Mandible Dislocation Follow-up

  • Author: Meher Chaudhry, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 5, 2010
 

Further Inpatient Care

  • In the rare cases of mandible dislocation that cannot be reduced by the methods described in Emergency Department Care, closed reduction under general anesthesia or open reduction may be required.
  • Dislocations associated with fractures of the mandible are best reduced by oral maxillofacial surgeons or otolaryngologists.
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Further Outpatient Care

  • Successfully relocated mandible dislocations do not require any specific ongoing treatment, although the patient should be cautioned against opening the mouth wide, which could easily cause a recurrence.
  • A soft collar may be considered for support of the TMJ after reduction.
  • All patients with reduced mandible dislocations should be monitored by an appropriate specialist because of the possibility of jaw instability, ligamentous damage, and chronic TMJ pain.
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Transfer

  • In many cases, relocation is simple to perform at the initial ED visit, and the patient can be referred for ongoing care at another facility, precluding the need for transfer.
  • Patients with dislocation of the mandible can be transferred providing no severe associated injuries are present, vital signs are stable, and the airway is patent.
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Complications

Complications from mandibular dislocation and reduction are rare.

  • Complications of dislocation
    • Chronic recurrent anterior dislocations can result in injury to the joint capsule and degenerative disease of the joint space.
    • Injury to the external carotid and facial nerve can result.
    • Posterior dislocations can injure the external auditory canal.
    • Deafness can result from damage to the auditory canals and surrounding structures.
    • Superior dislocations have been associated with cerebral contusion, CNS deficits, and seventh and eighth cranial nerve injury.
  • Complications of reduction
    • Iatrogenic fracture of the mandibular condyle may occur as it passes under the articular eminence.[1]
    • The physician's thumbs may be injured as a consequence of rapid jaw closure with reduction.
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Prognosis

The prognosis for most isolated mandibular dislocations is good but varies based on the type of dislocation.

  • Acute anterior mandibular dislocations carry an excellent prognosis with few cases that progress to chronic recurrent dislocation.
  • Lateral dislocations are often associated with fractures and require open reduction.
  • Posttraumatic ankylosis is possible for dislocations with displaced condylar fractures.
  • Posterior dislocations occasionally require fixation of the external auditory canal and may result in hearing deficits.
  • Superior dislocations and those unreducible by a closed technique require emergent consultation by an oromaxillofacial surgeon and should be assessed for damage to the surrounding cranial nerves and cerebral structures.
  • Slight facial asymmetry and lack of development of the mandibular ramus have been reported in long-term follow-up of a case of pediatric superior mandible dislocation.[8]
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Patient Education

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Contributor Information and Disclosures
Author

Meher Chaudhry, MD  Clinical Instructor of Emergency Medicine, George Washington University Hospital Medical Faculty Associates

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

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD  Assistant Professor, 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, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

James E Keany, MD, FACEP  Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

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.

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

Disclosure: Medscape Salary Employment

Tom Scaletta, MD  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.

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  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, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Edward J Newton, MD, and Christian D McClung, MD, to the development and writing of this article.

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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