U.S. Department of Defense


Date of this Version



Published in J Oral Maxillofac Surg, 68: 2639-2641 (2010)


Mandibular hypomobility can develop from direct injury to, or as a result of disorders affecting, the supporting structures of the temporomandibular joint. This can be subdivided into intra-articular and extraarticular processes. Ankylosis is commonly associated with trauma (31% to 98%), followed by infections (10% to 49%) and systemic disease (10%). Temporomandibular joint ankylosis is an intra-articular process characterized by fibrous, fibro-osseous, or osseous obliteration of the joint space. Pseudoankylosis involves extracapsular causes of restricted jaw motion that include, but are not limited to, coronoid-zygomatic fusion, coronoid hypertrophy, and muscular fibrosis. Shrapnel injuries can be as devastating as high-velocity gunshot wounds, with functional and esthetic consequences, depending on the velocity, size, shape, and jagged edges of the fragments. Traumatic life support measures are paramount during the immediate postinjury setting. The airway and hemodynamic status must be maintained, because the oxygen-carrying capacity is essential for wound healing and the prevention of infection. A secure airway controlled with an endotracheal tube or tracheostomy needs early consideration because bleeding and edema can result in airway compromise. The securing of the airway should be followed by a comprehensive examination of the patient to reveal additional injuries.