Treatment of Open Jaw Lock (Temporomandibular Joint Dislocation)
Immediate manual reduction using intraoral manipulation or the "pumping technique" is the primary treatment for acute open jaw lock, followed by extraoral automobilization exercises using mandibular elevator muscles if initial attempts fail. 1, 2
Immediate Management
Manual Reduction Techniques
Intraoral manipulation should be attempted first to manually reduce the displaced mandibular condyle back into the glenoid fossa 1, 2
The "pumping technique" using hydraulic pressure can be highly effective when conventional manipulation fails, successfully releasing the lock in 80% of acute cases 3
Extraoral automobilization using mandibular elevator muscles should be considered if intraoral manipulation is unsuccessful - this involves having the patient actively contract their jaw-closing muscles in a controlled manner to guide the condyle back into position 1
Post-Reduction Management
Immediate soft diet and activity modification to avoid re-dislocation 4
Jaw exercises and stretching should begin shortly after reduction to restore neuromuscular control and prevent recurrence - these provide approximately 1.5 times the minimally important difference in pain reduction 4, 1
Manual trigger point therapy for associated masticatory muscle spasm, which provides nearly twice the minimally important difference in pain severity reduction 4
Conservative Treatment for Recurrent Cases
First-Line Approaches
Stabilization splints (not anterior repositioning splints) combined with manipulation, moist heat, and exercises are preferred over repositioning splints to avoid occlusal changes like posterior open-bite 5
Patient education about avoiding aggravating activities such as wide yawning, prolonged mouth opening, and hard foods 4
NSAIDs for pain relief and inflammation reduction if discomfort persists after reduction 4
Cognitive behavioral therapy with biofeedback if psychological factors or anxiety about recurrence are present 4
Second-Line Approaches
Manipulation techniques for joint realignment may benefit patients with recurrent episodes who don't respond adequately to exercises alone 4
Heat and cold therapy application to reduce inflammation and muscle tension 4
Minimally Invasive Procedures for Chronic/Refractory Cases
Intra-articular lavage (arthrocentesis) without steroids may provide symptomatic relief in chronic cases with persistent hypomobility, showing 66% reduction in pain and 9.8mm improvement in mouth opening 4, 6
Arthroscopic lavage and lysis is effective in 84% of chronic closed lock cases (though less commonly needed for open lock), particularly when fibrillation and synovitis are present 6
Intra-articular glucocorticoid injections may be indicated for refractory symptomatic dysfunction in skeletally mature patients, but should not be first-line treatment 4, 7
Common Pitfalls to Avoid
Do not rely solely on occlusal splints without combining them with exercises and manual therapy, as evidence for splints alone is limited 4, 8
Avoid anterior repositioning splints as they cause occlusal changes like posterior open-bite; use stabilization splints instead 5
Do not proceed to invasive surgical procedures before exhausting conservative options including manual reduction, exercises, and arthrocentesis 8
Avoid using NSAIDs with opioids as this carries significant risk without clear additional benefit 8
Special Considerations
For patients with chronic internal derangement, open lock can occur through abrupt reduction of a displaced articular disk, requiring careful assessment with MRI if recurrent 2
Occlusal interferences should be evaluated and corrected if present, as they may contribute to recurrent episodes 2
Long-term follow-up is essential as some patients may have persistent posterior disk displacement even after successful reduction, manifesting as limited lateral excursion or mandibular deviation 1