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ENT

MANDIBLE DISLOCATION

Stem - onset of jaw pain + inability to close mouth after yawning.
Prompt
ResponseBilateral anterior TMJ dislocation

Mandibular condyle (Of mandible) moves anteriorly and out of mandibular fossa (of temporal bone)
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PromptRisks factors for spontaneous TMJ dislocation
ResponsePrevious TMJ dislocation >> acquired laxity
Ligamentous laxity syndrome (Ehlers Danlos, Marfan)
TMJ dysfunction or previous trauma >> TMJ mismatch between fossa and articular eminence
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PromptCauses of TMJ dislocation
ResponseIatrogenic - dental procedures, laryngoscopy
Extreme mouth opening - Yawning, eating, vomiting, laughing, oral sex
Seizures
Dystonic drug reactions
Trauma
Tetanus
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PromptApproach to imaging
ResponseSpontaneous = no imaging
Traumatic = CT facial bones
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PromptDescribe 2 techniques for managing this
ResponseSyringe technique
  • 10 mL syringe placed between mandibular and maxillary molars, patient rolls syringe anterior and posterior, await spontaneous reduction
Manual reduction/”Traditional”
  • Gloves/rolled gauze, thumbs placed on mandibular molars. Firm pressure inferio-posteriorly (Down and back) until reduction. May require procedural sedation but often not
Gag
  • Elicit gag reflex and reflex inhibition of muscles may result in location. Beware of vomiting
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PromptDischarge instructions post mandibular dislocation
ResponseSimple analgesia
Sof/liquid diet
Avoid yawning/taking large bites
If recurrent - maxillofacial review
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PromptSuperior and inferior TMJ dislocation complications
ResponseSuperior - Mandibular fossa fracture
Posterior - fracture of temporal bone or external auditory canal
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