eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Dislocation, Mandible: Differential Diagnoses & Workup

Author: Meher Chaudhry, MD, Chief Resident, Department of Emergency Medicine, Detroit Receiving Hospital, University Health Center
Coauthor(s): Adam J Rosh, MD, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Contributor Information and Disclosures

Updated: Jan 14, 2009

Differential Diagnoses

Acute closed locking of the TMJ meniscus
Traumatic hemarthrosis
Condylar fracture
Trismus
Dystonic reaction
Fractures, Mandible
TMJ dysfunction

Workup

Laboratory Studies

  • No initial laboratory workup is necessary in a healthy patient with an isolated jaw injury and an otherwise normal examination and vital signs.
  • A pregnancy test may be indicated in women of childbearing age prior to imaging studies.
  • In patients with associated injuries, other comorbid illnesses, or those requiring open reduction, laboratory workup may be useful.

Imaging Studies

Imaging studies should be obtained prior to reduction to identify any fractures. In rare cases of chronic dislocations, imaging studies can be avoided based on the discretion of the treating physician. 

  • Fractures associated with nontraumatic anterior mandibular dislocations are rare. However, traumatic dislocations are often associated with mandibular fractures. Isolated trauma to the mandible can be evaluated by using an orthopanoramic radiograph and a mandible posteroanterior (PA) view with maximal mouth opening. This is an acceptable option for patients with chronic recurrent dislocations and a nontraumatic mechanism. However, certain fractures, such as nondisplaced mental fractures, may not be recognized on panoramic and PA radiographs because of the overlapping spine obscuring the image. In addition, restricted mouth opening can result in inadequate projection of the condylar process on the PA view, resulting in missed fracture of the mandibular ramus. 
  • The use of CT scanning for mandible injuries is increasing because CT scan provides greater sensitivity in diagnosing mandibular abnormalities. The use of CT in traumatic mandible injuries is increasing.16  The ability to obtain reconstructed images along the sagittal and coronal plane and along the alveolar ridge to create panoramiclike images further contributes to improved visualization of the fractures and acceptability of CT as the initial imaging modality in stable patients with traumatic mandible injury. 
  • Although MRI is not the first-line imaging modality in patients with mandible dislocations, it is useful in assessing the integrity of the TMJ joint, articular disks, and associated structures. MRI is also informative in patients with chronic recurrent dislocations while planning further long-term management. MRI is highly sensitive in detecting complications of mandibular injuries, such as pseudoarthrosis from fragment nonunion of traumatic fractures, ischemic necrosis of the condylar head, and traumatic damage to the articular disk. Both CT and MRI can be used to assess for posttraumatic osteomyelitis.16

More on Dislocation, Mandible

Overview: Dislocation, Mandible
Differential Diagnoses & Workup: Dislocation, Mandible
Treatment & Medication: Dislocation, Mandible
Follow-up: Dislocation, Mandible
Multimedia: Dislocation, Mandible
References
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References

  1. Haddon R, Peacock IV WF. Face and Jaw Emergencies. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw Hill; 2004:1471-1476.

  2. Mangi Q, Ridgway PF, Ibrahim Z, et al. Dislocation of the mandible. Surg Endosc. Mar 2004;18(3):554-6. [Medline].

  3. Lowery LE, Beeson MS, Lum KK. The wrist pivot method, a novel technique for temporomandibular joint reduction. J Emerg Med. Aug 2004;27(2):167-70. [Medline].

  4. Hoard MA, Tadje JP, Gampper TJ, et al. Traumatic chronic TMJ dislocation: report of an unusual case and discussion of management. J Craniomaxillofac Trauma. Winter 1998;4(4):44-7. [Medline].

  5. Ozcelik TB, Pektas ZO. Management of chronic unilateral temporomandibular joint dislocation with a mandibular guidance prosthesis: a clinical report. J Prosthet Dent. Feb 2008;99(2):95-100. [Medline].

  6. Undt G, Kermer C, Piehslinger E, et al. Treatment of recurrent mandibular dislocation, Part I: Leclerc blocking procedure. Int J Oral Maxillofac Surg. Apr 1997;26(2):92-7. [Medline].

  7. Stone KC, Humphries RL. Maxillofacial and head trauma. Mandible fractures. In: Current Diagnosis & Treatment Emergency Medicine. 6th ed. McGraw Hill; 2008.

  8. Ohura N, Ichioka S, Sudo T, et al. Dislocation of the bilateral mandibular condyle into the middle cranial fossa: review of the literature and clinical experience. J Oral Maxillofac Surg. Jul 2006;64(7):1165-72. [Medline].

  9. Schwab RA, Genners K, Robinson WA. Clinical predictors of mandibular fractures. Am J Emerg Med. May 1998;16(3):304-5. [Medline].

  10. Lee SH, Son SI, Park JH, et al. Reduction of prolonged bilateral temporomandibular joint dislocation by midline mandibulotomy. Int J Oral Maxillofac Surg. Nov 2006;35(11):1054-6. [Medline].

  11. Ferretti C, Bryant R, Becker P, et al. Temporomandibular joint morphology following post-traumatic ankylosis in 26 patients. Int J Oral Maxillofac Surg. Jun 2005;34(4):376-81. [Medline].

  12. Talley RL, Murphy GJ, Smith SD, Baylin MA, Haden JL. Standards for the history, examination, diagnosis, and treatment of temporomandibular disorders (TMD): a position paper. American Academy of Head, Neck and Facial Pain. Cranio. Jan 1990;8(1):60-77. [Medline].

  13. Alonso LL, Purcell TB. Accuracy of the tongue blade test in patients with suspected mandibular fracture. J Emerg Med. May-Jun 1995;13(3):297-304. [Medline].

  14. Luyk NH, Larsen PE. The diagnosis and treatment of the dislocated mandible. Am J Emerg Med. May 1989;7(3):329-35. [Medline].

  15. Bauss O, Sadat-Khonsari R, Fenske C, et al. Temporomandibular joint dysfunction in Marfan syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. May 2004;97(5):592-8. [Medline].

  16. Schuknecht B, Graetz K. Radiologic assessment of maxillofacial, mandibular, and skull base trauma. Eur Radiol. Mar 2005;15(3):560-8. [Medline].

  17. Totten VY, Zambito RF. Propofol bolus facilitates reduction of luxed temporomandibular joints. J Emerg Med. May-Jun 1998;16(3):467-70. [Medline].

  18. Chen YC, Chen CT, Lin CH, et al. A safe and effective way for reduction of temporomandibular joint dislocation. Ann Plast Surg. Jan 2007;58(1):105-8. [Medline].

  19. Bauss O, Sadat-Khonsari R, Fenske C, et al. Temporomandibular joint dysfunction in Marfan syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. May 2004;97(5):592-8. [Medline].

  20. Chacon GE, Dawson KH, Myall RW, et al. A comparative study of 2 imaging techniques for the diagnosis of condylar fractures in children. J Oral Maxillofac Surg. Jun 2003;61(6):668-72; discussion 673. [Medline].

  21. Fonseca RJ, Walker RV, eds. Management of injuries to the temporomandibular joint region. In: Oral and Maxillofacial Trauma. Philadelphia: WB Saunders Co; 1991:430-1.

  22. Gassner R, Tuli T, Hachl O, et al. Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg. Feb 2003;31(1):51-61. [Medline].

  23. Laskin DM. Temporomandibular joint disorders. In: Frederickson JM, Krause CJ, eds. Otolaryngology: Head and Neck Surgery. St. Louis: Mosby-Yearbook; 1993:1443-50.

  24. Thexton A. A case of Ehlers-Danlos syndrome presenting with recurrent dislocation of the temporomandibular joint. Br J Oral Surg. Mar 1965;3:190-3. [Medline].

  25. van der Linden WJ. Dislocation of the mandibular condyle into the middle cranial fossa: report of a case with 5 year CT follow-up. Int J Oral Maxillofac Surg. Apr 2003;32(2):215-8. [Medline].

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Further Reading

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Keywords

jaw dislocation, mandible dislocation, temporomandibular joint dislocation, TMJ syndrome, temporomandibular joint syndrome, TMJ joint, traumatic mandible injury, TMJ dislocation, mandible dislocation types, mandibular dislocation, Marfan syndrome, Ehlers-Danlos syndrome

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Contributor Information and Disclosures

Author

Meher Chaudhry, MD, Chief Resident, Department of Emergency Medicine, Detroit Receiving Hospital, University Health Center
Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

James E Keany, MD, FACEP, Medical Director, JetWest International Air Ambulance; Consulting Staff, Department of Emergency Services, Mission Hospital Regional Medical Center; Host of Healthbuzz at Jim.MD
James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, 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 and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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