A Missed Case of Occult Bilateral Temporomandibular Dislocation Mistaken for Dystonia

TL;DR

A young man with psychiatric history was misdiagnosed with dystonia when he actually had a rare TMJ dislocation missed on X-ray.

Contribution

This is the first reported case of bilateral anterior TMJ dislocation with a false negative X-ray.

Findings

Plain film X-rays failed to detect bilateral TMJ dislocation in a patient.

Maxillofacial CT confirmed the dislocation, highlighting limitations of X-rays in such cases.

The case emphasizes the importance of clinical judgment alongside imaging.

Abstract

A 24-year-old male with a history of psychiatric disorder and no prior significant temporomandibular joint (TMJ) pathology presented to the emergency department for “lockjaw.” Plain film X-rays of the mandible were read as unremarkable by an attending radiologist, leading to the initial diagnosis of medication-induced dystonic reaction. Following unsuccessful medical treatment a maxillofacial computed tomography (CT) was ordered. CT confirmed bilateral dislocation, illustrating the importance of clinical judgment, and limitations of certain radiographic images. The authors believe this case to be the first reported case in the medical literature of bilateral anterior TMJ dislocation with a false negative X-ray.

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