Guidelines Summary

The AO craniomaxillofacial (CMF) classification identifies 3 levels of mandible fractures/dislocations^[40]:

Level 1 dentifies the presence of fractures in 4 areas: mandible, midface, skull base, and cranial vault.
Level 2 describes the location of the fractures within those defined areas.
Level 3 describes fracture morphology, such as fragmentation, displacement, and dislocation.

Medication

Hillam J, Isom B. Mandible Dislocation. 2021 Jan. [QxMD MEDLINE Link]. [Full Text].
Varedi P, Bohluli B. Autologous blood injection for treatment of chronic recurrent TMJ dislocation: is it successful? Is it safe enough? A systematic review. Oral Maxillofac Surg. 2015 Sep. 19 (3):243-52. [QxMD MEDLINE Link].
Stark TR, Perez CV, Okeson JP. Recurrent TMJ Dislocation Managed with Botulinum Toxin Type A Injections in a Pediatric Patient. Pediatr Dent. 2015 Jan-Feb. 37 (1):65-9. [QxMD MEDLINE Link].
Prechel U, Ottl P, Ahlers OM, Neff A. The Treatment of Temporomandibular Joint Dislocation. Dtsch Arztebl Int. 2018 Feb 2. 115 (5):59-64. [QxMD MEDLINE Link].
Sharma NK, Singh AK, Pandey A, Verma V, Singh S. Temporomandibular joint dislocation. Natl J Maxillofac Surg. 2015 Jan-Jun. 6 (1):16-20. [QxMD MEDLINE Link].
Rattan V, Rai S, Sethi A. Midline mandibulotomy for reduction of long-standing temporomandibular joint dislocation. Craniomaxillofac Trauma Reconstr. 2013 Jun. 6 (2):127-32. [QxMD MEDLINE Link].
Kahveci R, Simsek ME, Akın S, Ozbek S, Ozgenel GY, Gökmen ZG. Treatment of recurrent temporomandibular joint dislocation. J Maxillofac Oral Surg. 2013 Dec. 12 (4):379-81. [QxMD MEDLINE Link].
Stolbizer F, Saiegh J, Andrada MM. Anterior dislocation of the temporomandibular joint: a simplified non-traumatic manual technique. J Man Manip Ther. 2020 Sep. 28 (4):246-250. [QxMD MEDLINE Link].
Nabil S, Kuppusamy E, Nordin R, Nazimi AJ, Ramli R. Long-Term Follow-Up following Condylotomy in a Case of Traumatic Unilateral Anterosuperior Mandibular Condyle Dislocation. Case Rep Dent. 2019. 2019:6810461. [QxMD MEDLINE Link].
Haddon R, Peacock IV WF. Face and Jaw Emergencies. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw Hill; 2004. 1471-1476.
Mangi Q, Ridgway PF, Ibrahim Z, Evoy D. Dislocation of the mandible. Surg Endosc. 2004 Mar. 18(3):554-6. [QxMD MEDLINE Link].
Lowery LE, Beeson MS, Lum KK. The wrist pivot method, a novel technique for temporomandibular joint reduction. J Emerg Med. 2004 Aug. 27(2):167-70. [QxMD MEDLINE Link].
Ruiz S, Lim R. Spontaneous Temporomandibular Joint Dislocation. J Craniofac Surg. 2019 May/Jun. 30 (3):e265-e267. [QxMD MEDLINE Link].
Isler SC, Cakarer S, Yalcin BK, Sitilci T. Management of the Bilateral Chronic Temporomandibular Joint Dislocation. Ann Maxillofac Surg. 2018 Jan-Jun. 8 (1):154-157. [QxMD MEDLINE Link].
Lum VWM, Poh J. Refractory Temporomandibular Joint Dislocation - Reduction Using the Wrist Pivot Method. Clin Pract Cases Emerg Med. 2017 Nov. 1 (4):380-383. [QxMD MEDLINE Link].
Hoard MA, Tadje JP, Gampper TJ, Edlich RF. Traumatic chronic TMJ dislocation: report of an unusual case and discussion of management. J Craniomaxillofac Trauma. 1998 Winter. 4(4):44-7. [QxMD MEDLINE Link].
Ozcelik TB, Pektas ZO. Management of chronic unilateral temporomandibular joint dislocation with a mandibular guidance prosthesis: a clinical report. J Prosthet Dent. 2008 Feb. 99(2):95-100. [QxMD MEDLINE Link].
Undt G, Kermer C, Piehslinger E, Rasse M. Treatment of recurrent mandibular dislocation, Part I: Leclerc blocking procedure. Int J Oral Maxillofac Surg. 1997 Apr. 26(2):92-7. [QxMD MEDLINE Link].
Stone KC, Humphries RL. Maxillofacial and head trauma. Mandible fractures. Current Diagnosis & Treatment Emergency Medicine. 6th ed. McGraw Hill; 2008.
Harstall R, Gratz KW, Zwahlen RA. Mandibular condyle dislocation into the middle cranial fossa: a case report and review of literature. J Trauma. 2005 Dec. 59(6):1495-503. [QxMD MEDLINE Link].
Ohura N, Ichioka S, Sudo T, Nakagawa M, Kumaido K, Nakatsuka T. Dislocation of the bilateral mandibular condyle into the middle cranial fossa: review of the literature and clinical experience. J Oral Maxillofac Surg. 2006 Jul. 64(7):1165-72. [QxMD MEDLINE Link].
Schwab RA, Genners K, Robinson WA. Clinical predictors of mandibular fractures. Am J Emerg Med. 1998 May. 16(3):304-5. [QxMD MEDLINE Link].
Luyk NH, Larsen PE. The diagnosis and treatment of the dislocated mandible. Am J Emerg Med. 1989 May. 7(3):329-35. [QxMD MEDLINE Link].
Bauss O, Sadat-Khonsari R, Fenske C, Engelke W, Schwestka-Polly R. Temporomandibular joint dysfunction in Marfan syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 May. 97(5):592-8. [QxMD MEDLINE Link].
Lee SH, Son SI, Park JH, Park IS, Nam JH. Reduction of prolonged bilateral temporomandibular joint dislocation by midline mandibulotomy. Int J Oral Maxillofac Surg. 2006 Nov. 35(11):1054-6. [QxMD MEDLINE Link].
Ferretti C, Bryant R, Becker P, Lawrence C. Temporomandibular joint morphology following post-traumatic ankylosis in 26 patients. Int J Oral Maxillofac Surg. 2005 Jun. 34(4):376-81. [QxMD MEDLINE Link].
Talley RL, Murphy GJ, Smith SD, Baylin MA, Haden JL. Standards for the history, examination, diagnosis, and treatment of temporomandibular disorders (TMD): a position paper. American Academy of Head, Neck and Facial Pain. Cranio. 1990 Jan. 8(1):60-77. [QxMD MEDLINE Link].
Alonso LL, Purcell TB. Accuracy of the tongue blade test in patients with suspected mandibular fracture. J Emerg Med. 1995 May-Jun. 13(3):297-304. [QxMD MEDLINE Link].
Schuknecht B, Graetz K. Radiologic assessment of maxillofacial, mandibular, and skull base trauma. Eur Radiol. 2005 Mar. 15(3):560-8. [QxMD MEDLINE Link].
Totten VY, Zambito RF. Propofol bolus facilitates reduction of luxed temporomandibular joints. J Emerg Med. 1998 May-Jun. 16(3):467-70. [QxMD MEDLINE Link].
Young AL, Khan J, Thomas DC, Quek SY. Use of masseteric and deep temporal nerve blocks for reduction of mandibular dislocation. Anesth Prog. 2009 Spring. 56(1):9-13. [QxMD MEDLINE Link]. [Full Text].
Awant MN. A New Approach to the Reduction of Acute Dislocation of the Temporomendibular Joint: A Report of Three Cases. British Journal of Oral and Maxillofacial surgery. 1987. 24:244-249.
Chen YC, Chen CT, Lin CH, Chen YR. A safe and effective way for reduction of temporomandibular joint dislocation. Ann Plast Surg. 2007 Jan. 58(1):105-8. [QxMD MEDLINE Link].
Ardehali MM, Kouhi A, Meighani A, Rad FM, Emami H. Temporomandibular joint dislocation reduction technique: a new external method vs. the traditional. Ann Plast Surg. 2009 Aug. 63(2):176-8. [QxMD MEDLINE Link].
Shorey CW, Campbell JH. Dislocation of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Jun. 89(6):662-8. [QxMD MEDLINE Link].
Ziegler CM, Haag C, Mühling J. Treatment of recurrent temporomandibular joint dislocation with intramuscular botulinum toxin injection. Clin Oral Investig. 2003 Mar. 7(1):52-5. [QxMD MEDLINE Link].
Segami N. A modified approach for eminectomy for temporomandibular joint dislocation under local anaesthesia: report on a series of 50 patients. Int J Oral Maxillofac Surg. 2018 Nov. 47 (11):1439-1444. [QxMD MEDLINE Link].
Yoshida K. Botulinum Neurotoxin Injection for the Treatment of Recurrent Temporomandibular Joint Dislocation with and without Neurogenic Muscular Hyperactivity. Toxins (Basel). 2018 Apr 25. 10 (5):[QxMD MEDLINE Link].
Chhabra S, Chhabra N, Gupta P Jr. Recurrent Mandibular Dislocation in Geriatric Patients: Treatment and Prevention by a Simple and Non-invasive Technique. J Maxillofac Oral Surg. 2015 Mar. 14 (Suppl 1):231-4. [QxMD MEDLINE Link].
AO Trauma Classification Study Group . The Comprehensive AO CMF Classification System for Mandibular Fractures: A Multicenter Validation Study. Craniomaxillofac Trauma Reconstr. 2019 Dec. 12 (4):254-265. [QxMD MEDLINE Link].
Kotimäki J, Saarinen A. [Treatment of recurrent dislocation of the temporomandibular joint with botulinum toxin: an alternative approach]. Duodecim. 2011. 127 (19):2088-91. [QxMD MEDLINE Link].
Bauss O, Sadat-Khonsari R, Fenske C, Engelke W, Schwestka-Polly R. Temporomandibular joint dysfunction in Marfan syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 May. 97(5):592-8. [QxMD MEDLINE Link].
Chacon GE, Dawson KH, Myall RW, Beirne OR. A comparative study of 2 imaging techniques for the diagnosis of condylar fractures in children. J Oral Maxillofac Surg. 2003 Jun. 61(6):668-72; discussion 673. [QxMD MEDLINE Link].
Fonseca RJ, Walker RV, eds. Management of injuries to the temporomandibular joint region. Oral and Maxillofacial Trauma. Philadelphia: WB Saunders Co; 1991. 430-1.
Gassner R, Tuli T, Hachl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg. 2003 Feb. 31(1):51-61. [QxMD MEDLINE Link].
Laskin DM. Temporomandibular joint disorders. Frederickson JM, Krause CJ, eds. Otolaryngology: Head and Neck Surgery. St. Louis: Mosby-Yearbook; 1993. 1443-50.
Shun TA, Wai WT, Chiu LC. A case series of closed reduction for acute temporomandibular joint dislocation by a new approach. Eur J Emerg Med. 2006 Apr. 13(2):72-5. [QxMD MEDLINE Link].
Thexton A. A Case of Ehlers-danlos Syndrome Presenting with Recurrent Dislocation of the Temporomandibular Joint. Br J Oral Surg. 1965 Mar. 3:190-3. [QxMD MEDLINE Link].
van der Linden WJ. Dislocation of the mandibular condyle into the middle cranial fossa: report of a case with 5 year CT follow-up. Int J Oral Maxillofac Surg. 2003 Apr. 32(2):215-8. [QxMD MEDLINE Link].

Media Gallery

The temporomandibular joint.
Classic reduction technique. The physician places gloved thumbs on the patient's inferior molars bilaterally, as far back as possible. The fingers of the physician are curved beneath the angle and body of the mandible.
Recumbent approach. The patient is placed recumbent, and the physician stands behind the head of the patient. The physician places his or her thumbs on the inferior molars and applies downward and backward pressure until the jaw pops back into place.
Wrist pivot method. The patient is placed in a sitting position, and the physician stands facing the patient. The physician grasps the mandible at the apex of the mentum with both thumbs. The fingers are placed on the inferior molars.
Ipsilateral approach - extraoral route. The patient is placed in a sitting position, and the physician stands behind the patient. The physician stabilizes the patient's head with his or her nondominant hand and uses the dominant hand to apply downward pressure on the displaced condyle that is palpated just inferior to the zygomatic arch.

of 5

Author

Meher Chaudhry, MD Emergency Medicine, Team Health, University of Tennessee Medical Center

Meher Chaudhry, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

James E Keany, MD, FACEP Associate Medical Director, Emergency Services, Mission Hospital Regional Medical Center, Children's Hospital of Orange County at Mission

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, California Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Christian D McClung, MD, MPhil(Cantab) Staff Physician, Department of Emergency Medicine, Los Angeles County/University of California Medical Center

Disclosure: Nothing to disclose.

Edward J Newton, MD, FACEP, FRCPC Professor of Clinical Emergency Medicine, Chairman, Department of Emergency Medicine, University of Southern California Keck School of Medicine

Disclosure: Nothing to disclose.

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Mandible (TMJ) Dislocation Guidelines

Guidelines Summary

References

Tables

Contributor Information and Disclosures

What would you like to print?