Equipment
Equipment employed in reduction of a temporomandibular joint (TMJ) dislocation includes the following:
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Gauze bandages
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Tape
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Gloves
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Lidocaine, 1%
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Syringe, 3-5 mL
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Needle, 27 gauge
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Monitoring and airway equipment (for procedural sedation)
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 Sedation, Pediatric 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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The temporomandibular joint.
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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.
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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.
