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December Radiology 2008 Answer Key

December 2008 Radiology Answer Key

 

This patient is a 23 year old female who presents to the ED2 with the chief complaint of jaw pain. The following Xray is shown.

 Questions:

1. Describe what you see?

    • Both mandibular condyles (labeled M) are dislocated anterior to their respective mandibular fossae (red and black arrows) in the temporal bones. The blue arrow
      points to the articular eminence which prevents the mandibular condyle (black M) from relocating in the mandibular fossa (black arrow).

      • Diagnosis: Anterior Mandibular Dislocation

2. How do these patients typically present?

    • Dislocations of the mandible tend to be uncomfortable but not severely painful for the patient
      • The presence of a fracture increases the pain
    • Patients are unable to close mouth completely
    • Difficulty speaking and, possibly, swallowing
    • Dislocations may be unilateral or bilateral
      • Prognathic appearance to jaw when both are dislocated

3. What would be your management for this patient?

    • Dental Consult
    • Manual reduction is usually performed with sedation
    • After successful reduction, patients are placed on a soft diet and instructed not to open their mouths wider than 2 cm for 2 weeks.

Trivia:  English rock band The Who released a Christmas song. What is its name?

    • A: Christmas.
  • The song can be found on the album "Tommy". It tells how on Christmas morning, Tommy's father (others claim it is both of Tommy's parents) is worried about Tommy's future and soul. He claims "Tommy doesn't know what day it is. He doesn't know who Jesus was or what praying is" and he wonders "How can he be saved from the eternal grave?".

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