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!
ReplyDelete