Techniques and procedures
The wrist pivot method, a novel technique for temporomandibular joint reduction

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Abstract

Temporomandibular joint (TMJ) dislocation is an infrequent dislocation of the mandible. The usual technique of reduction, recommended by most Emergency Medicine textbooks, consists of downward forces applied to the mandible. In the authors' experience this is often painful and requires significant sedation. We present a patient in whom the usual manner of TMJ dislocation reduction was difficult. We describe a novel technique for TMJ dislocation reduction that uses the intrinsic biomechanical properties of the mandible.

Introduction

An infrequently used but necessary technique emergency physicians (EPs) must have in their arsenal is reduction of a mandibular dislocation at the temporomandibular joint (TMJ). Although most textbooks describe a straightforward approach to reduction, it has been the authors' experience that conscious sedation and significant force is required to achieve reduction. In this article, a novel approach to reduction is described, along with a discussion of the biomechanics of mandibular dislocation affecting reduction techniques. Our approach is based on using the intrinsic biomechanical properties of the mandible.

Section snippets

Case report

A 53-year-old man with a remote history of bilateral TMJ dislocation presented to the Emergency Department (ED) with the chief complaint of “locked jaw.” The patient stated that while laying back in a recliner and yawning he felt sudden pain in his lower face and was unable to close his mouth. This episode was similar to a prior TMJ dislocation 30 years ago. The patient was experiencing such pain with any attempted jaw motion that he was writing all answers. The patient denied any recent

Discussion

Mandibular dislocation at the TMJ is an infrequent presentation to the ED. At our institution, consisting of two EDs with approximately 100,000 combined annual visits, 37 TMJ dislocations have presented over a 7-year period, 1995–2002. Although infrequent, reduction of TMJ dislocation is a technique EPs must have in their repertoire.

The TMJ is a ginglymoarthrodial joint, combining gliding and hinge motions. Dislocation can occur anteriorly, posteriorly, laterally or superiorly. Discussion here

Conclusion

In conclusion, we describe a novel technique, the wrist-pivot technique, for mandibular dislocation, which has not been previously described in the literature. It utilizes the muscles of mastication in conjunction with the forces applied by the physician for a smoother, more comfortable reduction of the mandible for the patient and the physician.

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Techniques and Procedures is coordinated by George Sternbach, md, of Stanford University Medical Center, Stanford, California

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