Jaw
Jaw Dislocation
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Jaw Dislocation
, Mandible Dislocation, Temporomandibular Joint Dislocation
Pathophysiology
Mandibular condylar process displaces from the mandibular fossa of the
Temporal Bone
Types
Anterior dislocation (most common)
Most often occurs with extreme mouth opening
May occur after laughing, yawning,
Vomiting
, taking a large bite or
Trauma
Also reported to occurr with oral sex, dental extraction,
Tonsillectomy
or general
Anesthesia
Patient presents with an open locked jaw
Posterior dislocation
Typically due to direct blow to chin
Associated with injury to external auditory canal
Superior dislocation
Typically due to direct blow to a partially open mouth
Associated with glenoid fossa
Fracture
,
Skull Fracture
, CSF leak, as well as
CN 7
and
CN 8
injury
Lateral dislocation
Associated with
Mandible
Fracture
Preparation
Anterior Relocation
Consider
Procedural Sedation and Analgesia
Patient sits upright with head well supported
Precautions
Anterior Relocation
Consider imaging (e.g. Panorex XRay or CT maxillofacial) prior to reduction attempt
While attempting reduction, examiner should avoid placing thumbs on molars (risk of bite)
Articular cartilaginous disc anterior dislocation may prevent relocation (may require surgery)
Management
Relocation techniques for anterior dislocation
Self-reduction method
May reduce spontaneously in some cases with patient opening jaw wider
Intra-oral Jaw method
Examiner wraps both their thumbs for protection against biting
Sandwhich each thumb between two halves of a
Tongue
depressor
Wrap each with kerlix or similar gauze roll
Examiner places one thumb on each of the patient's lower molars
Wrap fingers around the under-side of the
Mandible
Apply downward pressure
Dislodge the mandibular condyle from beneath the zygomatic arch
Push the
Mandible
posteriorly so it relocates into the glenoid fossa
Wrist
-pivot method
Examiner places fingers on each side of the patients mouth
Fingers are draped over the teeth from the lateral incisors posteriorly
Thumbs wrap underneath and apply pressure to the underside of the chin
Wrist
pivots and applies downward traction on the jaw
Push the jaw posteriorly and superiorly and it shoul re-seat in back in the glenoid fossa
Extraoral method
Examiner applies thumbs to bony prominence over the cheek bone, below the zygomatic arch
This prominence represents the anteriorly displaced mandibular condyle
Examiner wraps fingers behind the angle of the jaw
Examiner pushes the jaw downward with thumbs and pulls forward with fingers to clear the edge of the glenoid fossa
Management
Post-reduction
Avoid extreme mouth opening
Soft diet for first 2 weeks after reduction
Soft
Cervical Collar
to prevent extreme mouth opening
Follow-up with ENT or orofacial surgery
References
Wu in Majoewsky (2012) EM:Rap 12(11): 11
Chaudhry in Kulkami (2012) Medscape EMedicine: Mandible Dislocation
http://emedicine.medscape.com/article/823775-overview#showall
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