NP was a 60-year-old housewife who\npresented with a three hour history of inability to close\nthe mouth after yawning. There was associated pain\nand discomfort in the preauricular area bilaterally. She\nhad a similar incident four (4) months earlier. No\nprevious history of trauma. She is a known\nhypertensive on moduretic. A diagnosis of bilateral\nanterior TMJ dislocation was made. She had a\nsuccessful treatment using the extra-oral technique after\nfailed Hippocrates manouvre attempts. She was\nsubsequently immobilized with the barrel bandage
JMO was a 48-year-old married female\nteacher who was a victim of assault. She was attacked\nby armed robbers on her way to work 5 days earlier.\nShe was stifled by her assailants to prevent her from\nshouting for help. She subsequently discovered she\ncould not close her mouth after the incident. Attempt\nat a private clinic and a teaching hospital in Lagos was\nunsuccessful. On examination, patient had bilateral\npreauricular depression and marked tenderness.\nSince the patient had previously had several failed\nattempts at close reduction using Hippocrates\nmaneuver while alert, Hippocrates maneuver was\nattempted under general anaethesia, this was also\nunsuccessful, and was abandoned after a second\nattempt. The patient was placed in a class III\nmaxillomandibular wires for gradual traction with daily\nadjustment which also did not produce the desired\neffect and was abandoned after 5 days. Patient was\neventually planned for open reduction under general\nanesthesia. She had open reduction under general\nanaesthesia which was successful. The outcome was a\nlimited mouth opening which was managed with jaw\nexercises using acrylic screws.\nShe had multiple reviews up till 6 weeks after surgery\nwith a gradual restoration of jaw movements.