TECHNICAL NOTES
J Oral Maxillofac Surg
Dautreys Procedure in Treatment of
Recurrent Dislocation of the Mandible
Kiran Shrikrishna Gadre, MDS,* Deepak Kaul, MDS,
Shandilya Ramanojam, MDS, and Shishir Shah, MDS
The temporomandibular joint (TMJ) is the most com-
plex joint in the human body. This joint is in use even
when no activity seems to be apparent. It is the most
used, as well as the most abused, joint. This abuse brings
with it a number of problems, one of which is hyper-
mobility of the TMJ. Hypermobility of the joint can
result in recurrent dislocation of the mandible which,
although uncommon, is a distressing condition.
Various methods have been tried for the treatment of
this disorder. The treatment modalities have been either
conservative or surgical. Although initially conservative
treatment is preferred, when it fails, the only option
remaining is surgical. In patients with chronic recurrent
dislocation, conservative treatment such as maxilloman-
dibular fixation (MMF) and injections of sclerosing solu-
tions often result in failure. Thus, such cases require
surgical management.
The surgical procedures can be categorized un-
der 2 main headings: 1) procedures that enhance
the path of condylar movement; and 2) those that
inhibit the path of condylar movement. The most
common procedure in the first category is eminec-
tomy, as described by Myrhaug1 in 1951. It includes
a reduction in the height of the articular eminence
such that the condyle will readily slip back into the
fossa if subluxation occurs. However, it has been
found to encroach on the physiologic pattern of
condylar movement.
Mayer2 was the first to report the displacement of
the zygomatic arch (or a segment of it) to obstruct
Received from the Department of Oral and Maxillofacial Surgery,
Bharati Vidyapeeth Dental College and Hospital, Pune, Maharash-
tra, India.
*Professor.
Former Resident.
Former Resident.
Former Resident.
Address correspondence and reprint requests to Dr Gadre: Sun-
rise 2122, Vijaynagar Colony, Behind Kaveri Hotel, Pune, Maharash-
tra 411-030 India; e-mail: kiran_gadre@hotmail.com
2010 American Association of Oral and Maxillofacial Surgeons
0278-2391/10/6808-0047$36.00/0
doi:10.1016/j.joms.2009.10.015
2021
68:2021-2024, 2010
the condylar path. LeClerc and Girard3 performed a
vertical osteotomy of the zygomatic arch and low-
ered the proximal segment and placed a thicker
part of the zygoma into the path of the condyle.
The procedure was refined by Gosserez and Dau-
trey4 in 1967. Currently, the procedure is known as
Dautreys procedure. In this procedure, the zygo-
matic arch is osteotomized downward and forward
just in front of the articular eminence to create a
mechanical obstruction. This procedure gained
popularity during its initial years but somehow was
lost thereafter for quite some time.
Recently, many investigators have been using this
procedure, but few have reported their findings.
Therefore, the aim of the present study was to under-
stand the philosophy behind the procedure and to
evaluate the efficacy of fixation in this procedure to
achieve better outcomes.
Materials and Methods
In the present retrospective study, 20 patients
(12 males and 8 females, mean age 37.55 years)
with bilateral chronic recurrent dislocation of the
TMJ with or without symptoms such as pain and
clicking were selected and treated using Dautreys
procedure during a 5-year period (2001 to 2006).
The total number of procedures performed was 40.
None of the patients were medically compromised
or had any psychiatric disorder. The youngest was
14 years and the oldest was 60 years of age (Table
1). The total number of joints treated was 40. The
duration of symptoms ranged from 3 months to 11
years. All patients had undergone several manual
reductions and other treatment modalities such as
MMF, injections of sclerosing solutions, and emi-
nectomy. No abnormality was detected on the pre-
operative TMJ radiographs (right and left transcra-
nial view of the TMJ in the closed and open mouth
positions). A comparison of the preoperative and
postoperative interincisal opening (IIO) values was
performed. The IIO amount was recorded at 1, 6,
12, 18, and 36 months postoperatively. The subjec-
2022 DAUTREYS PROCEDURE FOR RECURRENT MANDIBLE DISLOCATION

Table 1. RESULTS OF DAUTREYS PROCEDURE IN 20 PATIENTS (40 JOINTS)

Mouth Opening (mm)

Pt No. Gender Age (yr) Baseline 1 mo 6 mo 12 mo 18 mo Follow-Up (mo) Recurrence

1 Male 23 52 26 36 38 38 60 No
2 Male 51 56 30 32 36 36 57 No
3 Female 17 47 24 30 39 41 51 No
4 Female 43 53 32 37 41 41 51 No
5 Male 57 46 28 29 37 36 47 No
6 Female 33 39 36 40 41 42 42 No
7 Male 29 48 29 39 38 38 42 No
8 Female 47* 42 27 36 42 43 42 No
9 Male 24 54 24 32 40 41 37 No
10 Male 55 55 33 30 40 41 35 No
11 Male 21 47 31 42 42 43 31 No
12 Female 19 49 28 37 45 45 34 No
13 Male 56* 50 35 42 41 41 34 No
14 Male 44 38 31 31 39 41 31 No
15 Female 37 45 25 29 37 37 29 No
16 Female 22 51 24 35 41 40 31 No
17 Male 53 33 29 39 39 39 30 No
18 Male 14 42 31 41 42 42 28 No
19 Female 46 36 29 35 38 39 22 No
20 Male 60 56 26 32 36 36 19 No
Mean 47 31 35 40 40
Abbreviation: Pt No., patient number.
*Bone graft use.
Arch fracture occurred.
Gadre et al. Dautreys Procedure for Recurrent Mandible Dislocation. J Oral Maxillofac Surg 2010.

tive description of the overall well-being of the prefer a nasal septal osteotome to perform these ma-
patient was noted. neuvers. The arch is kept in its new position by the
In Dautreys procedure,5 the zygomatic arch is inherent elasticity of the bone.
cut downward and forward just in front of the
articular eminence and then locked under the em-
inence, preventing excessive forward movement of
the condyle.
We prefer a preauricular approach with temporal
extension from the variety of available approaches.
Along the temporal fascia, the zygomatic arch and
capsule of the TMJ are easily reached. The fascia and
periosteum are horizontally incised only at the root of
the zygoma. Next, the posterior portion of the arch
and the superolateral aspect of the capsule are ex-
posed. Care should be taken not to strip the fascial
and periosteal attachment from the anterior portion
of the zygomatic arch, especially at the zygomatico-
malar suture.5 If their attachment is stripped off, a
true fracture will occur at the suture, and the conti-
nuity and elasticity of the arch will be lost, defeating
the purpose. The osteotomy cut should start postero-
superiorly on the zygomatic arch in front of the artic-
ular eminence and end anteroinferiorly (Fig 1). At the
distal fragment of the zygomatic arch, firm and con-
trolled pressure should be applied to create a green
stick fracture anterior to the osteotomy site. The frag- FIGURE 1. Osteotomy.
ment is then mobilized laterally and then downward Gadre et al. Dautreys Procedure for Recurrent Mandible Dislo-
and finally locked under the articular eminence. We cation. J Oral Maxillofac Surg 2010.
GADRE ET AL
FIGURE 2. Fixation with miniplates and screws.
Gadre et al. Dautreys Procedure for Recurrent Mandible Dislo-
cation. J Oral Maxillofac Surg 2010.
To avoid any movement or displacement at the
osteotomy site, rigid fixation with a 2- or 1.5-mm
4-holed plate and screws 6 mm in length was done in
all cases (Fig 2). MMF is not needed postoperatively.
Excessive mouth opening was prohibited for 21 days.
Results
In all the cases, we achieved total resolution of the
recurrent dislocation immediately after surgery. The
follow-up ranged from 19 to 60 months. After 1
month, the minimal and maximal IIO were 24 and 36
mm, respectively. A gradual increase occurred in the
IIO postoperatively that had settled within a range of
35 to 45 mm by 12 months postoperatively. The
maximal improvement in the IIO without subluxation
from 1 to 18 months was 17 mm, and the minimum
was 6 mm. The IIO was unchanged thereafter. Other
symptoms such as pain and clicking had also resolved
by 3 months postoperatively. Fixation with miniplates
and screws in all cases provided stable results for a
long period. None of the patients required plate re-
moval. The results we achieved were favorable, and
no recurrence developed in any of our patients. Other
than postoperative pain and edema, no major compli-
2023
cations occurred in any patient. Also, no patient de-
veloped postoperative infection or experienced in-
jury to the temporal branch of the facial nerve. None
of the patients had experienced postoperative pain or
clicking throughout the follow-up period. The post-
operative radiographs at the end of 12 and 18 months
showed no pathologic changes in the joints.
Discussion
Recurrent dislocation of the mandible is defined as
a displacement of the condyle in front of the articular
eminence where it is held by spasm of the muscles of
mastication. When this occurs, the patient requires
medical assistance to reduce the condyle back into
the glenoid fossa.6
A variety of treatment modalities have been used
for chronic recurrent dislocation of the mandible.
Both medical and surgical modalities have been ex-
tensively tried. Most of them have had limitations in
the form of recurrence, morbidity, functional impair-
ment, and a lack of satisfactory results. This has left
the patient with chronic recurrent dislocation of the
mandible in jeopardy.
Medical treatments have also been tried, including
the injection of sclerosants into the joint to produce
capsular fibrosis and eliminate excessive condylar
movement.7
Of the surgical modalities, enhancing the condylar
path has normally been accomplished by either con-
dylectomy8 or eminectomy.1,9,10 To inhibit the con-
dylar movement, both soft and hard tissue procedures
have been used.
Soft tissue operations have included plication of the
capsule,11,12 detachment of the lateral pterygoid mus-
cle from the condyle with capsulorrhaphy,13 menisec-
tomy,14 and scarification of the temporalis tendon.15
Hard tissue procedures have included displace-
ment of the zygomatic arch (or a segment of it) to
obstruct the condylar path,2 placing a thicker part
of the zygoma into the path of the condyle by
performing vertical osteotomy of the zygomatic
arch,3 and posteroanterior slanting osteotomy of
the eminence.4,6,16-20
Various heterogeneous materials have been used to
restrict the condylar pathway, such as a stainless steel
pin,21 vitallium mesh,22 a Dacron strip to ligate the
zygomatic arch to the condyle,23-25 and on-lay bone
grafting.26
Although the procedures enhancing the path of
condylar movement can lead to increased laxity of the
ligaments of the TMJ and can cause additional injury
to the meniscus, Dautreys procedure restores the
normal functional and physiologic movement of the
TMJ without abnormal forward excursion. Proce-
2024 DAUTREYS PROCEDURE FOR RECURRENT MANDIBLE DISLOCATION
dures such MMF and other soft tissue procedures also
temporarily prevent abnormal forward excursion.
In 2 cases, grafting was needed. In the first, the
height of the zygomatic arch was inadequate. The
second patient had been treated with eminectomy
elsewhere 10 years previously and had recurrent pain
owing to increased laxity of the ligaments of the TMJ.
The bone was harvested from the mastoid region,
which was in the vicinity of the surgical site.
In 1 case (a 60-year-old man), a complete fracture of
the zygomatic arch anteriorly on one side occurred
that was recognized and fixed with miniplates and
screws.
The IIO at which the dislocation occurred varied
greatly from 33 to 56 mm.
Published reports have suggested the need for fix-
ation of the osteotomized fragments.6 Several studies
have reported that Dautreys original procedure
(without fixation) is effective, and no fixation is need-
ed.18,20 Poirier et al27 stated that the use of
miniplates for fixation avoids recurrence. Revington28
concluded that the reason for the recurrence was that
the small condylar head was able to pass anteromedi-
ally to the downward fractured zygomatic arch. In the
first operation, the downward fractured zygomatic
arches were still in a satisfactory position without
fixation. In the second operation, the zygomatic arch
was pushed further medially; therefore, wire ligatures
were required. If the condylar width had been nor-
mal, the fixation would not have been necessary.
Except in 1 case, in which biodegradable implants
were used, the others were performed using stainless
steel implants. Irrespective of the plating system used,
the outcome was the same. We believe fixation pro-
vides not only rigidity to the osteotomy site during
healing, but also allows the arch and graft to be
positioned and retained in an optimal position, thus
reducing the risk of recurrence.
Dautreys surgical procedure is extremely effective
for the treatment of chronic recurrent dislocation of
the mandible without restricting the normal mouth
opening. Fixation provides better rigidity of the os-
teotomized segment and reduces the risk of recur-
rence.
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