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Mandible Dislocation Workup

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

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, trauma radiographs and/or laboratory workup may be useful.

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Imaging Studies

Imaging studies should be obtained prior to reduction to identify any fractures. In rare cases of recurrent dislocations, imaging studies may be deferred, 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.[21] 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.[21]

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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.

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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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