Mandible dislocation - Revision history

Rossdonaldson1: Undo revision 240006 by Rossdonaldson1 (talk)

2019-12-17T20:43:20Z

Undo revision 240006 by Rossdonaldson1 (talk)

← Revisión anterior		Revisión del 20:43 17 dic 2019
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	*No		*No
	\|		\|
	[[File:Anterior Dislocation.jpeg\|~~150px~~]]		[[File:Anterior Dislocation.jpeg\|100px]]
	\|-		\|-
	\| '''Posterior'''		\| '''Posterior'''
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	*Possible		*Possible
	\|		\|
	[[File:Posterior Dislocation.jpeg\|~~150px~~]]		[[File:Posterior Dislocation.jpeg\|100px]]
	\|-		\|-
	\| '''Lateral'''		\| '''Lateral'''
Línea 55:		Línea 55:
	*Yes		*Yes
	\|		\|
	[[File:Lateral Dislocation.jpeg\|~~150px~~]]		[[File:Lateral Dislocation.jpeg\|100px]]
	\|-		\|-
	\| '''Superior'''		\| '''Superior'''
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	*Yes		*Yes
	\|		\|
	[[File:Superior Dislocation.jpeg\|~~150px~~]]		[[File:Superior Dislocation.jpeg\|100px]]
	\|}		\|}
	[[File:Gray311.png\|thumb\|Sagittal section of the articulation of the mandible.]]		[[File:Gray311.png\|thumb\|Sagittal section of the articulation of the mandible.]]

Rossdonaldson1: /* Background */

2019-12-17T20:42:57Z

Background

← Revisión anterior		Revisión del 20:42 17 dic 2019
Línea 27:		Línea 27:
	*No		*No
	\|		\|
	[[File:Anterior Dislocation.jpeg\|~~100px~~]]		[[File:Anterior Dislocation.jpeg\|150px]]
	\|-		\|-
	\| '''Posterior'''		\| '''Posterior'''
Línea 41:		Línea 41:
	*Possible		*Possible
	\|		\|
	[[File:Posterior Dislocation.jpeg\|~~100px~~]]		[[File:Posterior Dislocation.jpeg\|150px]]
	\|-		\|-
	\| '''Lateral'''		\| '''Lateral'''
Línea 55:		Línea 55:
	*Yes		*Yes
	\|		\|
	[[File:Lateral Dislocation.jpeg\|~~100px~~]]		[[File:Lateral Dislocation.jpeg\|150px]]
	\|-		\|-
	\| '''Superior'''		\| '''Superior'''
Línea 70:		Línea 70:
	*Yes		*Yes
	\|		\|
	[[File:Superior Dislocation.jpeg\|~~100px~~]]		[[File:Superior Dislocation.jpeg\|150px]]
	\|}		\|}
	[[File:Gray311.png\|thumb\|Sagittal section of the articulation of the mandible.]]		[[File:Gray311.png\|thumb\|Sagittal section of the articulation of the mandible.]]

Rossdonaldson1: /* Background */

2019-12-17T20:41:49Z

Background

← Revisión anterior		Revisión del 20:41 17 dic 2019
Línea 1:		Línea 1:
	==Background==		==Background==
	~~[[File:Gray311.png\|thumb\|Sagittal section of the articulation of the mandible.]]~~
	{\| class="wikitable"		{\| class="wikitable"
	\|-		\|-
Línea 73:		Línea 72:
	[[File:Superior Dislocation.jpeg\|100px]]		[[File:Superior Dislocation.jpeg\|100px]]
	\|}		\|}
			[[File:Gray311.png\|thumb\|Sagittal section of the articulation of the mandible.]]

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Background */

2019-12-17T20:41:32Z

Background

@@ Línea 1: / Línea 1: @@
 ==Background==
 [[File:Gray311.png|thumb|Sagittal section of the articulation of the mandible.]]
-===Anterior Dislocation===
+{| class="wikitable"
-*Most common dislocation
+|-
-*Mandibular condyle forced in front of the articular eminence
+! Dislocation Type
 *Risk factors:
 **Prior dislocation
-**Weak or lax capsule
+**Weakness or laxity of capsule
 **Ligamentous injury
-*Often occurs spontaneously while patient is yawning, "popping" ears, or laughing
+*Mandibular condyle forced in front of the articular eminence
-===Posterior Dislocation===
+*May happen bilaterally or unilaterally
 *Follows a blow to the mandible that may or may not break the condylar neck
 *Condylar head may prolapse into the external auditory canal
+|
-===Lateral Dislocation===
+*Possible
 *Often associated with mandibular fracture
+|
-===Superior Dislocation===
+*Yes
 *Occur from blow to the partially opened mouth
 *Associated with cerebral contusions, facial nerve palsy, deafness
 ==Clinical Features==

Rossdonaldson1: /* Background */

2019-12-12T20:53:30Z

Background

← Revisión anterior		Revisión del 20:53 12 dic 2019
Línea 1:		Línea 1:
	==Background==		==Background==
			[[File:Gray311.png\|thumb\|Sagittal section of the articulation of the mandible.]]
	===Anterior Dislocation===		===Anterior Dislocation===
	*Most common dislocation		*Most common dislocation

Rossdonaldson1 at 20:51, 12 December 2019

2019-12-12T20:51:16Z

← Revisión anterior		Revisión del 20:51 12 dic 2019
Línea 54:		Línea 54:
	#If the opposite side does not spontaneously (it generally will), may repeat same technique on the opposite side		#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> ~~Video [http://brownemblog.com/blog-1/2019/11/9/brown-em-whit-ticisms-mandible-reduction Link]~~===		===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 the patient in seated position
	#Place one thumb on the one zygomatic arch, and the fingers of the same hand behind the mandible		#Place one thumb on the one zygomatic arch, and the fingers of the same hand behind the mandible
Línea 87:		Línea 87:
	**Nerve injury		**Nerve injury
	**Inability to reduce		**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==

Hoxbox: /* Extra-oral Reduction Techniquehttp://sjrhem.ca/rcp-save-thumbs-extra-oral-reduction-anterior-mandibular-dislocations/ */

2019-12-03T14:03:17Z

Extra-oral Reduction Techniquehttp://sjrhem.ca/rcp-save-thumbs-extra-oral-reduction-anterior-mandibular-dislocations/

← Revisión anterior		Revisión del 14:03 3 dic 2019
Línea 54:		Línea 54:
	#If the opposite side does not spontaneously (it generally will), may repeat same technique on the opposite side		#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>===		===Extra-oral Reduction Technique<ref>http://sjrhem.ca/rcp-save-thumbs-extra-oral-reduction-anterior-mandibular-dislocations/</ref> Video [http://brownemblog.com/blog-1/2019/11/9/brown-em-whit-ticisms-mandible-reduction Link]===
	#Place the patient in seated position		#Place the patient in seated position
	#Place one thumb on the one zygomatic arch, and the fingers of the same hand behind the mandible		#Place one thumb on the one zygomatic arch, and the fingers of the same hand behind the mandible

ClaireLewis at 21:10, 30 September 2019

2019-09-30T21:10:27Z

← Revisión anterior		Revisión del 21:10 30 sep 2019
Línea 45:		Línea 45:
	*If no concern for fracture, perform closed reduction in the emergency department (see techniques below)		*If no concern for fracture, perform closed reduction in the emergency department (see techniques below)
	**Often easiest to reduce one side at a time		**Often easiest to reduce one side at a time
	*Provide pain control and anxiolysis as needed		*Provide [[analgesia\|pain control]] and anxiolysis as needed
	*Consider procedural sedation, especially if the mandible has been dislocated for an extended period		*Consider [[procedural sedation]], especially if the mandible has been dislocated for an extended period
	**Local ~~anesthetic~~ may also be effective when injected into the preauricular depression just anterior to the tragus		**[[Local anesthetics]] may also be effective when injected into the preauricular depression just anterior to the tragus

	===Syringe Reduction Technique===		===Syringe Reduction Technique===
Línea 93:		Línea 93:
	[[Category:ENT]]		[[Category:ENT]]
	[[Category:Orthopedics]]		[[Category:Orthopedics]]
			[[category:Trauma]]

SLuckettG: /* Anterior Dislocation */

2019-05-13T20:06:38Z

Anterior Dislocation

← Revisión anterior		Revisión del 20:06 13 may 2019
Línea 1:		Línea 1:
	==Background==		==Background==
	===Anterior Dislocation===		===Anterior Dislocation===
	*Most common		*Most common dislocation
	*Mandibular condyle is forced in front of the articular eminence		*Mandibular condyle forced in front of the articular eminence
	*Risk factors: Prior dislocation~~, weak~~ capsule~~, torn ligaments~~		*Risk factors:
			**Prior dislocation
			**Weak or lax capsule
			**Ligamentous injury
	*Often occurs spontaneously while patient is yawning, "popping" ears, or laughing		*Often occurs spontaneously while patient is yawning, "popping" ears, or laughing

SLuckettG: /* Management */

2019-05-13T20:05:33Z

Management

← Revisión anterior		Revisión del 20:05 13 may 2019
Línea 40:		Línea 40:

	==Management==		==Management==
	*~~Closed~~ reduction in the emergency department (~~if no concern for fracture~~)		*If no concern for fracture, perform closed reduction in the emergency department (see techniques below)
	**~~If dislocation is bilateral, may be easier~~ to ~~relocate~~ one side at a time.		**Often easiest to reduce one side at a time
	*~~Pain~~ control or anxiolysis		*Provide pain control and anxiolysis as needed
	**~~Consider local analgesia - inject local~~ anesthetic into the preauricular depression just anterior to the tragus.		*Consider procedural sedation, especially if the mandible has been dislocated for an extended period
	*Consider procedural sedation		**Local anesthetic may also be effective when injected into the preauricular depression just anterior to the tragus

	===Syringe Reduction Technique===		===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		#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		#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		#If the opposite side does not spontaneously (it generally will), may repeat same technique on the opposite side

	~~'Note that this technique is preferred in a cooperative patient as it avoids sedation and placing the practitioner's hands inside the patient's mouth'~~		===Extra-oral Reduction Technique<ref>http://sjrhem.ca/rcp-save-thumbs-extra-oral-reduction-anterior-mandibular-dislocations/</ref>===
			#Place the patient in seated position
	===Extra-oral Reduction Technique===		#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===		===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>===		====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]]		[[File:wrist-pivot-method.jpg\|thumbnail]]
	*Place patient in seated position		#Place patient in seated position
	*While facing the patient, grasp the mandible with your thumbs at the apex of the mentum and ~~ﬁngers~~ on the occlusal surface of the inferior molars.		#Face the patient and grasp the mandible with your thumbs at the apex of the mentum
	*Apply cephalad force with the thumbs and ~~caudad~~ pressure with the ~~ﬁngers~~		#Place well-wrapped and gloved fingers on the occlusal surface of the inferior molars
	*Then pivot your wrists.		#Apply cephalad force with the thumbs and caudal pressure with the fingers
	*Note: This is a more physiologic reduction technique for the provider, allowing greater and more sustained force to ~~be exerted.~~		#Pivot your wrists to reduce joint

	===~~Older "~~Traditional" Technique===		====Traditional Technique====
	[[File:Mandible dislocation.jpg\|thumb\|Posterior position]]		[[File:Mandible dislocation.jpg\|thumb\|Posterior position]]
	*Place patient in seated position (anterior approach) or supine (posterior approach)		#Place patient in seated position (anterior approach) or supine (posterior approach)
	**Advisable to wrap thumbs in gauze to guard against accidental bite		#Place well-wrapped and gloved thumbs over occlusal surface of inferior molars or lateral to molars in the buccal fold
	*Placed gloved thumbs ~~in patient's mouth~~ over ~~the~~ occlusal ~~surfaces~~ of ~~the~~ molars, or lateral to ~~patient's~~ molars in buccal fold ~~(to avoid being bitten)~~		#Apply caudal and posterior pressure to reduce joint
	*Apply pressure ~~downward (toward the feet) and then backward (posteriorly)~~

	==Disposition==		==Disposition==