Management of TMJ Dislocation in an Emergency

Introduction:

The temporomandibular joints, or TMJ, are the joints that connect the lower part of the jaw (mandible) to the skull in front of each ear. Trauma or other causes can result in the jaw being dislocated from its original position and pulled away. This type of lower jaw dislocation is known as temporomandibular joint dislocation or TMJ dislocation. At times, the dislocated jaw pops back into position on its own, but it can cause problems such as clicking sounds while opening and closing the mouth and pain. Most of the time, jaw dislocation requires emergency medical care. If a person has a dislocated jaw, they should not try to push it back into position by themselves. It is important to seek medical help immediately.

When Can TMJ Dislocation Occur?

TMJ dislocation or dislocation of the jaw can occur due to the following:

1. Injury or trauma.

2. Falls (jaw getting hurt).

3. Motor vehicle accidents.

4. Opening the mouth too wide (during a dental procedure, yawning, eating, or vomiting).

5. Disorders of the temporomandibular joint.

How to Know if Jaw Is Dislocated?

A dislocated jaw is a serious condition that interferes with a person’s routine life (such as sleeping or eating). The jaw feels swollen, stiff, or sore if dislocated. It is better to consult a doctor as soon as possible as it reduces the possibility of future problems. The most common symptoms of jaw dislocation include the following:

1. Pain in the temporomandibular joint (jaw) that worsens on moving, opening, or closing the mouth.

2. The teeth do not line up as they did, and the bite position changes.

3. Unable to talk properly as the abnormal jaw movements affect speaking ability.

4. Unable to close the mouth properly.

5. Unable to move the jaw as before.

6. Jaw twisted to one side.

7. Drooling.

8. Difficulty swallowing.

9. Jaw sticking out forward and unable to move the joint (locked jaw).

What to Do if the Jaw Gets Dislocated?

One must suspect a jaw dislocation if they have pain and tenderness in the TMJ that does not go away or cannot open or close their mouth completely. If a person has a locked jaw or symptoms of TMJ dislocation, they should immediately rush to seek medical help. It is an urgent problem that requires prompt management by a dentist or doctor. There are no established prehospital care protocols for jaw dislocation. The patients should hold and stabilize their jaw with a loose bandage or hands on the way to the hospital. In addition, they should take care not to bandage too tight. It should be easy to remove when needed (in case of vomiting).

How Is TMJ Dislocation Managed?

• On Initial Presentation: In case of severe accidents, rush to the emergency department. Upon initial presentation, the patient’s airway, breathing, and circulation will be checked and stabilized. Stabilizing the patient’s life-threatening conditions is given priority in the initial workup.

• Physical Examination and Diagnosis: The dentist or doctor promptly diagnoses a dislocated TMJ with a careful physical examination of the jaw and X-ray. They will examine the jaw for symmetry to determine if the dislocation is on one side or both sides. Suppose the TMJ is dislocated on both sides; the patient will have an open locked jaw. One side dislocation will cause the jaw to deviate to one side. They will also determine the type of jaw dislocation (based on the direction of deviation and its extent). The imaging test of choice for traumatic, unclear diagnosis or concern for fracture is a computed tomography (CT) scan.

• Treatment: After evaluation and diagnosis, they will correct the jaw position by manually manipulating the temporomandibular joint back into place. First, an anesthetic (a numbing agent such as an intravenous Propofol bolus or a local anesthetic injection) is administered so that the patients do not feel any pain during the procedure. Medications to relax the jaw muscles are also administered while attempting to correct the TMJ dislocation.

There are several techniques to reposition the jaw. These include:

1. Intraoral techniques include wrist pivot, bimanual, and recumbent position.

2. Extraoral techniques (such as the syringe method, gag reflex method, and the external approach). These protect the doctor’s fingers from being bitten.

In the most common manual repositioning procedure followed, the dentist or doctor wraps their fingers with gauze and places their thumbs inside the patient’s mouth (on the lower back teeth). Next, they position their other fingers below the patient’s jaw, firmly holding and controlling the jaw in their hands. They will then press down on the lower back teeth and push the chin up to reposition the patient’s jaw into place. Once the jaw is put back in place, bandages (barton bandages) will be used to stabilize the jaw. The bandage helps to prevent the patient from opening their mouth too wide and preventing another jaw dislocation till the inflammation in the jaw resolves.

When Is Surgery Used to Treat TMJ Dislocation?

Jaw dislocation correction or repositioning is usually done manually, but severe, complicated cases with fractures or more than one dislocation (due to loose joints) may require surgery. Surgical treatment includes shortening the ligaments of the temporomandibular joints to make the joint tighter, to prevent another dislocation.

What to Follow after the TMJ Dislocation Correction?

After the dislocated jaw is repositioned, follow the following simple tips to prevent another dislocation:

1. The patients should avoid opening their mouths wide for six weeks following the procedure.

2. Their hands must be used to support their jaw if they yawn or sneeze during the healing period.

3. In case of pain post the procedure, the patients must use the prescribed medicines to control pain. They can also use a cold pack (placed for ten to 20 minutes) every two to three hours.

4. Posy procedure, one should not move their joint too much during the healing period.

5. The patients must eat soft food that does not require opening their jaw wide.

6. It is beneficial to cut food into small pieces before eating.

7. The patients must avoid chewing gums.

8. Patients must not clench their jaws.

9. Using a mouthguard at night to prevent night grinding of teeth is beneficial.

10. Relaxation exercises to reduce stress can help.

11. If the dentist or doctor suggests, simple exercises can be used to strengthen the jaws.

Conclusion:

Opening the jaw too wide, temporomandibular disorders or trauma can cause the jaw to dislocate. Temporomandibular jaw dislocation is an emergency that requires prompt medical help. A person with TMJ dislocation should not reposition their jaw at home, as it can worsen the condition and cause further complications and pain. In most cases, the dentist or doctor can reposition the jaw into its place manually. In addition, the patients may require surgery if they have multiple dislocations or fractures of the jaw.