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 — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical 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 "Initial evaluation and management of 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.
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