AM was a 25-year-old female trader who\ndiscovered that she could no longer close her mouth\nafter yawning a day before presentation. She also had\npain in the preauricular region. This was her first\nexperience of such, and she had no comorbid\nconditions. On examination, it was noticed that she\nhad limitation in mouth opening and closure, her lip\nseal was incompetent and there was bilateral tenderness\nin the preauricular regions. TMJ movement\ntransmission was not detected bilaterally. Radiologic\ninvestigations revealed an anterior displacement of the\ncondylar head beyond the articular eminence. No other\nabnormality was seen. Patient had Hippocrates\nmanouvre done to reposition the head of the condyle\nback in the glenoid fossa and this was successful. Barrel\nbandage was applied to immobilize the joint. The\noutcome as at two (2) days post reduction was a\nsuccessful restoration of TMJ movement
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.