Recurrent mandibular dislocation –which surgical approach?

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Recurrent mandibular dislocation is an uncommon condition that has been managed surgically and non-surgically. A wide range of surgical techniques have been described including eminectomy, the Dautrey procedure and the use of implants.

The aim of this review was to assess the quality of the available evidence on the surgical management of recurrent mandibular dislocation.

Methods

The PubMed and Web of Science databases were searched from 1974 for English language studies on open surgical management of recurrent mandibular dislocation.  Two independent reviewers selected studies which were classified according to the Oxford Centre for Evidence-based Medicine’s levels of evidence.  A narrative summary was provided.

Results

  • 23 studies, all case series were included.
  • Only one of the studies was prospective, 9 retrospective and 13 were unclear.

Conclusions

The authors concluded: –

The present review revealed that articles on open surgical treatment for recurrent mandibular dislocation exhibit a low level of scientific evidence. Thus, further studies on this topic with greater methodological rigour are needed.

Comments

This review has searched a limited number of databases and restricted findings to publications in the English language so it is possible that relevant studies could have been missed.  In view of  the uncommon nature of the condition it is perhaps unsurprising the all the included studies were case series. However, it would help future reviewers if more authors and journals would use the new preferred reporting of case series in surgery guidelines, the PROCESS statement, given that a significant proportion of studies published in oral and maxillofacial surgery are case series.  In relation to the inclusion of the case series the text suggests that only those reporting 10 or more cases were included although this is not clearly specified in the inclusion criteria.   The review authors highlight the challenges of conducting RCTs in surgery and for the development of new procedures in particular, the adoption of the IDEAL Framework would be valuable.

Links

Primary paper

elo AR, Pereira Júnior ED, Santos LA, Vasconcelos BC. Recurrent dislocation: scientific evidence and management following a systematic review. Int J Oral Maxillofac Surg. 2017 Mar 31. pii: S0901-5027(16)30291-0. doi:10.1016/j.ijom.2016.10.018. [Epub ahead of print] Review. PubMed PMID: 28372991.

Other references

 The PROCESS Statement   Preferred reporting of case series in surgery

The IDEAL Collaboration

dislocation

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