Reduction of Mandibular Dislocation Periprocedural Care

Updated: Apr 03, 2017
  • Author: Erik D Schraga, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Periprocedural Care

Equipment

Equipment employed in reduction of a temporomandibular joint (TMJ) dislocation includes the following:

  • Gauze bandages
  • Tape
  • Gloves
  • Lidocaine, 1%
  • Syringe, 3-5 mL
  • Needle, 27 gauge
  • Monitoring and airway equipment (for procedural sedation)
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Patient Preparation

Anesthesia

The typically intense spasm that occurs with TMJ dislocation often necessitates the use of substantial analgesia and procedural sedation prior to attempts at reduction.

Local anesthesia with 1-2 mL of 1% intra-articular lidocaine may be used as an adjunctive measure but is unlikely to provide adequate pain relief when used alone. (See Procedural SedationPediatric Procedural Sedation, and Local Anesthetic Agents, Infiltrative Administration.) Without adequate sedation, reduction is unlikely to be successful. Agents of choice include midazolam, propofol, and other medications with muscle-relaxant properties.

Positioning

In the conventional approach, the patient is seated in an upright position and facing forward, with the back and head braced posteriorly. Either a chair with a firm backrest or a low stool placed against a wall may be used. Alternatively, the patient may be positioned with the back turned to the practitioner performing the procedure and with the posterior portion of the head braced firmly against the practitioner’s body.

A randomized single-blind study by Xu et al suggested that reduction in the supine position might be a more viable alterative to conventional positioning for manual reduction of acute nontraumatic TMJ dislocation. [7]  In this study, procedural time was shorter and pain perception reduced in the supine group as compared with the conventional group.

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