Mandibular dislocation is just one of several dental emergencies that require immediate treatment.
Spontaneous mandibular dislocation usually occurs in people with a history of such dislocations. Although a dislocated mandible is occasionally caused by trauma, the initiating episode is typically a wide opening followed by biting pressure (eg, biting into a large sandwich with hard bread), a wide yawn, or a dental procedure. People prone to dislocation may have naturally loose temporomandibular joint (TMJ) ligaments.
Manual reduction may be necessary (see figure Mandibular Reduction
Mandibular Reduction
The patient’s head is stabilized. The operator's thumbs are placed on the external oblique line of the mandible (lateral to the third molar area) or, after wrapping the thumbs in gauze, on the occlusal surface of the lower molars. The other fingers are curled under the mandible. The patient is asked to open wide, as if yawning, and the operator then applies downward force on the molars while applying upward force over the chin until the mandible reduces. |
A Barton bandage (see figure Barton Bandage) may be needed for 2 or 3 days. Most importantly, the patient must avoid opening the mouth wide for at least 6 weeks. (See How to Reduce a Mandibular Dislocation.) When anticipating a yawn, the patient should place a fist under the chin to prevent wide opening. Food must be cut into small pieces. If the patient suffers from chronic dislocations and more conservative treatment modalities have been exhausted, an oral and maxillofacial surgeon may be consulted. As last-resort treatments, the ligaments around the TMJ can be surgically tightened (shortened) in an attempt to stabilize the joint or the articular eminence can be reduced (eminectomy).
Barton Bandage
This figure 8 bandage is wrapped around the head and jaw to provide support below and anterior to the lower jaw. |
