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Age and Ageing Advance Access originally published online on September 19, 2007
Age and Ageing 2007 36(6):703; doi:10.1093/ageing/afm114
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Copyright © The Author 2007. Published by Oxford University Press on behalf of the British Geriatrics Society.

Clinical Reminder

Lost for words—a forgotten differential of dysarthria

Terry Quinn

University of Glasgow, Institute of Cardiovascular and Medical Sciences, Gardiner Institute, Western Infirmary, Church Street, Glasgow G11 6NT, UK

Email: tjq1t{at}clinmed.gla.ac.uk

An 80-year-old right-handed arteriopath was referred with non-fluent speech disorder. On examination, the admitting team noted facial asymmetry and dysarthria. Initial brain imaging was unremarkable. Orthopantomography revealed anterior dislocation of the left mandibular head (Appendix 1 on website). Manual reduction was successful and she resumed normal speech.

Geriatricians should be aware of temperomandibular joint (TMJ) dislocation. Classical symptoms of jaw pain and inability to bite are less common in older patients [1]. Any form of exaggerated jaw opening can provoke dislocation. Common medical interventions such as intubation, endoscopy and feeding tube placement have all been implicated [2]. In a review of TMJ dislocation in an aged population, all cases were associated with chronic neurological disease, the majority occurring in stroke patients [3]. Seizure and dystonic movement were common precipitants.

In our patient, recognition of TMJ dislocation led to ‘cure’ of mutism to the patient's relief, and we hope, her husband's satisfaction.

Funded departmentally, there are no relevant conflicts of interests. Full informed consent was given by the patient and her family.


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Supplementary data for this article is available online at http://ageing.oxfordjournals.org.


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  1. Luyk NH, Larsen PE. The diagnosis and treatment of the dislocated mandible. Am J Emerg Med (1989) 7:329–35.[CrossRef][Web of Science][Medline]
  2. Shorey CW, Campbell JH. Dislocation of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod (2000) 89:662–8.[Web of Science][Medline]
  3. Kobayashi H, Yamazaki T, Okudera H. Correction of recurrent dislocation of the mandible in elderly patients by the Dautrey procedure. Br J Oral Maxillofac Surg (2000) 38:54–7.[CrossRef][Web of Science][Medline]

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow Supplementary Data
Right arrow All Versions of this Article:
36/6/703    most recent
afm114v1
Right arrow E-letters: Submit a response
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Right arrow Articles by Quinn, T.
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Right arrow Articles by Quinn, T.
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