Temporomandibular joint dislocation due to acute propranolol intoxication

Abbas Aghabiklooei¹, Homan Elahi², Babak Mostafazadeh<sup>3

1</sup>Department of Medical Toxicology and Forensic Medicine, Iran University of Medical Sciences, Tehran, Iran; ²Firouzgar Hospital, Department of ENT, Tehran, Iran; ³Department of Medical Toxicology and Forensic Medicine, Shaheed Beheshty University of Medical Sciences, Tehran, Iran

Abstract: Temporomandibular joint (TMJ) dislocation has not previously been reported as a complication of beta-blocker toxicity. We are reporting two cases of TMJ dislocation resulted from acute severe intoxication with pure propranolol (PPL) for the first time. Bilateral TMJ dislocation happened in two patients who were admitted to intensive care unit with diagnosis of severe acute PPL toxicity. Clinical diagnosis of TMJ dislocation was obtained by physical examination. Successful reduction was performed for both patients without subsequent recurrence in two weeks following hospital discharge. Both of our subjects had no previous history of lower jaw dislocation. There was not any risk factor for dislocation such as convulsion during admission period, recent face trauma, or oral manipulation by the medical team. This study showed that TMJ dislocation may occur after severe acute PPL toxicity probably due to spastic contraction of the lateral pterygoid muscle. This is against previously mentioned hypothesis that stated masseteric muscles contraction as the main cause of a bilateral dislocated TMJ.

Keywords: propranolol, toxicity, temporomandibular joint dislocation