dental disorders
How To Reduce a Mandibular Dislocation
Step by Step Description of Procedure
Elicit patient relaxation and cooperation It is important to allay anxiety and obtain cooperation before attempting reduction. In a calm, reassuring voice, explain to the patient that the Condition can be treated successfully, but that full cooperation is necessary Mouth and jaw need to be relaxed and the procedure should not be resisted Jaw will feel pressure but not sharp pain Head needs to remain solidly on the headrest as the jaw is put back in place If the patient remains unable to relax and cooperate with the reduction, give IV procedural sedation and analgesia as needed. Optional: Local anesthetic injection: Externally palpate the TMJ space, just below the zygoma and about 2.5 cm anterior to the tragus. Swab the area with antiseptic solution and allow it to dry for at least 1 minute. Insert the needle perpendicularly to the skin and advance it medially, about 0.5 cm, into the joint space. Aspirate, to rule out intravascular placement. Slowly inject about 1 mL anesthetic. Massage the site to hasten the onset of anesthesia. Distract the condyles and reduce the jaw: Instruct the patient to completely relax the mouth and jaw. Stabilize the head. Instruct the patient to keep the head still and firmly braced against the headrest. Wear nonsterile gloves. Place your thumbs on the external oblique ridge on either side of the mandible, lateral to the third molar area. Alternatively, wrap your thumbs with layers of gauze and place them as posteriorly as possible on the occlusal surface of the lower molars bilaterally (this increases the risk of being bitten during reduction). Curl your other fingers around and under the mandible, with the index fingers behind the rami. Fingers should be in contact with the bony mandible, not the soft tissues beneath the tongue. First, apply firm and continuous downward force on the back of the jaw,using your thumbs to distract the condyles inferiorly. This is a steady, firm force,not a sudden, jerking, thrusting force. Simultaneously apply a reciprocal upward force on the anterior mandible(ie, rock the chin upward), which may enhance the condylar distraction. Then, maintaining these distraction forces, apply posterior forceon the dislocated side, or both sides if the dislocation is bilateral, to reduce the condyle(s) (ie, push the mandible back into normal position). The key is to first apply significant pressure downward in the back of the jaw,thenslowly guide the entire mandible posteriorly: "Down …thenback." Often the mandible will snap into position as the condyles clear the articular eminence. Determine successful TMJ reduction: Successful TMJ reduction restores the patient's ability to close the mouth, although soreness from muscle spasms will linger. Instruct the patient to feel if the teeth seem to come together normally as they slightly open and close the jaw. Tell the patient not to open wide to check. 