Risk factors for intraoperative dislocation of the total temporomandibular joint replacement and its management.

Total replacement of the temporomandibular joint (TMJ) is an effective treatment for intractable pain and impaired function that is a consequence of end-stage joint disease. Prospective assessment of 138 joint replacements identified an 8% risk of intraoperative dislocation of the joint, which was associated primarily with coronoidectomy (30%) and inflammatory arthropathy (24%). Management included the use of intermaxillary elastic traction and treatment of masticatory dystonia when present. Of the 11 patients who had light elastic traction for one week, only one required further treatment for dislocation. Patients with no intraoperative dislocation did not require elastics, and joints remained stable postoperatively.