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Mandible Dislocation Clinical Presentation

  • Author: Meher Chaudhry, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Apr 08, 2016
 

History

Most patients present with jaw pain and trismus after extreme mouth opening or after a direct blow to the jaw. In addition, patients describe difficulty with speaking or swallowing, and malocclusion.[11, 17]

A history of previous dislocations, hypermobility syndromes, or injury to the TMJ joint should be elicited from patients.

In rare cases of multisystem trauma, head injuries, intoxication, or other causes of altered mental status, the patient may not be able to give a history suggestive of mandible dislocation.

Malocclusion is not unique to mandible fractures or dislocations, and maxillary fractures should be considered in the differential diagnosis in patients with malocclusion and pain.[14]

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Physical

A thorough examination of the head, neck, and nervous system should be performed in patients with suspected mandible dislocation. Usually pain and difficulty with jaw movement is present in all patients with mandible injury.

Anterior mandible dislocations usually result in a visible and palpable periauricular depression from displacement of the condyle. Unilateral dislocations result in a deviation of the jaw away from the dislocation. When both mandibular condyles are dislocated anteriorly, the patient appears to have an underbite, or prognathia, with pain over both TMJ areas.[17]

A thorough examination of the central nervous system, especially cranial nerves V and VII, should be performed in all patients with suspected jaw dislocations. This is vital, especially in cases of superior jaw dislocation.

External auditory canal should be inspected, and hearing should be assessed in patients with suspected posterior mandible dislocation.

The condylar head can sometimes be felt in the temporal space in cases of lateral dislocation.

Inspect the oral cavity for gingival lacerations, which may signal an open fracture.

A "tongue blade test" can be performed in subtle cases of jaw injury. A tongue blade is placed between the molars, and the patient is asked to bite down. If the patient can stabilize the tongue blade sufficiently for the examiner to twist it until it breaks, a mandibular fracture is unlikely.[18, 14] Alonso et al and Schwab et al reported that the tongue blade test is 95% sensitive. It should be performed on both sides.

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Causes

Risk factors for mandible dislocation include the following:

  • Shallow mandibular fossa
  • Previous TMJ trauma or dislocation that disrupted the joint capsule
  • Dystonic reactions
  • Hypermobility syndromes, such as Marfan syndrome or Ehlers-Danlos syndrome, which predisposes the TMJ to dislocation due to increased laxity of surrounding connective tissue [19, 14, 20]
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Contributor Information and Disclosures
Author

Meher Chaudhry, MD Emergency Medicine, Team Health, University of Tennessee Medical Center

Meher Chaudhry, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, Society for Academic Emergency Medicine

Disclosure: Received salary from WebMD for employment.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

James E Keany, MD, FACEP Associate Medical Director, Emergency Services, Mission Hospital Regional Medical Center, Children's Hospital of Orange County at Mission

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, California Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Christian D McClung, MD, MPhil(Cantab) Staff Physician, Department of Emergency Medicine, Los Angeles County/University of California Medical Center

Disclosure: Nothing to disclose.

Edward J Newton, MD, FACEP, FRCPC Professor of Clinical Emergency Medicine, Chairman, Department of Emergency Medicine, University of Southern California Keck School of Medicine

Disclosure: Nothing to disclose.

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

References
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The temporomandibular joint.
Classic reduction technique. The physician places gloved thumbs on the patient's inferior molars bilaterally, as far back as possible. The fingers of the physician are curved beneath the angle and body of the mandible.
Recumbent approach. The patient is placed recumbent, and the physician stands behind the head of the patient. The physician places his or her thumbs on the inferior molars and applies downward and backward pressure until the jaw pops back into place.
Wrist pivot method. The patient is placed in a sitting position, and the physician stands facing the patient. The physician grasps the mandible at the apex of the mentum with both thumbs. The fingers are placed on the inferior molars.
Ipsilateral approach - extraoral route. The patient is placed in a sitting position, and the physician stands behind the patient. The physician stabilizes the patient's head with his or her nondominant hand and uses the dominant hand to apply downward pressure on the displaced condyle that is palpated just inferior to the zygomatic arch.
 
 
 
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