Anterior temporomandibular joint (TMJ) dislocations are among the most common non-traumatic dislocations of the jaw. Although non-traumatic TMJ dislocations are infrequent in the ED, it is important to find useful methods for managing these patients in order to improve patient outcomes in a safer and more effective manner. The traditional approaches to managing TMJ have numerous disadvantages, including the risk of bite injuries, which in turn increases the risk of transmitting diseases like hepatitis and HIV. Traditional approaches also require procedural sedation because the application of additional force to manually manipulate the mandible can be difficult and painful.
In addition to these disadvantages, repeated attempts may be necessary before successfully reducing the dislocated TMJ. Another complication with traditional approaches is that they may inadvertently fracture the mandibular or condyle. Other techniques for reducing TMJ have also been tested, but these strategies still require procedural sedation and manual reduction. “Traditional approaches to TMJ can be time consuming, difficult, and sometimes ineffective,” explains Julie A. Gorchynski, MD, MSC, FACEP, FAAEM. “They can also be risky to patients and emergency physicians because it involves intraoral manual manipulation of the mandible as well as procedural sedation.”
A New Technique
In a prospective study published in the Journal of Emergency Medicine, Dr. Gorchynski and colleagues evaluated a simple and novel syringe technique for reducing acutely non-traumatic TMJ dislocations using a hands-free approach. The technique requires that a syringe be placed between the posterior molars as they slide over the syringe to glide the anteriorly displaced condyle back into its normal position.
Over the 3-year study period, researchers collected information on demographics, mechanisms, duration of dislocation, and reduction time using the syringe technique for TMJ. The two most common mechanisms for acute TMJ dislocations were due to chewing (61%) and yawning (29%). Of the 31 patients involved in the study, 30 (97%) had a successful reduction after undergoing the syringe technique. “The majority of TMJ dislocations were reduced in less than 1 minute and there were no recurrent dislocations when patients were reassessed at 3-days follow-up,” adds Dr. Gorchynski. “The syringe technique is safe, rapid, and effective, and doesn’t require procedural sedation.”
More to Come
The technique described in the study is promising, but additional research is needed to include additional patients with bilateral TMJ dislocations and in edentulous patients. Emergency physicians should consider using this method as a useful technique in the management of acute non-traumatic TMJ dislocations in the ED. Dr. Gorchynski and colleagues are also developing a video that shows the procedure being performed on a patient with TMJ in real time. The intent of the video is to help educate other emergency physicians on the proper technique so that they can implement the syringe approach at their institution.
Readings & Resources (click to view)
Gorchynski J, Karabidian E, Sanchez M. The ‘syringe’ technique: a hands-free approach for the reduction of acute nontraumatic temporomandibular dislocations in the emergency department. J Emerg Med. 2014;47:676-681.
Chen Y, Chen C, Lin C, et al. A safe and effective way for reduction of temporomandibular joint dislocation. Ann Plast Surg. 2007;58:105-108.
Lori EL, Michael SB, Kevin KL. The wrist pivot method, a novel technique for temporomandibular joint reduction. J Emerg Med. 2004;27:167-170.
Ardehali MM, Kouhi A, Meighani A, Rad FM, Emami H. Temporomandibular joint dislocation reduction technique, a new external method vs the traditional. Ann Plast Surg. 2009;63:1-3.
Scamahorn GF. Treating acute mandibular dislocation [Reader’s Forum]. Postgrad Med. 1989;86:44.