Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent
CPT4 code
Name of the Procedure:
Closed Treatment of Temporomandibular Dislocation; Complicated (e.g., Recurrent Requiring Intermaxillary Fixation or Splinting), Initial or Subsequent
Summary
This procedure involves non-surgical methods to reposition a dislocated jaw (temporomandibular joint or TMJ) that has become dislocated. It includes complex cases that might require the use of devices such as intermaxillary fixation or splinting to stabilize the jaw.
Purpose
The procedure addresses dislocated temporomandibular joints, particularly in cases where dislocations are recurrent or complicated. The goal is to realign the joint to alleviate pain, restore normal jaw function, and prevent further dislocations.
Indications
- Recurrent dislocation of the temporomandibular joint.
- Complicated dislocations that are not easily treated by simple closed reduction.
- Patients with a history of TMJ instability.
Preparation
- Fasting may be required if sedation or general anesthesia is planned.
- Medication adjustments may be necessary, particularly for blood thinners.
- Diagnostic imaging (e.g., X-rays, MRI) to assess the extent of the dislocation and joint condition.
Procedure Description
- Anesthesia: Local anesthesia, sedation, or general anesthesia may be administered based on the complexity of the case and patient needs.
- Reduction: The healthcare provider manually manipulates the jaw to reposition the dislocated joint.
- Stabilization: In complicated cases, intermaxillary fixation or splinting devices are applied to keep the jaw in the correct position. This may involve wiring the upper and lower teeth together or using customized splints.
- Final Assessment: The alignment and stability of the jaw are checked before the procedure is concluded.
Duration
The procedure typically takes around 30 minutes to an hour.
Setting
The procedure can be performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Oral and maxillofacial surgeon or an ENT specialist
- Nurses
- Anesthesiologist (if sedation or general anesthesia is used)
Risks and Complications
- Pain or discomfort during the procedure
- Temporary or permanent joint stiffness
- Risk of infection
- Possible nerve damage
- Difficulty in eating or speaking temporarily
- Risk of recurrence even after treatment
Benefits
- Immediate relief from pain and discomfort due to the dislocation
- Restoration of normal jaw movement and function
- Reduced likelihood of future dislocations
Recovery
- Post-procedure care includes instructions on eating soft foods and avoiding excessive jaw movements.
- Pain management may involve prescribed medications.
- Regular follow-up appointments are necessary to monitor healing and joint stability.
- Recovery time varies but typically spans a few weeks.
Alternatives
- Conservative treatments such as physical therapy, jaw exercises, and anti-inflammatory medications.
- Open surgical interventions for severe or recurrent dislocations that do not respond to closed treatment.
- Pros and cons: Conservative treatments may take longer to see results and carry less immediate risk, while open surgery is more invasive with a potentially longer recovery time but can provide a more permanent solution.
Patient Experience
- Patients may feel pressure or discomfort during the manipulation of the jaw.
- Post-procedure soreness and restricted jaw movements are expected.
- Pain management options, including medications, will help ensure comfort during recovery.