eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Dislocation, Mandible: Follow-up

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

Follow-up

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.

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.

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.
  • 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.

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 and CNS deficits.   
  • 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.

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.

Patient Education

 
Acknowledgments

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.



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References
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References

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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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