Diferencia entre revisiones de «Mandible dislocation»

Revisión del 18:32 7 nov 2011

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

Anterior Dislocation Reduction
1. Analgesia
  1. Inject local anesthetic into the preauricular depression just ant to the tragus
2. Muscle relaxation
  1. Short-acting IV benzo (e.g. midazolam)
3. Technique
  1. Place pt in seated position (anterior approach) or supine (posterior approach)
  2. Apply gauze over gloved thumbs for protection
  3. Placed gloved thumbs in pt's mouth over the occlusal surfaces of the molars
  4. Apply pressure downward and backward (toward the pt)
    1. If dislocation is bilateral it may be easier to relocate one side at a time

Posterior position

Disposition

Admit:
- Open dislocation
- Superior dislocation
- Associated w/ fracture
- Nerve injury
- Inability to reduce
Discharge spontaneous, successfully reduced anterior dislocation with:
- Soft diet
- Do not open mouth wider than 2cm x2wk
- Support the mandible with a hand when they yawn

Source

Tintinalli

Authors:

@@ Línea 1: / Línea 1: @@
 == Background ==
-*Anterior dislocation of mandibular condyle(s) in relation to fossa
+*Anterior Dislocation
-*Risk factors include prior dislocation,weak capsule, and torn ligaments
+**Most common
-*Yawning, "popping" ears, or laughing may predispose
+**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
-== Diagnosis ==
+== Clinical Features==
-*Clinical diagnosis, but XR/CT if fracture suspected in setting of trauma
+*Anterior Dislocation
-*Pt unable to open mouth with locked jaw
+**Difficulty speaking or swallowing
-**Unilateral or bilateral
+**Malocclusion
-**Jaw deviates to contralateral side if unilateral
+**Pain localized anterior to the tragus
-*Palpation of TMJ reveals anterior condyle(s)
+**Prominent-appearing lower jaw
-**Palpate with fingers in the auditory canal
+**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 ==
-*Analgesia
+#Anterior Dislocation Reduction
-*Benzodiazepines for muscle relaxation
+##Analgesia
-*Wrap physician's thumbs circumferentially with 4x4's and tape
+###Inject local anesthetic into the preauricular depression just ant to the tragus
-**Thumbs will be placed intra-orally and may be bitten upon relocation
+##Muscle relaxation
-*Can stand anterior or posterior to patient (see image below)
+###Short-acting IV benzo (e.g. midazolam)
-**First, downward pressure is applied to release condyles
+##Technique
-**Second, move chin posteriorly to seat condyles in fossa
+###Place pt in seated position (anterior approach) or supine (posterior approach)
-**Posterior position is easier in this author's opinion
+###Apply gauze over gloved thumbs for protection
-***Allows for increased leverage, less patient anxiety
+###Placed gloved thumbs in pt's mouth over the occlusal surfaces of the molars
-*Soft diet for one week
+###Apply pressure downward and backward (toward the pt)
-*Avoid wide opening of mouth, Barton's bandage may be helpful
+####If dislocation is bilateral it may be easier to relocate one side at a time
-*Refer recurrent dislocations
 *[[File:Mandible dislocation.jpg|thumb|Posterior position]]
 == Disposition ==
-*Outpatient management as above
+*Admit:
-*ENT or OMFS referral with recurrent dislocations
+**Open dislocation
+**Superior dislocation
+**Associated w/ fracture
+**Nerve injury
+**Inability to reduce
+*Discharge spontaneous, successfully reduced anterior dislocation with:
+**Soft diet
+**Do not open mouth wider than 2cm x2wk
+**Support the mandible with a hand when they yawn
-== Sources ==
+== Source ==
-*Clinical Procedures in Emergency Medicine
+*Tintinalli
-*Emedicine
 [[Category:ENT]]