Mandible Dislocation Medication

  • Author: Meher Chaudhry, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 19, 2012
 

Medication Summary

Sedation and analgesia are indicated if reduction is attempted. The medications traditionally used for this purpose are diazepam and morphine. Other conscious sedation protocols can be used providing the patient maintains an adequate gag reflex. Deep conscious sedation is not desirable because the patient should remain seated during relocation. Certain medications that can cause masseter spasm (eg, methohexital, chlordiazepoxide, phenothiazines) should be avoided because this complication would prevent relocation of the mandible.

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Analgesics

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients with injuries.

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Morphine (Astramorph, Duramorph)

 

DOC for analgesia due to reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Various IV doses are used; commonly titrated until desired effect obtained.

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Fentanyl citrate (Duragesic, Sublimaze)

 

Potent narcotic analgesic with much shorter half-life than morphine sulfate. With short duration (30-60 min) and easy titration, an excellent choice for pain management and sedation. Easily and quickly reversed by naloxone.

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Anxiolytics

Class Summary

Patients with painful injuries usually experience significant anxiety. Anxiolytics allow the clinician to administer a smaller analgesic dose to achieve the same effect.

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Diazepam (Valium)

 

Individualize dosage and increase cautiously to avoid adverse effects.

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Lorazepam (Ativan)

 

Sedative hypnotic in benzodiazepine class that has short onset of effect and relatively long half-life. By increasing action of GABA, a major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation. Excellent medication for patients requiring sedation for >24h. Monitor BP after administering dose and adjust as necessary.

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Anesthetics

Class Summary

These agents are used to reduce pain and can be used for nerve blocks in mandible reductions.

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Lidocaine (Lidocaine CV, Lidopen)

 

Lidocaine injections can be used for nerve blocks in mandible reductions.

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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 Medscape Reference 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

  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, Evoy D. 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, Edlich RF. 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, Rasse M. 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. Harstall R, Gratz KW, Zwahlen RA. Mandibular condyle dislocation into the middle cranial fossa: a case report and review of literature. J Trauma. Dec 2005;59(6):1495-503. [Medline].

  9. Ohura N, Ichioka S, Sudo T, Nakagawa M, Kumaido K, Nakatsuka T. 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].

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

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

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

  13. 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].

  14. 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].

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

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

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

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

  19. Young AL, Khan J, Thomas DC, Quek SY. Use of masseteric and deep temporal nerve blocks for reduction of mandibular dislocation. Anesth Prog. Spring 2009;56(1):9-13. [Medline]. [Full Text].

  20. Awant MN. A New Approach to the Reduction of Acute Dislocation of the Temporomendibular Joint: A Report of Three Cases. British Journal of Oral and Maxillofacial surgery. 1987;24:244-249.

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

  22. Ardehali MM, Kouhi A, Meighani A, Rad FM, Emami H. Temporomandibular joint dislocation reduction technique: a new external method vs. the traditional. Ann Plast Surg. Aug 2009;63(2):176-8. [Medline].

  23. Shorey CW, Campbell JH. Dislocation of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jun 2000;89(6):662-8. [Medline].

  24. Ziegler CM, Haag C, Mühling J. Treatment of recurrent temporomandibular joint dislocation with intramuscular botulinum toxin injection. Clin Oral Investig. Mar 2003;7(1):52-5. [Medline].

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

  26. Chacon GE, Dawson KH, Myall RW, Beirne OR. 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].

  27. 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.

  28. Gassner R, Tuli T, Hachl O, Rudisch A, Ulmer H. 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].

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

  30. Shun TA, Wai WT, Chiu LC. A case series of closed reduction for acute temporomandibular joint dislocation by a new approach. Eur J Emerg Med. Apr 2006;13(2):72-5. [Medline].

  31. 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].

  32. 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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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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