
matic arch just anterior to the articular tubercle. A
Dacron (Mersilene) mesh suture was threaded through
the 2 holes and tightened enough to prevent dislocation
by manipulating the mandible under direct vision. This
procedure may be done bilaterally and without MMF.
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
June 2000
A potential advantage of the Georgiade method is that
the Dacron mesh suture may provide a medium for
fibrous tissue penetration. However, long-term efficacy
of this procedure has not been reported.
Closed condylotomy has likewise been performed to
indirectly affect the lateral pterygoid muscle. 3°,31 This
intraoral procedure bisects the condylar neck with a
Gigli saw. The condylar head typically displaces in an
anteromedial direction, thus eliminating the effect of
spasticity of the lateral pterygoid muscle. Of patients
who underwent this procedure, 81% were reported to
be free of dislocation, according to a follow-up ques-
tionnaire with a reported follow-up of 1 to 6 years.
However, the usefulness of this intervention has been
limited by the potential for serious bleeding from the
internal maxillary artery.
In contrast to any indirect approach, the bilateral
release of the lateral pterygoid muscles will directly
alter the musculature. 32 This procedure involves exci-
sion of the insertion of the lateral pterygoid muscle at
the condylar neck and joint capsule. The operation
attempts to disable the lateral pterygoid muscles,
allowing only rotational movement of the condyle.
This is accomplished from an intraoral approach,
followed by MMF for 7 to 10 days. Only 5 cases were
reported, with a maximal follow-up period of 18
months. However, the authors reported no recurrence.
Its disadvantages include difficulty in visualization
and the risk of bleeding in this highly vascular site.
Muscle tissue may reattach during healing, placing the
long-term efficacy of the procedure in doubt.
Another direct intraoral procedure involves scarifica-
tion of the temporalis tendon at its area of insertion,
along the ascending ramus. 33 In this procedure, the
majority of the tendinous fibers are stripped from the
ramus and sutured to the reflected periosteum and oral
mucosa in a fashion that creates tissue disorientation
and subsequent scar formation. Theoretically, this
suturing technique will create a horizontal scar, which
may tighten the tendon and limit the range of motion. 34
This procedure is highly technique-sensitive, and
complications include profound swelling (lasting 5-10
days) and buccal nerve hypoesthesia, caused by the
location of the intraoral incision.33, 34 No long-term
studies have been conducted to ascertain the efficacy of
this procedure. In addition, only 11 cases have been
reported to date. Gould 34 commented on a gradual
trend toward relapse after analyzing similarly-treated
patients at l-year follow-up appointments. 34,35 Five
days after surgery, the interincisal distance measure-
ment began to increase in 100% of patients followed.
This 5-day period was confluent with the period of
reported edema, which strongly suggests that this
procedure does not produce the desired effect.
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
Volume 89, Number 6
Bony alteration
The third methodology for treatment of habitual
dislocation involves alteration of the bony anatomy. 15
In 1883, Reidel performed the first condylectomy for
the treatment of dislocation, and this procedure was
subsequently advocated by Henny and Baldridge. 9,36
The resulting pseudoarthrosis (or nearthrosis) may
limit the range of mandibular motion.9,37
In 1933, Mayer 38 was the first to describe the
displacement of the zygomatic arch to augment the
articular eminence and obstruct the path of the trans-
lating condyle. Leclerc and Girard modified the proce-
dure, and Dautrey further altered the technique. 39-42
The Dautrey procedure was designed to avoid interfer-
ence with normal movements, but to prevent abnormal
forward excursive movements. 21 A preauricular inci-
sion exposes the zygomatic arch and capsular ligament,
the periosteum is reflected from the arch, and an
oblique osteotomy is performed on the zygomatic arch.
A greenstick fracture should occur at the zygomatico-
temporal suture, thus giving the segment some rebound
elasticity to provide stability in its altered position. 39
MMF is not necessary for postoperative stability. 39,42,43
This procedure may be advantageous in that it does not
violate the joint space and allows immediate, normal
anterior movement with little limitation in maximal
opening. The main disadvantage is the risk of fracture
of the distal segment, which might require bone plate or
wire fixation. 23,44,45 Iizuka et al21 recommended that
care be taken to avoid reflection of periosteum from the
zygomatico-temporal suture, lest a true fracture result
when repositioning the arch. 21,44 In order to prevent or
reduce the likelihood of sutural fracture, this procedure
should only be attempted in younger individuals (under
age 40, approximately) because of increasing brittle-
ness of the skeletal system with age. 43,46 One study,
however, reported that even with complete fracture of
the distal segment, the use of wire or bone plate fixation
did not present any complications and held the distal
segment in place. 39
Another potential problem associated with the
Dautrey procedure is the resorption of the distal
segment. 45,47 Bone resorption (and remodeling) was
noted radiographically on follow-up studies in all the
patients from one study. 42 In another article, the interin-
cisal distance was reported to increase over many
months after surgery, which may indicate resorption of
the down-fractured segment. 21,48 Another reported
disadvantage is that the arch tends to engage only the
lateral third of the condylar head with mandibular
movement. 49 An attempt to place the down-fractured
arch as far medially as possible is necessary to fully
engage the translating condyle, and fixation of the
segment may be necessary to stabilize this medial posi-
Shorey and Campbell 665
tion. 49 The mediolateral relationship of the condylar
head to the glenoid fossa and zygomatic arch should be
assessed before surgery to assure that the arch will actu-
ally engage the condyle. Overall, a cure rate of 91% was
reported among a total of 58 cases, with a recurrence of
only 9%. Approximately 5% of patients incurred a
zygomatic arch fracture, 8% reported to have temporary
facial nerve paresis, and 7% complained of postopera-
tive pain and clicking of the TMJ. Follow-up periods
ranged from 6 months to 5 years.
Iliac or calvarial bone grafts may also be used to
augment the articular eminence for prevention of dislo-
cation.27,50 After reflecting the periosteum from the
zygomatic arch and articular eminence, the capsule can
be displaced posteriorly to create a space for graft
placement. Alternatively, various osteotomies of the
zygomatic arch may be performed for graft insertion.
Variable degrees of iliac bone graft resorption have
been reported,46,51 whereas calvarial grafts have been
suggested to show no appreciable lOSS.46 However, use
of the cranium as a donor site is not without complica-
tion. Dural tears, arachnoid bleeding with subsequent
hematoma, and scalp infections are possible adverse
sequelae. 52 A severe decrease in maximal opening has
been reported as another potential complication. 27 In
comparing reported cases of iliac crest bone grafts and
calvarial grafts, 6 of 39 iliac crest grafts had a recur-
rence of dislocation. All 12 calvarial grafts were
without recurrence. However, the length of follow-up
was staggered, with the iliac crest grafts reporting a
follow-up of 1 to 14 years and the calvarial grafts
reporting a follow-up of 5 to 20 months.
In light of possible resorption of iliac grafts, Whear
et a153 advocated the use of bovine cartilage (chon-
droplast). Of 7 cases performed, there were no reports
of recurrent dislocation. Length of follow-up, however,
was not indicated. According to the authors, cartilage is
dimensionally stable when used as a graft material, and
the gradual calcification of the graft can further
enhance its stability.
The use of L-shaped pins, vitallium mesh implants,
and miniplates to enhance the eminence have been
reported in the literature. 54-57 Accumulating evidence
indicates that these appliances are prone to fracturing
or loosening under functional loads. 56,57 Destruction of
the anterior portion of the condylar head has also been
reported as a possible complication. 57
The incorporation of silicone blocks has been advo-
cated in similar osteotomy procedures. 58 The allo-
plastic material, trimmed into the shape of a wedge,
may be inserted into the surgically developed space.
Twenty-three joints were operated on with this proce-
dure, with no recurrence noted after a follow-up period
ranging from 1 to 4 years. However, this material may
666 Shorey and Campbell ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
June 2000

]able I. Comparisons of reported treatment modalities mended to avoid the possibility of sepsis. 66 The poten-
No. o f Follow- % without tial postoperative complications of eminectomy are
Procedure cases up recurrence recurrent subluxation and the formation of osteo-
Sclerosing agent6,13A8 135 0-18 mo 72% phytes, along with crepitus and pain. 67,68 Subluxation
Intermaxillary fixation9,11,21,22 6 NRD NRD may be prevented in some instances by subsequent scar
Capsular plication 24-26 12 4 mo-5 y 100% formation around the joint. 7,69 The formation of osteo-
Physical therapy9 NRD NRD NRD phytes has been observed many years after surgery and
Botox injections 28 1 20 mo NRD
can produce mild crepitus. 68 Postoperative crepitus and
Ligation of mandible 11,29 7 NRD NRD
Condylotomy30,31 21 1-6 y 81% pain may be alleviated by smoothing the roughened
Lateral pterygoid myotomy32 5 2-18 mo 100% bony surface and by active postoperative physical
Muscle scarification 33-35 11 Up to 1 y NRD therapy. 67,7° A loss of condylar guidance is expected,
Condylectomy36, 37 NRD NRD NRD either partially or completely. Reportedly, the joint
Zygomatic arch down- 58 6 too-5 y 91%
fracture21,23,38-45,47-49
remains clinically stable, without gross deficiency in
Iliac crest bone graft27,46,50 39 1-14 y 65% mastication. 71 According to the literature, 175 cases
Calvarial bone graft50,51 12 5-20 mo 100% have been reported. Of these, 95% were free of recur-
Chondroplast52 7 NRD 100% rence, with follow-up ranging from 4 months to 9
Metallic implants53-57 22 1 mo-2.5 y 95% years, and only 5% of cases had recurrence of disloca-
Synthetic, nonmetallic alloplasts58 23 1-4 y 100%
Eminectomy5,7,10,11,35,59-74 175 4 mo-9 y 95%
tion. Approximately 12% of cases reported temporary
facial nerve paresis, and less than 5% showed crepitus
NRD, No reported data.
caused by radiographic osteophytes. The eminectomy
procedure has been recommended for patients who
habitually dislocate and have a disability that inhibits
act as a foreign body, may elicit an immune reaction, controlled muscular movements (eg, Parkinson's
and could also be displaced as a result of functional disease, multiple sclerosis, and Huntington's chorea)
movements. 53 Similar problems of displacement were and for patients undergoing neuroleptic drug therapy,
reported with porous coralline hydroxyapatite placed which can cause akinesia and dyskinesia. 14,72
into the space. 59 Overall, eminences augmented by
either the zygomatic downfracture procedure or inter- SUMMARY
positional grafts probably act initially as a mechanical Many treatment modalities are available for mitiga-
block, but long-term success may be focused around tion of pain and dysfunction of the habitually dislo-
the formation of a surgical scar. 45 cating temporomandibular joint. In most cases, more
Another treatment modality that involves the alter- conservative methods provide only temporary allevia-
ation of bony anatomy is the reduction of the articular tion of symptoms, and recurrence is common. Surgical
eminence, otherwise known as eminectomy. 5,60-64 In intervention has generally been considered the more
1951, Myrhaug 11 first reported eminectomy for treat- effective definitive treatment. No matter which surgical
ment of recurrent dislocation. He rationalized that intervention is undertaken, it should be realized that
removal of the obstacle (ie, the articular eminence) in postoperative scarring probably provides a significant
the path of the condyle would eliminate the possibility portion of the surgical benefit. Evidence suggests that
of dislocation. Blankestijn et a135 further modified immobilizing the joint after any surgical procedure will
Myrhaug's procedure by exposing the eminence result in fibrosis, which may make assessment of effi-
without violating the intracapsular space. cacy of the actual surgical procedure difficult. Some
When treating a case of failed bilateral eminectomy, authors have claimed that signs of recurrence were
Loh and Yeo23 observed that the most medial portion of related to early mobilization of the joint and that MMF
the eminence had not been reduced. The removal of the is always indicated.
entire eminence was subsequently recommended True comparisons of the reported treatment morali-
because the condyle interacts intimately with the ties are difficult because of differing periods of follow-
medial portion of the eminence. However, surgical up and different definitions of success (Table I).
access to this area is difficult and may account for at Several factors should suggest caution before using
least some operative failures. 58 some of the procedures reviewed here. Studies that do
Potential anatomic complications of the eminectomy not report length of follow-up, or that report follow-up
procedure include pneumatization of the eminence and less than 1 year, should not be viewed as other than
resultant dural tear during its removal. 65,66 The pilot data. Likewise, series incorporating fewer than 25
frequency of such occurrences are rare; however, the patients should be viewed with caution. Techniques
administration of parenteral antibiotics is recom- reported in only 1 series with a single clinician may not
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
Volume 89, Number 6
a c h i e v e t h e s a m e results w h e n a p p l i e d b y others. T h e
l i k e l i h o o d o f p e r m a n e n t a d v e r s e s e q u e l a e or n e e d f o r
r e p e a t s u r g e r y s h o u l d w e i g h h e a v i l y in t h e d e c i s i o n to
u s e a n y t r e a t m e n t modality.
With these considerations in mind, we believe that
certain treatment modalities should be avoided.
Sclerosing agents, in general, have an unacceptably
l o w r a t e o f s u c c e s s a n d s h o u l d .not b e c o n s i d e r e d
permanent treatment. The addition of MMF has not
improved outcomes significantly. Capsular plications
h a v e b e e n r e p o r t e d t o o r a r e l y to b e c o n s i d e r e d m a i n -
s t r e a m t r e a t m e n t , as h a v e p h y s i c a l t h e r a p y a n d b o t u -
linum toxin injection. Zygomatic arch downfracture,
w i t h or w i t h o u t grafting, a p p e a r s to o f f e r a h i g h d e g r e e
of resolution of dislocation, although the number of
r e p o r t e d c a s e s is less t h a n h a l f t h a t o f e m i n e c t o m y .
With an impressive success rate, we believe that
e m i n e c t o m y offers t h e b e s t c h a n c e f o r l o n g - t e r m r e s o -
l u t i o n o f r e c u r r e n t d i s l o c a t i o n , p r o v i d e d t h a t c a r e is
t a k e n to c o m p l e t e l y r e m o v e t h e m o s t m e d i a l p o r t i o n o f
the eminence.
Although additional studies may yield improved
t h e r a p e u t i c t e c h n i q u e s , it a p p e a r s t h a t s u r g i c a l i n t e r -
v e n t i o n c u r r e n t l y r e m a i n s t h e m a i n s t a y in m a n a g e m e n t
o f this u n c o m m o n c l i n i c a l entity.
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Reprint requests:
John H. Campbell, DDS, MS
Assistant Professor
Department of Oral Surgery, Medicine, and Pathology
Indiana University
1001 W 10th St, Room 4201
Indianapolis, IN 46202
johhcamp @ iupui.edu