Reduction of temporomandibular joint (TMJ) dislocation
- Donna Reyes Mendez, MD
Donna Reyes Mendez, MD
- Associate Professor of Emergency Medicine
- University of Texas Health Science Center (UTHSC) Medical School Houston
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Ann Griffen, DDS, MS
Ann Griffen, DDS, MS
- Section Editor — Pediatric Oral Health
- Professor of Pediatric Dentistry
- The Ohio State University
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will review the evaluation and reduction of TMJ dislocations. The evaluation and management of pediatric dental injuries and jaw fractures are discussed separately. (See "Evaluation and management of dental injuries in children" and "Jaw fractures in children" and "Facial trauma in adults".)
MECHANISM OF INJURY
Anterior TMJ dislocation commonly follows extreme opening of the mouth (eg, during eating, yawning, laughing, singing, kissing, vomiting, or dental treatment) and less often occurs after trauma [1-3]. Dislocation also can result from dystonic reactions to drugs, seizures, or tetanus infection [4,5]. In addition, iatrogenic dislocation during anesthesia induction and upper endoscopy have been described [6,7]. Symmetric mandibular dislocation is most common, but unilateral dislocation with the jaw deviating to the opposite side can also occur.
Superior and posterior dislocations of the TMJ are rare and usually associated with trauma . Superior dislocations occur in association with mandibular fossa fractures. Posterior dislocations may be associated with disruption of the external auditory canal or fracture of the temporal plate.
RISK FACTORS FOR DISLOCATION
Patients prone to mandibular dislocation include those with an anatomic mismatch between the fossa and articular eminence, weakness of the capsule and the temporomandibular ligaments (eg, patients with Ehlers-Danlos or Marfan syndrome), and torn ligaments. Patients who have had one episode of dislocation are predisposed to recurrence .
The TMJ consists of the articulation of the temporal and mandibular bones (figure 1). TMJ dislocation occurs when the condyle travels anteriorly along the articular eminence and becomes locked in the anterior superior aspect of the eminence, preventing closure of the mouth (figure 2) . Dislocation results in stretching of the ligaments, and is associated with severe spasm of the muscles that open and close the mouth (ie, the masseter, medial pterygoid, and temporalis) (figure 3) [10,11]. The resultant trismus prevents the condyle from returning to the mandibular fossa.
- Shorey CW, Campbell JH. Dislocation of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89:662.
- Whiteman PJ, Pradel EC. Bilateral temporomandibular joint dislocation in a 10-month-old infant after vomiting. Pediatr Emerg Care 2000; 16:418.
- Liddell A, Perez DE. Temporomandibular joint dislocation. Oral Maxillofac Surg Clin North Am 2015; 27:125.
- Amsterdam JT. Oral medicine. In: Rosens Emergency Medicine: Concepts and Clinical Practice, Marx JA, Hockberger RS, Walls RM (Eds), Elsevier Saunders, Philadelphia 2014. p.895.
- Thachil RT, Philip B, Sridhar CB. Temporomandibular dislocation: a complication of tetanus. J Trop Med Hyg 1993; 96:60.
- Gambling DR, Ross PL. Temporomandibular joint subluxation on induction of anesthesia. Anesth Analg 1988; 67:91.
- Lacy PD, Lee JM, O'Morain CA. Temporomandibular joint dislocation: an unusual complication of upper gastrointestinal endoscopy. Am J Gastroenterol 2000; 95:3653.
- Pratt A, Loiselle JM. Reduction of temporomandibular joint dislocation. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King C, Henretig FM. (Eds), Wolters Kluwer | Lippincott, Williams & Wilkins, Philadelphia 2008. p.688.
- Kai S, Kai H, Nakayama E, et al. Clinical symptoms of open lock position of the condyle. Relation to anterior dislocation of the temporomandibular joint. Oral Surg Oral Med Oral Pathol 1992; 74:143.
- Undt G, Kermer C, Piehslinger E, Rasse M. Treatment of recurrent mandibular dislocation, Part I: Leclerc blocking procedure. Int J Oral Maxillofac Surg 1997; 26:92.
- Undt G, Kermer C, Rasse M. Treatment of recurrent mandibular dislocation, Part II: Eminectomy. Int J Oral Maxillofac Surg 1997; 26:98.
- Lovely FW, Copeland RA. Reduction eminoplasty for chronic recurrent luxation of the temporomandibular joint. J Can Dent Assoc 1981; 47:179.
- Awang MN. A new approach to the reduction of acute dislocation of the temporomandibular joint: a report of three cases. Br J Oral Maxillofac Surg 1987; 25:244.
- Lowery LE, Beeson MS, Lum KK. The wrist pivot method, a novel technique for temporomandibular joint reduction. J Emerg Med 2004; 27:167.
- Chen YC, Chen CT, Lin CH, Chen YR. A safe and effective way for reduction of temporomandibular joint dislocation. Ann Plast Surg 2007; 58:105.
- Gorchynski J, Karabidian E, Sanchez M. The "syringe" technique: a hands-free approach for the reduction of acute nontraumatic temporomandibular dislocations in the emergency department. J Emerg Med 2014; 47:676.
- Young AL, Khan J, Thomas DC, Quek SY. Use of masseteric and deep temporal nerve blocks for reduction of mandibular dislocation. Anesth Prog 2009; 56:9.
- Ziegler CM, Haag C, Mühling J. Treatment of recurrent temporomandibular joint dislocation with intramuscular botulinum toxin injection. Clin Oral Investig 2003; 7:52.
- Martins WD, Ribas Mde O, Bisinelli J, et al. Recurrent dislocation of the temporomandibular joint: a literature review and two case reports treated with eminectomy. Cranio 2014; 32:110.
- Rose, L, Hendler, BH, Amsterdam, JT. Temporal mandibular disorders and odontic infections. Consult 1982; 22:110.
- Jaisani MR, Pradhan L, Sagtani A. Use of cervical collar in temporomandibular dislocation. J Maxillofac Oral Surg 2015; 14:470.