What is the treatment for a 17-year-old patient with a locked jaw (temporomandibular joint dislocation)?

From the Guidelines

A 17-year-old patient with a locked jaw (temporomandibular joint dislocation) should be treated with prompt manual reduction by a healthcare provider, followed by jaw rest, soft foods, and NSAIDs for pain and inflammation, as this approach is supported by the most recent and highest quality evidence 1. The patient should avoid further opening of the jaw and can apply a warm compress to relax the muscles while awaiting professional care.

• Key steps in management include:
  • Manual reduction of the dislocation by a healthcare provider, which may involve the use of muscle relaxants such as diazepam (5-10mg) or cyclobenzaprine (5-10mg) to ease the procedure 1.
  • Application of downward and backward pressure to guide the mandible back into position 1.
  • Local anesthesia or procedural sedation might be necessary in difficult cases 1.
  • After successful reduction, the patient should rest the jaw, eat soft foods for several days, and avoid wide mouth opening 1.
  • NSAIDs like ibuprofen (400-600mg every 6-8 hours) can be taken for pain and inflammation 1. The goal of treatment is to reduce the dislocation, relieve pain and inflammation, and prevent future episodes, with a focus on conservative and reversible approaches 1.
• Additional interventions that may be considered include:
  • Jaw exercises and stretching 1.
  • Trigger point therapy 1.
  • Postural exercise 1.
  • Augmented cognitive behavioural therapy 1. It is essential to prioritize the patient's comfort and safety during the treatment process, and to seek immediate medical attention if the dislocation cannot be reduced or if the patient experiences severe pain or difficulty breathing 1.

From the Research

Treatment Options for Temporomandibular Joint Dislocation

The treatment for a 17-year-old patient with a locked jaw (temporomandibular joint dislocation) can vary depending on the severity and duration of the dislocation.

• For acute dislocations, manual reduction with or without general anesthesia is often the first line of treatment 2.
• If the dislocation becomes chronic, open reduction may be required 3.
• In some cases, maxillomandibular fixation may be used to treat chronic or complex dislocations 2.
• A novel method for reduction of the dislocated TMJ via extraoral route has also been proposed, which involves applying steady pressure over the prominent part of the coronoid process and anterior border of the ramus to reduce the anteriorly dislocated mandible 4.
• Automobilization intervention and exercise may also be useful in treating TMJ open lock, including posterior disk displacement or TMJ anterior dislocation 5.

Key Considerations

• Determining the presence of a predisposing factor is important in guiding the correct treatment and management for this condition 2.
• The treatment strategy should aim at managing acute, chronic, and recurrent dislocation 6.
• The use of scissors mouth props, Erich arch bars, and postoperative elastic traction may be necessary in some cases 3.