From the Guidelines
To treat a Temporomandibular Joint (TMJ) dislocation, the most effective approach is to attempt manual reduction using the Hippocratic or wrist pivot technique, followed by conservative management with analgesics, muscle relaxants, and physical therapy, as recommended by recent guidelines 1. The initial step in managing TMJ dislocation involves manual reduction, which can be performed by a healthcare professional or, in some cases, by the patient themselves.
- Place your thumbs on the patient's lower molars with fingers wrapped around the mandible,
- Then push downward and backward to guide the condyle back into the glenoid fossa. For acute pain,
- Take ibuprofen 400-600mg every 6-8 hours or acetaminophen 500-1000mg every 6 hours,
- Apply ice packs for 10-15 minutes several times daily for the first 24-48 hours to reduce swelling. After reduction,
- Limit jaw movement for 1-2 weeks by eating soft foods,
- Avoiding wide yawning, and
- Refraining from chewing gum. Muscle relaxants like cyclobenzaprine 5-10mg may help with muscle spasms, as suggested by guidelines from the Royal College of Dental Surgeons of Ontario 1. If self-reduction fails or dislocations recur frequently,
- Seek immediate medical attention as sedation or surgical intervention might be necessary,
- Options such as arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint may be considered,
- As recommended by the American Association of Oral and Maxillofacial Surgeons 1.
From the Research
Treatment Options for Temporomandibular Joint (TMJ) Dislocation
- Manual reduction is a common treatment approach for acute TMJ dislocation, which can be performed with or without general anesthesia 2
- The "syringe" technique is a novel, hands-free approach for reducing acute nontraumatic TMJ dislocations, which is simple, fast, safe, and effective 3
- Botulinum toxin type A injections can be used to treat recurrent TMJ dislocation, especially in cases with neurogenic origin or muscle hyperactivity 4, 5
- Maxillomandibular fixation may be reserved for chronic, more complex dislocations 2
Considerations for Treatment
- Determining the presence of predisposing factors is important in guiding the correct treatment and management for TMJ dislocation 2
- The use of procedural sedation or intravenous analgesia may not be required for some treatment approaches, such as the "syringe" technique 3
- Treatment options may vary depending on the etiology and severity of the TMJ dislocation, as well as the patient's overall health and medical history 6