28 year old female student was in her usual\nstate of health until a week earlier when she was unable\nto close her mouth after brushing her teeth. There was\nassociated pain in the preauricular area bilaterally. She\nwas a known RVD patient awaiting treatment\ncommencement of HAART but had no other\ncomorbid conditions. On general examination, the\npatient was frail, and weak, with a prognathic mandible.\nPreauricular depression and tenderness were present\nbilaterally. Intraorally, there was an anterior open bite,\nposterior gagging of occlusion, oral thrush. Patient\nwas diagnosed as having bilateral TMJ dislocation and\nwas successfully treated with Hippocratic manouvre\nunder diazepam and PCM after the second attempt,\nwith restoration of full TMJ functions.
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.