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
- Place pt in seated position (anterior approach) or supine (posterior approach)
- Advisable to wrap fingers in gauze to guard against accidental bite
- 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)
- Apply pressure downward (toward the feet) and then backward (posteriorly)
===Wrist Pivot Method===<ref>1<ref>
- Place pt 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.
- Apply cephalad force with the thumbs and caudad pressure with the fingers
- 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
- Massage the TMJ externally prior to beginning the reduction attempt.
- Don't Forget the Analgesia!
- Consider IV benzodiazepines, opioids, or procedural sedation.
- Inject local anesthetic into the preauricular depression just anterior to the tragus.
- 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