OM was a 26-year-old male student who\npresented with chronic recurrent TMJ dislocation\nfollowing wide mouth opening (yawning) of about\none day duration having had about 10 previous\nepisodes (talking, laughing, yawning) all of which were\nsuccessfully treated with the Hippocrates manouvre.\nHe presented with a desire for a definitive treatment.\nPlain X-rays (TMJ views) revealed short mandibular\ncondyles. He had reduction using the Hippocrates\nmanouvre and subsequent immobilization with maxillomandibular\nfixation for two weeks but had a recurrence\nimmediately after. Definitive care was bilateral\neminectomy which involved grounding down of the\narticular eminences using round/acylic burs under\ngeneral anesthesia. There was complete resolution of\nsymptoms, restoration of temporomandibular joint functions and resolution of associated facial nerve\nweakness at five month post-operative review.
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.