An Unexpected Cause of Post-Operative Temporomandibular Joint Subluxation

Sir,

A young, healthy, 20 years male was taken up for excision of tongue hemangioma of size 2 x 3 cm on the left anterior one-third of the dorsum of the tongue. He had no other anomaly and airway examination revealed an oral mass which was not expected to pose much difficulty in intubation. Standard anesthesia induction was instituted with smooth and uneventful insertion of 8.5 mm endotracheal tube using a Bonfil’sretromolar scope through midline approach. Oro-pharyngeal packing was done and Denhardt’s mouth retractor was applied on the left sidefor surgical exposure by the surgeon. Intraoperative period, reversal and extubation were uneventful. Post operatively, upon regaining full consciousness, the patient complained of pain and swelling over left Temporomandibular Joint (TMJ) with inability to close the mouth. The anesthesiologist and surgeon diagnosed it as left TMJ subluxation. The subluxation was corrected by manual reduction under sedation with propofol. Immediate pain relief with return of full range of movement was achieved. On retrospective history the patient denied any such previous episodes.