Ver el código de «Mandible dislocation»

==Background==
{| class="wikitable"
|-
! Dislocation Type
! Frequency
! Associated with trauma?
! Mechanism
! Additional Comments
! Associated with fracture?
! Image
|-
| '''Anterior'''
|
*Most common
| 
*No
|
*Spontaneously while patient is yawning, "popping" ears, or laughing
*Risk factors:
**Prior dislocation
**Weakness or laxity of capsule
**Ligamentous injury
|
*Mandibular condyle forced in front of the articular eminence
*May happen bilaterally or unilaterally
|
*No
|
[[File:Anterior Dislocation.jpeg|100px]]
|-
| '''Posterior'''
|
*Rare
|
*Yes
| 
*Follows a blow to the mandible that may or may not break the condylar neck
| 
*Condylar head may prolapse into the external auditory canal
|
*Possible
|
[[File:Posterior Dislocation.jpeg|100px]]
|-
| '''Lateral'''
|
*Rare
|
*Yes
| 
*Lateral trauma to mandible
| 
*Often associated with mandibular fracture
|
*Yes
|
[[File:Lateral Dislocation.jpeg|100px]]
|-
| '''Superior'''
|
*Rare
|
*Yes
|  
*Occur from blow to the partially opened mouth
| 
*Can result in a fracture of the glenoid fossa and displacement of the condyle into the middle cranial fossa, potentially injuring the facial and vestibulocochlear nerves and the temporal lobe. 
*Associated with cerebral contusions, facial nerve palsy, deafness
|
*Yes
|
[[File:Superior Dislocation.jpeg|100px]]
|}
[[File:Gray311.png|thumb|Sagittal section of the articulation of the mandible.]]

==Clinical Features==
*Inability to close mouth
*Difficulty speaking or swallowing
*Malocclusion
*Pain localized anterior to the tragus
*Prominent-appearing lower jaw
*Preauricular depression
*Condylar head palpable in the temporal space (in lateral dislocation)

===Posterior Dislocation===
*Must examine the external auditory canal

==Differential Diagnosis==
{{Jaw spasms DDX}}

==Evaluation==
*Generally a clinical diagnosis
*For traumatic etiology, obtain CT face to evaluate for fracture
**Also obtain CT IAC if concern for posterior dislocation
*Examine external auditory canal, especially in posterior dislocation
*Evaluate the cranial nerves to rule out concomitant injury

==Management==
*If no concern for fracture, perform closed reduction in the emergency department (see techniques below)
**Often easiest to reduce one side at a time
*Provide [[analgesia|pain control]] and anxiolysis as needed
*Consider [[procedural sedation]], especially if the mandible has been dislocated for an extended period
**[[Local anesthetics]] may also be effective when injected into the preauricular depression just anterior to the tragus

===Syringe Reduction Technique===
#Have the patient place an empty 5 or 10 mL syringe between the upper and lower molars on one side of the mouth
#Direct the patient to roll the syringe back and forth until reduction is achieved
#If the opposite side does not spontaneously (it generally will), may repeat same technique on the opposite side

===Extra-oral Reduction Technique<ref>http://sjrhem.ca/rcp-save-thumbs-extra-oral-reduction-anterior-mandibular-dislocations/</ref>===
#Place the patient in seated position
#Place one thumb on the one zygomatic arch, and the fingers of the same hand behind the mandible
#On the opposite side, place thumb on the coronoid process of the mandible
#Use the fingers of the first hand to pull the mandible forward while using the zygomatic arch to brace
#At the same time, apply firm and consistent pressure on the coronoid process with the second hand
#Once the first side is reduced, reverse hand positions and repeat the process on the second side

===Intra-oral Reduction Techniques===

====Wrist Pivot Method<ref>Lowery LE, Beeson MS, Lum KK. The wrist pivot method, a novel technique for temporomandibular joint reduction. J Emerg Med. 2004 Aug;27(2):167-70. http://www.ncbi.nlm.nih.gov/pubmed/15261360</ref>====
[[File:wrist-pivot-method.jpg|thumbnail]]
#Place patient in seated position
#Face the patient and grasp the mandible with your thumbs at the apex of the mentum
#Place well-wrapped and gloved fingers on the occlusal surface of the inferior molars
#Apply cephalad force with the thumbs and caudal pressure with the fingers
#Pivot your wrists to reduce joint

====Traditional Technique====
[[File:Mandible dislocation.jpg|thumb|Posterior position]]
#Place patient in seated position (anterior approach) or supine (posterior approach)
#Place well-wrapped and gloved thumbs over occlusal surface of inferior molars or lateral to molars in the buccal fold
#Apply caudal and posterior pressure to reduce joint

==Disposition==
*Generally may be discharged if uncomplicated and successfully reduced
**Instruct patient to use soft diet, not to open mouth wider than 2cm for 2 weeks, and to support mouth when yawning
*Admit for:
**Open dislocation
**Superior dislocation
**Fracture
**Nerve injury
**Inability to reduce

==See Also==

==External Links==
*[http://brownemblog.com/blog-1/2019/11/9/brown-em-whit-ticisms-mandible-reduction Extra-oral reduction technique video ]

==References==
<references/>

[[Category:ENT]]
[[Category:Orthopedics]]
[[category:Trauma]]