Permalink : http://hdl.handle.net/2115/90521

KEYWORDS : 顎関節脱臼;陳旧性顎関節脱臼;観血的整復術;関節隆起切除術;temporomandibular joint dislocation;chronic long-standing;open reduction;eminectomy

顎関節脱臼が陳旧化した場合，観血的整復術が必要となることが多い．症例は，84歳女性で，アルツハイマー型認知症の既往があった．他院手術での経口挿管時に脱臼し，整復されないまま2か月経過後に，北海道中央労災病院口腔外科・顎顔面外科を受診した．局所麻酔下では徒手整復できず，観血的に整復する方針とした．脱臼から約3か月経過後，全身麻酔下に顎関節を開放し，加えて関節隆起切除術を試行したが整復できず，関節包周囲の癒着組織剥離術を追加することで，整復し得た．術後，わずかな臼歯部開咬がみられたが，術後5日目には義歯を装着し咬頭嵌合位が得られた．術後12か月経過後も再脱臼なく，咬合状態は良好である．整復が困難な陳旧性顎関節脱臼症例においては，関節隆起切除術に加え，関節包周囲の癒着組織剥離術を施行することが必要と思われた．
Open reduction is performed frequently for chronic long-standing dislocation of the temporomandibular joint (TMJ) owing to difficulty with closed reduction. This case report presents a case of an 84-year-old woman with a medical history of Alzheimer’s disease who was referred to our hospital for treatment of TMJ dislocation attributed to tracheal intubation upon general anesthesia 2 months ago. Closed reduction with local anesthesia was unsuccessful; thus, open reduction with general anesthesia was performed 3 months later. Reduction was successful upon performing eminectomy and adhesiolysis around the articular capsule. Open bite was observed until 5 days after the surgery. No recurrence of the dislocation was observed at 1 year following her surgery. Thus, eminectomy and adhesiolysis around the articular capsule could be considered for challenging cases of chronic TMJ dislocation.