Mandible, or TMJ, dislocations occur when the patient excessively opens the mouth, such as in a yawn. They are typically bilateral and are difficult to relocate because of masseter and medial pterygoid muscle spasm. You can relocate the condyles back into the TMJ space with gentle but firm intraoral pressure inferiorly and posteriorly. Often it requires some sedation to help relax the muscles of mastication.
Trick of the Trade:
Tire out the muscles of mastication
Thanks to Dr. Sa'ad Lahri (Cape Town, South Africa), I viewed this innovative trick in relocating a TMJ dislocation, posted by the BBC on YouTube. The basic principle is that you slightly over-exaggerate the dislocation to stretch the muscles even more. This was done using a stack of tongue blades. This constant stretch of the muscles for a few minutes will cause them to be relaxed when you remove the tongue blades. This provides a small window of time when you can relocate the mandible.
Has anyone else tried this before? I haven't and can't personally vouch for it, but I'll be trying it on the next opportunity that I have. It'd be nice not to have to sedate the patient unnecessarily.
Poor patient -- this video has gotten over 1.3 million views...
How long will the tongue blades have to stay in place? The narrator in the video was too focused on the entertainment aspect to mention anything about that...
ReplyDeleteHi Tor: Having not done it before, I'm only going to guess. It seems that the jaw muscles would fatigue after about 5-10 minutes if really stretched. Yes, the video did seem very entertainment-focused but the underlying teaching point seems valid.
ReplyDeleteIn the ED right now trying this on a dislocated pt. Will let you know how it works out. Before this, we tried to relocate the jaw giving the pt Dilaudid and local anesthetic, but we were unsuccessful. There is a question if the pt may be pregnant, so we would really like to avoid sedation if possible.
ReplyDeleteThanks Dr. Lin! Your blog saves lives!
Hi Dr Carlos: hope this works! Let me know how it went!
ReplyDeleteMichelle, we just did this in the ED. We tried the traditional approach to no avail. Then we did the tongue blade stack. With the first try after 10 minutes it did not work but he said he felt a bit looser and wanted to try again before getting any sedating meds. We replaced the stack and the patient then even added a few more tongue blades himself over a few minutes and within 5 minutes he just let the stack drop out, moved his mandible side to side a bit, and was back in.
ReplyDeleteGuy Shochat, MD
Hey Guy: Wow, that is simply an amazing story! Love that it worked for you. For the one time I tried this, it didn't work, partly because it was difficult to find enough tongue blades! Thanks for the feedback.
DeleteThank you for this link Michelle. I was asked by a colleague to help on this also that was initially unsuccessful with versed/fentanyl. We used this method as a second attempt with the help of some propofol and it was successful. I plan to start with this as a first treatment prior to an IV when I see this again. It's amazing how youtube videos can help with ER procedures. I've now gone from using the Stimson technique to the Cunningham technique for shoulder dislocations because of youtube. If anyone has not seen this one yet it is here: http://www.youtube.com/watch?v=kYYI1fN3gRU
ReplyDeleteSo great to hear that this worked. I, however, not as sold on the Cunningham technique. Pretty unsuccessful thus far with it. Have had much more success with a long spinal needle for intraarticular injection and then a little versed for shoulder reductions. Thanks for your feedback and insight!
DeleteI just had this happen to me. I've had to go to the Dr. In the past but not this time. I just stuck a object in my mouth for 6 min. Let it out and wiggled my jaw back into place! I can't believe how easy it was.
ReplyDeleteThank you so much for putting this online!
Although this blog is intended to be used by medical providers, I am happy that your jaw is better.
Delete