Dislocated Jaw: Symptoms, Professional Adjustment, and Recovery

How do you adjust a dislocated jaw?

Adjusting a dislocated jaw is a complex medical procedure that should only be performed by a trained healthcare professional. Attempting to self-reduce or assist someone with a dislocated jaw without proper medical expertise can lead to serious complications and further injury.

Understanding Jaw Dislocation: Anatomy and Biomechanics

The temporomandibular joint (TMJ) is a bilateral synovial joint connecting the mandible (lower jawbone) to the temporal bone of the skull. It is one of the most complex joints in the body, facilitating a wide range of movements essential for speaking, chewing, and swallowing. A dislocated jaw, also known as mandibular dislocation, occurs when the condyle of the mandible moves out of its normal anatomical position within the glenoid fossa of the temporal bone, often anteriorly.

Several factors contribute to the TMJ's susceptibility to dislocation:

• Shallow Glenoid Fossa: The socket for the mandibular condyle is relatively shallow.
• Loose Ligamentous Support: While strong, the ligaments allow for significant movement, and extreme ranges can lead to dislocation.
• Muscular Forces: Powerful muscles of mastication (e.g., masseter, temporalis, medial and lateral pterygoids) can exert forces that contribute to the displacement.
• Mechanism of Injury: Typically, dislocation occurs during extreme mouth opening, such as a wide yawn, a dental procedure, vomiting, or trauma to the chin when the mouth is open. The mandibular condyle slides anteriorly past the articular eminence, locking in front of it.

Recognizing the Symptoms of a Dislocated Jaw

Identifying a dislocated jaw is crucial for prompt medical attention. Common signs and symptoms include:

• Inability to Close the Mouth: The jaw is often locked in an open position.
• Pain: Severe pain in and around the jaw joint, often exacerbated by attempts to move the jaw.
• Visible Deformity: The jaw may appear pushed forward, or there might be an asymmetry in the face.
• Drooling: Due to the inability to close the mouth and swallow saliva effectively.
• Difficulty Speaking: Impaired articulation due to the fixed jaw position.
• Palpable Condyle: The displaced condyle may be felt anterior to its normal position, just below the cheekbone.

Why You Should NOT Attempt Self-Reduction

While the idea of "adjusting" a dislocated jaw might sound simple, it carries significant risks when performed by an untrained individual:

• Further Injury: Improper technique can cause fractures of the mandible or temporal bone, damage to nerves (e.g., facial nerve), blood vessels, or the joint capsule.
• Increased Pain and Muscle Spasm: Forcing the jaw can intensify pain and trigger protective muscle spasms, making professional reduction more difficult.
• Incomplete Reduction: Without proper anatomical knowledge and technique, the jaw may not be fully reduced, leading to instability and recurrent dislocations.
• Diagnostic Oversight: A medical professional can rule out other injuries, such as fractures, that may accompany a dislocation and require different management.

The Medical Approach to Jaw Reduction

A trained healthcare professional, typically a physician, dentist, or oral surgeon, will employ specific techniques to safely reduce a dislocated jaw. The primary goal is to relax the muscles and guide the mandibular condyle back into the glenoid fossa.

Common professional reduction techniques involve:

• Patient Positioning: The patient is usually seated upright with their head supported against a wall or headrest.
• Pharmacological Intervention: Often, a local anesthetic is injected into the joint area, and muscle relaxants or mild sedatives may be administered intravenously to alleviate pain and reduce muscle spasm, making the reduction easier and less traumatic.
• Bilateral Downward and Backward Pressure (Hippocratic Method Variation):
  • The clinician stands in front of the patient.
  • They grasp the angles of the mandible with their thumbs placed on the occlusal surfaces of the lower molars (protected by gauze or cloth to prevent biting).
  • The fingers wrap around the body of the mandible.
  • Applying firm, steady downward and backward pressure on the molars, while simultaneously pushing upward and forward on the chin, the condyles are guided inferiorly past the articular eminence and then posteriorly into the glenoid fossa.
  • A distinct "clunk" or "pop" is often heard or felt as the joint reduces.
• Other Techniques: Variations exist, such as the wrist pivot method or the extraoral method, which may be used depending on the specific presentation and clinician preference.
• Post-Reduction Assessment: After reduction, the clinician will assess jaw mobility, occlusion, and stability. An X-ray may be taken to confirm proper alignment and rule out any associated fractures.

Immediate Steps While Awaiting Medical Help

While you should never attempt to reduce a dislocated jaw yourself, there are steps you can take to make the patient more comfortable and prevent further injury while waiting for medical assistance:

• Ensure Safety: Help the person sit in a comfortable, supported position, ideally upright, to prevent aspiration of saliva.
• Limit Movement: Advise the person to avoid trying to move their jaw or force it closed.
• Support the Jaw: Gently support the jaw with hands or a soft bandage under the chin to minimize movement and discomfort.
• Apply Cold Compress: Apply an ice pack wrapped in a cloth to the jaw area to help reduce swelling and pain.
• Manage Pain (if possible): If the person is able to swallow, over-the-counter pain relievers like ibuprofen or acetaminophen may offer some relief, but this should be done cautiously.
• Seek Immediate Medical Attention: Call emergency services (e.g., 911 in the US) or transport the individual to the nearest emergency department without delay.

Recovery, Rehabilitation, and Prevention

After professional reduction, the focus shifts to healing, restoring function, and preventing recurrence.

• Rest and Soft Diet: The jaw will need rest. A soft or liquid diet is usually recommended for several days to weeks to allow the joint and surrounding tissues to heal.
• Jaw Support: A Barton bandage or similar external support may be used for a period to limit jaw opening and provide stability.
• Activity Modification: Avoid wide yawning, shouting, singing, or any activities that require excessive mouth opening.
• Pain Management: Continue with prescribed or over-the-counter pain relief as needed.
• Rehabilitation Exercises: Once initial healing occurs, gentle jaw exercises may be recommended by a healthcare provider to restore range of motion and strengthen surrounding muscles. These might include controlled opening, closing, and lateral movements within a pain-free range.
• Prevention Strategies:
  • Awareness: Be mindful of extreme jaw movements.
  • Treat Underlying Issues: Address any underlying TMJ disorders, hypermobility, or dental issues with a specialist.
  • Mouthguards: For individuals prone to dislocation during sleep or certain activities, a custom-fitted mouthguard can help limit jaw opening.

When to Seek Professional Help

A dislocated jaw is a medical emergency requiring immediate professional intervention. Do not delay seeking medical care. Even if you suspect a partial dislocation or subluxation, it is best to be evaluated by a healthcare professional to ensure proper diagnosis and management, preventing chronic issues or recurrent dislocations.