Dislocated Mandible

Clinical Description

The condylar head moves forward and out of the socket.

Signs and Symptoms

• The mouth remains open and cannot close spontaneously. Sometimes pain is present. Diagnosis is mainly clinical. If the mandibular midline deviates to one side, the dislocation is unilateral.

Investigations

• CT Scan, MRI
• Skull views (PA, TL, OPG, Arthrography of TMJ)

Treatment

Reduction of dislocated mandible

AVULSED TOOTH

Xray

With alveolar fracture intact alveolus

Clean tooth with NSS Clean avulsed tooth withNSS

Replaced tooth intosocket

Replaced tooth in socket Splint wih Essig wiring orarchbars

Splint with archbar for 4 weeks

Review after 4 weeks review after 4 weeks

X ray

Tooth stable

Remove splint

Tooth stable tooth mobile

Remove splint leave splint for 2 more weeks

Review after 2 weeks

• Advise the patient on prevention and that there may be permanent changes in opening.
• Injection of Local anesthesia 2 % Lignocaine (2−5 mls) into the joint or adjacent area of insertion of lateral pterygoid muscle may allow spontaneous reduction.

MANUAL REDUCTION

• Pre−medicate with a benzodiazepine (e.g., Diazepam 5−10 mg IV). The patient's head is stabilized.
• The operator places his thumbs on the external oblique line of the mandible (lateral to the third molars) with fingers placed under the chin.
• A rotatory motion is performed by the thumbs pressing downwards and forwards, and the fingers pressing upwards until the mandible is reseated.
• Stabilize the jaw to maintain mandible in position using Barton's bandage for at least six (6) weeks.
• If conservative management fails, surgical intervention becomes inevitable