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.
OO is a 45 year old male shoe maker. He\nwas single. He presented with a one week history of\ninability to close the mouth following a fall from a moving bus. There was associated loss of\nconsciousness which lasted about 10 minutes. He was\npreviously treated for Tuberculosis 15 years prior to\npresentation and claimed to have completed the\nprescribed regimen. No other comorbid condition\nwas noted. On general examination, we saw middle-aged\nman who walked with a limp. There were facial\nbruises over the left supraorbital ridge and right\nzygomatic area, tip of the nose and right side of the\nupper lip, sutured laceration on right foot, but no\nobvious facial asymmetry nor bony discontinuity was\ndetected. Intraorally, there was gagging of occlusion\nposteriorly, and retained roots of 12 and 22. No other\nsignificant intraoral finding was detected. Radiological\nexamination revealed anterior dislocation of the\ntemporomandibular joint bilaterally. The patient had\nHippocrates maneuver for repositioning the condyle\nwhich was successful after four (4) attempts. Analgesia\nwas also administered and the patient discharged home.\nHowever, two days later he returned with a recurrent\nTMJ dislocation following yawning. The dislocation\nwas reduced using Hippocrates maneuver modified\nwith administration of diazepam. Barrel bandage was\napplied to limit joint mobility. The patient was seen\ntwo days later with no evidence of dislocation.