Acute nontraumatic temporomandibular joint (TMJ) dislocations are usually the consequence of excessive mouth opening, for example, tooth extraction, laughing, yawning, or taking a large bite of food. Anterior TMJ dislocations are the most common form in nontraumatic dislocations of the jaw. The emergency physician (EP) routinely relies on the traditional method of intraoral reduction of the TMJ, which commonly requires procedural sedation or substantial intravenous analgesia. The literature reports two alternative methods for the reduction of TMJ dislocations. In 2004, Lori et al. describe a variation of the intraoral approach, and in 2007, Chen et al. describe an extraoral or external approach. Both of these methods require the physician to manually manipulate the mandible 1, 2.
The traditional intraoral approach is time consuming, difficult, and at times, ineffective. It is also not without risk to the patient or the EP 1, 3, 4, 5, 6.
We introduce a simple and novel technique for the reduction of acutely nontraumatic TMJ dislocations using a hands-free approach. This technique is safe, rapid, and effective without the need for procedural sedation or intravenous analgesia.
This was a prospective convenience sample study.
This study was conducted in the emergency departments (EDs) at two university teaching hospitals with an annual ED census of 62,000 and 108,000. Thirty-one consecutive adult subjects that presented to the ED for acute nontraumatic TMJ dislocations during 2008–2011 were enrolled. These subjects represented a convenience sample population because two emergency physicians performed all the reductions. This maintained standardization because all the
There were 31 subjects between the ages of 18 and 65 years that presented to the ED with acute nontraumatic TMJ dislocations during the study period. The mean age was 38 years; there were 20 females and 11 males, with 23 Hispanics, 13 Caucasians, and 2 African-Americans. Comorbidities were not obtained.
The mechanisms of dislocation were due to chewing (n = 19, 61%), yawning (n = 8, 29%), talking/laughing (n = 3, 10%), or recent dental visits (n = 1, 0.03%). Nine subjects had prior TMJ
To our knowledge, our technique is the first described in the medical literature that does not require intraoral or external manual manipulation of the mandible for the reduction of acute nontraumatic TMJ dislocations in the ED. It is simple, safe, fast, and effective, and does not require procedural sedation. Most medical textbooks describe the traditional intraoral reduction method for TMJ dislocations. This technique requires a significant amount of force, especially in patients who have
Our described technique is a novel hands-free maneuver that is quick, simple, safe, and effective. EPs should consider this method as a useful technique in the management of acute nontraumatic TMJ dislocations in the ED. 1. Why is this topic important? The traditional intraoral manual reduction of temporomandibular joint (TMJ) dislocations is time consuming, difficult, and at times, ineffective, and commonly requires conscious sedation. This technique is a hands-free approach for the reduction of the acutely nontraumatic TMJArticle Summary
2. What does this study attempt to show?
The original authors reported a 100% success rate among 29 patients without complications.43 This method was originally described by Scamahorn,44 where a wine cork was used to perform the reduction; however, this method was later modified to use syringes because they are more widely available in the ED.45 First, place an empty 5- or 10-mL syringe in the posterior portion of patient’s mouth between their upper and lower molars (Figure 8).
It is therefore more comfortable for the patient and easier for the operator to manipulate the mandibular condyles inferiorly and posteriorly over the articular eminence using a technique of their choice: classic, recumbent, posterior, ipsilateral, gag reflex induction [1]. Classically sedation and/or muscle relaxants are required when reducing mandibular dislocations due to muscle spasms within the TMJ, as well as high levels of patient pain and anxiety [4]. In particularly difficult cases general anaesthetic is necessary.
Examples of this are lengthy wide-opening dental appointments, intubation, and trauma. Nevertheless, certain anatomic factors may predispose patients to this condition, such as the length and steepness of the articular eminence9 and generalized joint laxity.10 Patients with this anatomic predisposition might experience recurrent episodes of open lock after wide mouth opening, as depicted in the first case presented.
