Mandible dislocation

Background

• Anterior Dislocation
  • Most common
  • Mandibular condyle is forced in front of the articular eminence
  • Risk factors: Prior dislocation, weak capsule, torn ligaments
  • Often occurs spontaneously while pt is yawning, "popping" ears, or laughing
• Posterior Dislocation
  • 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
  • Often associated w/ mandibular fracture
• Superior Dislocation
  • Occur from blow to the partially opened mouth
  • Associated w/ cerebral contusions, facial nerve palsy, deafness

Clinical Features

• Anterior Dislocation
  • Difficulty speaking or swallowing
  • Malocclusion
  • Pain localized anterior to the tragus
  • Prominent-appearing lower jaw
  • Preauricular depression
• Posterior Dislocation
  • Must examine the external auditory canal
• Lateral Dislocation
  • Condylar head is palpable in the temporal space

Diagnosis

• Spontaneous atraumatic anterior dislocation: diagnosis is clinical
• Traumatic dislocation: obtain CT scan

Treatment

Standard Technique

1. Place pt in seated position (anterior approach) or supine (posterior approach)
   1. Advisable to wrap fingers in gauze to guard against accidental bite
2. Placed gloved thumbs in pt's mouth over the occlusal surfaces of the molars, or lateral to pt's molars in buccal fold (to avoid being bitten)
3. Apply pressure downward (toward the feet) and then backward (posteriorly)

Posterior position

===Wrist Pivot Method===<ref>1<ref>

1. Place pt in seated position
2. 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.
3. Apply cephalad force with the thumbs and caudad pressure with the fingers
4. Then pivot your wrists.

• Note: This is a more physiologic reduction technique for the provider, allowing greater and more sustained force to be exerted.

Tips

1. Massage the TMJ externally prior to beginning the reduction attempt.
2. Don't Forget the Analgesia!
   1. Consider IV benzodiazepines, opioids, or procedural sedation.
   2. Inject local anesthetic into the preauricular depression just anterior to the tragus.
3. If dislocation is bilateral it may be easier to relocate one side at a time.

Disposition

• Admit:
  • Open dislocation
  • Superior dislocation
  • Associated w/ fracture
  • Nerve injury
  • Inability to reduce
• Discharge spontaneous, successfully reduced anterior dislocation with:
  • Soft diet
  • Tell pt not to open mouth wider than 2cm x 2wks
  • Tell pt to support the mandible with a hand when they yawn

Source

• Tintinalli