SAQ 375 – Maxillofacial – bilateral TMJ dislocation

Maxillofacial – bilateral TMJ dislocation.

a. Diagnosis

• Bilateral temporomandibular joint dislocation.

b. Anatomy

• The mandibular condyle moves anteriorly out of the mandibular fossa of the temporal bone.

c. Imaging

• Spontaneous dislocation: no imaging required.
• Traumatic dislocation: CT facial bones.

d. Reduction techniques

• Syringe technique: place a 10 mL syringe between the mandibular and maxillary molars, ask the patient to roll it anteriorly and posteriorly, and await spontaneous reduction.
• Manual reduction: protect thumbs with gloves or rolled gauze, place thumbs on mandibular molars, then apply firm constant inferoposterior pressure until reduction. Procedural sedation may be needed but often is not.

e. Discharge advice

• Simple analgesia such as paracetamol or ibuprofen.
• Soft or liquid diet.
• Avoid yawning widely and avoid large bites.
• Maxillofacial review if recurrent.