Temporomandibular joint dislocation

She is young female presented with 2nd episode of temporomandibular joint dislocation while she was yawning.  

She presented 10 hours after the episode  and she was immediately taken up for manual reduction.   She cried because of pain. Her was scared and apprehensive so manual reduction failed in emergency.   So it was decided to retry under propofol Anesthesia.  Since she was in pain and to relax her, 1 mg midazolam ( a tranquillizer and sedative) was given intravenously.  The case was scheduled after 4 hours as she had just taken water.  

She want into sleep soon after as she was tired since morning.  

I received the call 2 hours after that I need not to come now as Patient herself has reduced it.   I was glad and surprised.  Then I realized how important is for masticator muscles to relax before temporomandibular joint reduces itself or by physician action.     

Sketch photo of patient during her agony.  Note open mouth and slight deviation of chin on right side suggesting dislocation of temporomandibular joint of left side.  

PRIMARY CLOSURE OF SEPTAL ABSCESS- A NOVEL TECHNIQUE – Our experience of 5 cases.

PRIMARY CLOSURE OF SEPTAL ABSCESS- A NOVEL TECHNIQUE – Our experience of 5 cases.

Dr. Ajay Jain, Dr. VP Sood (Late)

Senior ENT Consultant, Metro Hospital and Cancer Institute, New Delhi.

Septal abscess is a very common problem especially troublesome in immunocompromised and diabetic people. Conventional treatment involves an incision over the caudal septum followed by delayed primary or secondary closure. Few keep a stent to keep the drainage open. Whole treatment often involves hospital stay, intravenous antibiotics and prolonged agony.

The authors describe their technique of dealing with such cases. First, an aspiration of pus with wide bore needle is done which is sent for culture. Then a small Freer`s  incision is given. A zero degree telescope is used to inspect the septal cartilage and debriding any necrosed cartilage with slightest suspicion. Septum is closed with single suture and giving two quilting trans septal sutures. Nasal packs are kept on both sides for next 48-72 hours.

Patients were discharged on same day on antibiotic (Levofloxacin 500mg OD for 7 days).

All cases recovered uneventfully.

The key to success is thorough debridement of necrosed tissues aided with endoscopic vision and thorough irrigation. This procedure reduces prolonged hospital stay, ensures no more cartilage undergoes necrosis and hence prevents saddle deformity and exposure to intravenous antibiotics.   

Excision of recurrent Keloid