From the Research
Reducing a mandible dislocation in the emergency room involves administering propofol for sedation, as it has been shown to be more effective than combination fentanyl/midazolam in achieving successful reduction 1.
Procedure Steps
To reduce a mandible dislocation, follow these steps:
- Seat the patient in a chair with head support to ensure stability and comfort.
- Administer propofol for sedation, as it has been found to be more effective than other combinations in achieving successful reduction 1.
- Once adequate sedation is achieved, stand in front of the patient and place your thumbs on the patient's lower molars with gauze padding to prevent slipping, while wrapping your fingers around the mandible externally.
- Apply steady downward pressure on the molars to disengage the condyles, then guide the mandible backward into the glenoid fossa.
Post-Reduction Care
After successful reduction, restrict jaw movement with a soft bandage for 24-48 hours and advise a soft diet for 1-2 weeks to allow the jaw to heal and reduce the risk of recurrent dislocation.
Considerations
Patients with recurrent dislocations may need referral to oral-maxillofacial surgery for definitive management. Some studies suggest that ketamine/midazolam may be effective for procedural sedation in pediatric patients 2, but propofol has been shown to be more effective in adults 1. It's also important to consider the potential risks and benefits of opioid use in patients with mandible fractures, as excessive opioid use can lead to adverse outcomes 3.