What is the recommended approach for jaw dislocation reduction?

Management of Temporomandibular Joint Dislocation Reduction

The recommended approach for jaw dislocation reduction is manual reduction using downward and backward pressure on the mandible, followed by stabilization with intermaxillary elastics for at least one week to prevent recurrence. 1

Manual Reduction Techniques

• The traditional technique involves placing the operator's thumbs over the patient's molar teeth and applying downward and backward pressure to guide the mandible back into position 1, 2
• An alternative extraoral approach can be used by applying steady pressure over the coronoid process and anterior border of the ramus, which can be palpated over the cheek when the mandible is dislocated anteriorly 3
• The wrist pivot method is another technique that uses the intrinsic biomechanical properties of the mandible for reduction 4
• For patients who are tense or anxious, acupuncture at specific points (LI 4, P 6, Ext 1, H 7) may help calm the patient and reduce muscle spasm, facilitating reduction 5

Management of Difficult Reductions

• If initial reduction attempts fail due to muscle spasm, consider using muscle relaxants to overcome the spasm 1
• Local anesthetic injections around the temporomandibular joint area may be necessary in some cases to facilitate reduction 5
• For severely difficult cases that don't respond to the above measures, reduction under deep sedation in an operating room setting may be required 5

Post-Reduction Management

• Apply intermaxillary elastics to stabilize the joint for at least one week 1
• Advise jaw rest and avoidance of wide mouth opening or activities that may aggravate the condition 1
• Recommend a soft diet to minimize jaw movement and reduce stress on the TMJ 1
• Apply heat and/or cold therapy to reduce pain and inflammation 1
• Prescribe NSAIDs for pain relief and to reduce inflammation 1, 6

Prevention of Recurrence

• Implement jaw exercises and stretching to improve range of motion and strengthen muscles 1, 6
• Consider trigger point therapy to release tension in specific muscle points 1, 6
• Recommend postural exercises to improve head and neck alignment 1
• For chronic or recurrent dislocations, maxillomandibular fixation may be necessary 7

Common Pitfalls to Avoid

• Proceeding to invasive procedures before exhausting conservative options 1
• Neglecting to identify predisposing factors that may guide appropriate treatment 7
• Failing to provide adequate post-reduction stabilization, which can lead to recurrence 1
• Not addressing underlying TMJ disorders that may contribute to recurrent dislocations 6

Special Considerations

• For elderly patients, gentle reduction techniques are particularly important as they may have age-related changes in the TMJ 2
• In patients with recurrent dislocations, evaluate for underlying conditions such as hypermobility disorders or neuromuscular conditions 6
• For juvenile patients with TMJ arthritis, systemic treatment should be considered rather than focusing solely on mechanical reduction 6