A dislocated jaw, formally known as temporomandibular joint (TMJ) dislocation, occurs when the lower jawbone, or mandible, slips out of its correct position within the socket of the skull. This condition immediately disrupts the joint’s function, which is responsible for chewing, speaking, and swallowing. A dislocated jaw is considered a medical emergency that requires immediate professional attention. The process of repositioning the jaw, known as reduction, must be performed by a healthcare professional to prevent further damage. A layperson should never attempt to manipulate or fix the jaw back into place.
Recognizing the Emergency and Necessary Safety Precautions
The symptoms of a dislocated jaw are usually severe and obvious. A person will find themselves unable to close their mouth, or their teeth may not align properly, giving the jaw a visibly shifted or lopsided appearance. Pain is severe, concentrated around the joint just in front of the ear. The inability to close the mouth often leads to excessive drooling and garbled speech. In rare instances, severe misalignment or trauma can cause difficulty breathing or significant bleeding, requiring an immediate call for emergency services.
The most important safety precaution is to avoid any attempt at self-reduction; never try to force, push, or manipulate the jaw back into its socket. Improper manipulation can cause severe damage to the temporomandibular joint capsule, ligaments, facial nerves, and blood vessels. The jaw muscles, particularly the masseter and temporalis, often go into painful spasm following dislocation. This spasm actively resists any amateur attempt at relocation, and forcing the joint against this contraction can worsen the injury and complicate the professional reduction procedure.
Immediate Steps While Awaiting Medical Attention
While awaiting medical attention, the focus must be on pain management and gentle stabilization of the head and jaw. Applying a cold compress or ice pack, wrapped in a cloth, to the affected area can help reduce swelling and numb the pain. This cold therapy should be applied for periods of 15 to 20 minutes at a time.
To help stabilize the jaw and prevent excessive movement, a soft bandage or scarf can be used to gently support the chin and head. This involves looping the material under the chin and tying it over the top of the head to minimize movement without applying forceful pressure. The patient should be seated upright, which helps manage drooling due to the inability to close the mouth and aids in keeping the airway clear.
Avoid consuming food or liquid. If absolutely necessary, only soft foods or thin liquids that require no chewing or wide opening of the mouth should be consumed. Over-the-counter anti-inflammatory pain relievers, such as ibuprofen, may be taken to manage inflammation and discomfort until professional treatment begins. Keeping the patient calm and still is important, as anxiety and movement can increase muscle tension and pain.
How Healthcare Professionals Perform Jaw Reduction
Once under medical care, manual reduction is typically performed by an emergency physician or an oral surgeon. The success of the procedure relies heavily on relaxing the powerful jaw muscles that have gone into spasm. To achieve this, the patient often receives intravenous analgesia for pain and a muscle relaxant or sedative to ease tension in the masseter and temporalis muscles.
The classic technique used is a variation of the Hippocratic maneuver. This involves the provider placing their protected thumbs (wrapped in gauze) onto the back molars inside the mouth, with fingers curled around the outside of the mandible underneath the chin. The primary action is to apply firm, steady downward pressure on the molars to disengage the mandibular condyle from the bony eminence it is locked behind.
After the condyle is disengaged by the downward force, the physician applies a gentle backward and upward force to guide the jaw back into its socket. The jaw often snaps back into place abruptly, requiring the provider to protect their thumbs from being bitten when the mouth suddenly closes. For protracted or chronic dislocations, local anesthetic may be injected directly into the joint space or the muscles to aid in relaxation before the reduction attempt.
Post-Treatment Care and Preventing Recurrence
After a successful reduction, the jaw joint and surrounding ligaments require a period of rest and protection to heal correctly. Healthcare professionals advise a restricted jaw movement regimen for several days to weeks. This includes being placed on a soft diet, such as soups, mashed potatoes, and smoothies, to minimize the need for chewing and wide opening.
Patients may be instructed to wear a specialized jaw bandage, such as a Barton bandage, for a short period to limit maximal mouth opening and support the joint while ligaments recover. Avoiding activities that strain the joint is necessary, including refraining from yelling, singing loudly, or taking large bites of food. When the urge to yawn or sneeze occurs, the person should place a closed fist under the chin to press upward, preventing the jaw from opening too widely.
For individuals with chronic or recurrent dislocations, long-term prevention strategies may include specific jaw exercises or injections of Botulinum toxin A into the lateral pterygoid muscle to reduce its pulling power. The goal is to avoid the excessive forward movement of the jaw that caused the initial dislocation. Following all post-reduction instructions is important to prevent the joint from becoming unstable and dislocating again.