Treatment

Treatment

Prehospital Care

No specific treatment of mandibular dislocation is indicated in the field. The decision regarding self-transport versus paramedic transport is based upon factors other than the mandibular dislocation (eg, presence of multiple trauma, patient's level of pain and distress).

Emergency Department Care

A thorough assessment of the patient’s airway, breathing, and circulation (ABCs) should be performed at presentation. If a complete history, physical assessment, and appropriate imaging study reveal an isolated mandibular dislocation, a decision is to be made if closed reduction in the emergency department is appropriate. Oral maxillofacial surgery consultation is indicated for patients with dislocations associated with fractures and for chronic dislocations. Based on the degree and displacement of the fracture and damage to associated structures, many of these patients require open reduction in the operating room.
Providing analgesia and muscle relaxation prior to reduction is important. Several options are available including procedural sedation using a combination of intravenous sedatives and analgesics. Local anesthetics (eg, lidocaine) can be injected directly in the TMJ space at the site of the preauricular depression.17 A short-acting benzodiazepine, such as intravenous midazolam, can be used for muscle relaxation. Several methods have been proposed and successfully used for reduction of anterior jaw displacement.

Classic reduction technique

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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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.