Reduction of Mandibular Dislocation

Updated: Aug 08, 2023
Author: Erik D Schraga, MD; Chief Editor: Arlen D Meyers, MD, MBA 



Dislocation of the temporomandibular joint (TMJ; see the image below) is a painful condition that occurs when the mandibular condyle becomes fixed in the anterosuperior aspect of the articular eminence.[1]

The temporomandibular joint. The temporomandibular joint.

TMJ dislocation is due to either trauma (force against a partially opened mandible) or, more commonly, excessive opening of the mandible (such as may occur during yawning and dental procedures). Other mechanisms include passionate kissing, eating, yelling, singing, endoscopy, and intubation. Spasm of the masseter, temporalis, and internal pterygoid muscles results in trismus, preventing return of the condyle to the temporal fossa.[2]

More commonly, dislocation occurs bilaterally, resulting in a mandible that is fixed in a symmetrically open position so that only the most posterior teeth may be contacting. Infrequently, unilateral dislocation occurs with resultant deviation of the jaw to the unaffected side.[3]

With dislocation, the mandibular condyles may be palpated anterior to the articular eminence. The diagnosis should be obvious through history and physical examination, and radiographs should not be necessary for confirmation.[4] However, in the setting of trauma, radiographs should be obtained to exclude concomitant fracture.

Patients who have experienced previous dislocation are more prone to recurrence. Additionally, patients with weakness of the joint capsule, anatomic aberration of the joint, or injury to the associated ligaments are at greater risk of dislocation.


Indications for reduction of a TMJ dislocation include the following:

  • Acute dislocation of the TMJ, either unilaterally or bilaterally; acute episodes are most easily managed with manual reduction
  • Chronic recurrent dislocations and chronic persistent dislocations; manual reduction may be attempted, but chronic dislocations are likely to necessitate surgical treatment [5, 6, 7, 8] )


Contraindications for reduction of a TMJ dislocation include the following:

  • Mandibular fracture
  • Extensive facial trauma
  • Multiple prior unsuccessful attempts

Periprocedural Care


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)

Patient Preparation


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.


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.[9]  In this study, procedural time was shorter and pain perception reduced in the supine group as compared with the conventional group.



Temporomandibular Joint Reduction

Most commonly, reduction of a temporomandibular joint (TMJ) dislocation is performed via the intraoral route.[10]  To prevent trauma, the practitioner’s fingers should be gloved with thick gauze taped securely on both thumbs. To ensure adequate leverage, the patient should be positioned so that so that the mandible is below the level of the practicitioner's elbows. 

Place your thumbs upon the lower molars or on the ridge of the mandible intraorally, posterior to the molars, with your fingers wrapped externally around the mandibles. Apply firm, slow, and steady pressure in a downward and posterior direction. If bilateral reduction is not possible, reduction may be done one side at a time. (See the images below.) Reduction attempts that require excessive force should be aborted because they may cause iatrogenic fracture of the mandibular condyles.[11]

Classic reduction technique. The physician places 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 recumben 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.

After reduction has been successfully completed, plain radiographs may be obtained to exclude iatrogenic mandibular condylar fracture. However, this may not be necessary if reduction resolves the pain.

The patient may wear a soft neck brace, and warm compresses may be placed on the TMJs for comfort. The patient should be instructed to avoid extreme opening of the mouth, such as may occur during yawning, laughing, or dental procedures. Pain relief may be achieved with nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, or mild opiates.

Patients with chronic dislocations may benefit from the use of a Barton bandage, an elastic bandage that is wrapped around the bottom of the mandible and over the top of the head to prevent excessive jaw opening.

An oral-maxillofacial surgeon or otolaryngologist should be consulted for dislocations that are irreducible, associated with fracture, or immediately recurrent.

Outpatient observation should be arranged to evaluate for possible chronic TMJ pain and ligamentous damage or instability.

Gorchynski et al described a hands-free "syringe" technique for TMJ reduction that does not require procedural sedation or intravenous analgesia.[12]  Of 31 patients with acute nontraumatic TMJ dislocations studied by the investigators at two university centers, 30 (97%) had a successful reduction with this technique, and most of the dislocations (77%) were reduced in less than 1 minute. At 3-day follow-up, there were no recurrent dislocations.


Potential complications of reduction of a TMJ dislocation include the following:

  • Injury to the practitioner - This may occur during reduction as the jaw closes on the thumbs
  • Damage to dental hardware or oral prostheses
  • Fracture of the mandibular condyle
  • Complications of procedural sedation (eg, hypotension, respiratory compromise or apnea, aspiration, dysrhythmia, or allergy)
  • Injury to the facial nerve or external carotid artery (rare)
  • Delay in reduction - This may result in fibro-osseous ankylosis, which may produce limited TMJ mobility