Endoscopy 2009; 41(9): 818
DOI: 10.1055/s-0029-1214970
Letters to the editor

© Georg Thieme Verlag KG Stuttgart · New York

Dislocation of the temporomandibular joint during upper endoscopy without sedation

A.  Sayilir, M.  Kurt, S.  Kacar, Y.  Yesil
Further Information

Publication History

Publication Date:
10 September 2009 (online)

We read with great interest the article by Min et al. [1] concerning the prevention of endoscopy-related complications involving teeth or the temporomandibular joint (TMJ). We recently encountered a case of TMJ dislocation during an endoscopy procedure using a hard inflexible mouthpiece and no sedation.

A 25-year-old man underwent upper gastrointestinal endoscopy for chronic diarrhea. He received no premedication other than oral lidocaine spray. Only erythematous antral mucosa was found, and mucosal biopsies were taken from the second part of the duodenum to assess the cause of the chronic diarrhea. After removing the hard inflexible mouthpiece, the patient complained of an inability to close his mouth. On examination, his lower jaw had dislocated to the left side and his teeth were not occluded. With these findings, a diagnosis of right anterior TMJ dislocation precipitated by upper gastrointestinal endoscopy was made. During the evaluation, the TMJ spontaneously improved without intervention within 2 minutes. He had no relevant history of joint dislocation.

In English literature, there have been fewer than 10 reported cases of TMJ dislocation attributed to upper gastrointestinal endoscopy, and most of them were associated with sedation with midazolam [2] [3] [4] [5] [6] [7] [8]. The administration of midazolam reduces muscle tone and may predispose the patient to TMJ dislocation. Without sedation, TMJ dislocation may be associated with the use of a hard inflexible mouthpiece [1]. Gastroenterologists should be aware of this complication, particularly when sedation and inflexible mouthpieces are used.

Competing interests: None

References

  • 1 Min B H, Lee H, Jeong J S. et al . Comparison of a novel teeth-protecting mouthpiece with a traditional device in preventing endoscopy-related complications involving teeth or temporomandibular joint: a multicenter randomized trial.  Endoscopy. 2008;  40 472-477
  • 2 Fayman M S, Dunn S E, Wellsted M. Two unusual complications related to fibreoptic endoscopy. Case reports.  S Afr Med J. 1984;  65 354
  • 3 Schlidt R, Marsh W, Schorr S. Pseudo stroke after an ERCP.  Gastrointest Endosc. 1994;  40 649
  • 4 To E W, Pang P C, Lee D W. Temporomandibular joint dislocation during endoscopic retrograde cholangiopancreatography examination.  Endoscopy. 2000;  32 36-37
  • 5 Schwartz A J. Dislocation of the mandible: a case report.  AANA J. 2000;  68 507-513
  • 6 Rosemore J, Nikoomanesh P, Lacy B E. Bilateral temporomandibular joint dislocation after PEG tube placement.  Gastrointest Endosc. 2004;  59 146-147
  • 7 Mangi Q, Ridgway R F, Ibrahim Z. et al . Dislocation of the mandible.  Surg Endosc. 2004;  18 554-556
  • 8 Savas M C, Gulsen M T, Kadayifci A. Habitual dislocation of the temporomandibular joint during upper endoscopy.  Gastrointest Endosc. 2004;  60 325

A. SayilirMD 

Department of Gastroenterology
Turkiye Yuksek Ihtisas Teaching and Research Hospital

Kızılay Sk. No: 2, 06100
Sıhhiye
Ankara
Turkey

Fax: +90-312-3124120

Email: drabdurrahim@gmail.com

    >