Thangarajah et al. Journal of Medical Case Reports 2010, 4:263 http://www.jmedicalcasereports.com/content/4/1/263 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Bilateral temporomandibular joint dislocation in a 29-year-old man: a case report Tanujan Thangarajah1*, Neil Mcculloch1, Suthan Thangarajah2, Judith Stocker1 Abstract Introduction: A dislocation of the temporomandibular joint represents three percent of all reported dislocated joints. The treatment entails reduction of the deformity and this can often be achieved in a ward setting. Case presentation: We present the case of a 29-year-old Caucasian man with a non-traumatic bilateral anterior temporomandibular joint dislocation. Following several unsuccessful attempts, due to both inadequate patient analgesia and sedation, joint reduction had to be performed in theatre with the patient under general anesthesia. Conclusion: This case highlights the importance of providing the patient with adequate analgesia and sedation when attempting the reduction of temporomandibular joint dislocations. Introduction A dislocation of the temporomandibular joint (TMJ) represents three percent of all reported dislocated joints [1]. The majority of cases are non-traumatic and are often precipitated by yawning, eating, dental treatment, endoscopy, or oral intubation. The diagnosis is con- firmed by radiography and immediate closed reduction should be performed [2]. Pivotal to achieving joint reduction is adequate patient analgesia and sedation where appropriate. We present the case of a man with non-traumatic bilateral anterior TMJ dislocation and discuss his management. Case presentation A well-built 29-year-old Caucasian man attended the emergency department in the late evening unable to close his mouth immediately after yawning. Although he had no medical problems, he did admit to having long- standing ‘clicking’ of his left TMJ. He was not on any regular medication, was a non-smoker and drank alco- hol socially. His occupation was as an electrician. On examination his mouth was open and there was significant drooling. No oral or facial lacerations were present. Bilaterally, there was a depression in the his * Correspondence: tanujan1@hotmail.com 1University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK Full list of author information is available at the end of the article pre-auricular area associated with severe tenderness. Radiographs were taken and illustrated bilateral anterior dislocations of the patient’s TMJs. A closed reduction was attempted in the emergency department using 5 mg midazolam and 5 mg diazepam; however, after two attempts reduction could not be achieved. At this point, the maxillofacial team in the hospital were contacted. He was subsequently transferred later that evening to a regional oral and maxillofacial surgical unit. Upon further questioning, he admitted that during the previous attempts at joint reduction he had been in con- siderable pain and was unable to relax his muscles of mastication. With this in mind, a further reduction was attempted on a ward by a doctor specialising in oral and maxillofacial surgery. However, he was unable to relax his muscles sufficiently to facilitate reduction because of his ongoing anxiety and apprehension over the proce- dure. He also refused both local and regional anesthetic techniques due to the previous unsuccessful attempts and was insistent upon the use of general anesthesia. Given that this would occur only a few hours later in the morning, it was deemed a suitable option for him. The patient was promptly taken to theatre in the morning and with the aid of a muscle relaxant, both of his TMJs were reduced easily by applying force in an inferior direction to the mandibular rami. To maintain position, a Philadelphia collar was applied for 24 hours and he was advised to avoid excessive jaw movements. © 2010 Thangarajah et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.