HWN Suggests

Trick of the Trade: Extra-oral reduction technique of anterior mandible dislocation

The crux of this technique rests upon the following observations:

When the mandible is dislocated anteriorly, the coronoid process and anterior border of the ramus can be palpated easily over the cheek on the affected side. By applying steady pressure on the cheek over the coronoid process and anterior aspect of the mandibular ramus, the mandible can be easily reduced. Note that when the mandible is in its resting position and no dislocation is present, the coronoid process and anterior border of the ramus are not palpable as they are located posterior to the body of the zygoma.

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 Save your Thumbs: Extra-oral reduction of anterior mandibular dislocations

Chen et al. (2007) published a case series describing a rapid and effective extra-oral reduction method for anterior mandibular dislocations(2). Furthermore, their technique does not require any procedural sedation and analgesia, thereby minimizing risks to the patient and freeing up valuable ED resources.

 The Syringe Technique for TMJ Dislocations

The syringe technique can quickly reduce a TMJ dislocation without the use of sedation. This technique requires a 5 or 10ml syringe that is placed between the posterior upper or lower molars on one of the affected sides.

Articles of Interest

4 reduction techniques of anterior mandible dislocation

Includes the extra oral method.

Annals of B Pod - Jaw Dislocation

Several techniques for reduction in the emergency department have been described in the literature. Adequate analgesia and anxiolysis can facilitate both reduction and patient cooperation with certain reduction maneuvers. One of the most commonly discussed techniques for TMJ reduction is the syringe method, which was developed in 2014. [6] In the population studied, 97% of patients had successful reduction, the majority of which occurred within one minute.

Jaw Dislocations

When the mandible is dislocated, the coronoid process is palpable externally over the cheek. By applying steady posterior pressure over the coronoid, the mandible can be easily reduced. You'll know it's in when the coronoid process is no longer palpable. :And if that doesn't work, try the hands-free syringe method.

TMJ Dislocation Reduction Techniques

Video demonstration...

Resources

CORE EM

TMJ dislocations typically occur bilaterally. Consider using the syringe, gag and extraoral reduction techniques first line as they frequently do not require parenteral analgesics or procedural sedation.