Temporomandibular joint (TMJ) dislocation is a painful and acute condition where the lower jawbone, or mandible, slips out of its socket in the skull, located just in front of the ear. This displacement prevents the mouth from closing, resulting in a distressing and urgent medical situation. The joint’s rounded ends, called the condyles, move too far forward, often locking in front of a bony prominence known as the articular eminence. Because the jaw muscles immediately go into spasm, the condition rarely resolves without outside intervention, meaning professional medical attention is typically required for a safe and complete resolution.
Symptoms and Causes of Acute Dislocation
A sudden, acute TMJ dislocation is immediately recognizable because the person cannot bring their upper and lower teeth together, leaving the mouth fixed in an open position. This open-lock position leads to drooling and difficulty speaking clearly, which can cause significant distress. The face may appear visibly distorted, with the jaw shifted to one side or a noticeable depression in the cheek area just in front of the ear. Pain is often intense, localized near the joint, and is compounded by the powerful, involuntary clenching of the surrounding masticatory muscles.
Dislocations most commonly occur when the mouth is opened beyond its normal range, such as during a wide yawn, a hearty laugh, or when taking a large bite of food. Prolonged mouth-opening during dental procedures can also trigger an episode in susceptible individuals. Trauma, like a blow to the jaw, is another common cause, although this type of injury is more likely to involve a fracture. People with underlying conditions that cause joint hypermobility, where the ligaments are naturally loose, are at a higher risk for recurrent episodes.
What to Do Immediately and Self-Reduction
The first immediate step following a suspected jaw dislocation is to remain as calm as possible and seek medical evaluation, typically at an emergency department or from an oral surgeon. While waiting for medical help, the individual should find a supported, comfortable position and try to relax the jaw muscles. Applying a cold compress or an ice pack to the joint area for short intervals can help reduce swelling and lessen the intensity of the muscle spasms.
It is strongly advised to avoid attempting to force the jaw closed or perform any self-manipulation, especially if the injury resulted from a severe blow or trauma. A forceful maneuver could cause further injury, particularly if a fracture is present, which must first be ruled out by a medical professional. The risk of causing soft tissue damage or exacerbating the joint capsule injury outweighs the benefit of a quick fix for the average person.
In very rare, non-traumatic situations, a specific self-reduction technique may be successful if taught by a healthcare provider for recurrent episodes. This maneuver involves applying firm, steady downward and backward pressure on the back molar teeth with the thumbs. Simultaneously, the fingers placed under the chin attempt to push the jaw forward and up. This action aims to disengage the condyle from the articular eminence and guide it back into its socket. Because this technique carries the risk of the jaw snapping shut unexpectedly, professionals use gauze to protect their fingers and recommend against untrained attempts.
How Doctors Perform Joint Reduction
In a clinical setting, a healthcare professional assesses the jaw and typically orders X-rays to rule out an associated fracture, which would change the treatment approach. To facilitate reduction, intravenous medications are administered to relieve pain and induce muscle relaxation, overcoming the intense spasms that lock the joint. A short-acting benzodiazepine, such as midazolam, is commonly used for this purpose.
The most common method for manual repositioning is the Hippocratic technique, performed with the practitioner standing in front of the seated patient. The physician places gloved thumbs on the biting surface of the lower molars, wrapping fingers under the jaw’s body. The crucial first step is to apply strong, sustained downward pressure to disengage the condyle from the temporal bone.
Once the condyles are clear of the eminence, the second step guides the jaw backward until the joint snaps back into its correct fossa. Other techniques, such as the wrist pivot or extra-oral approaches, may be employed depending on the nature of the dislocation and the patient’s condition. Successful reduction provides immediate and significant relief, and post-reduction imaging confirms the condyle is correctly seated.
Minimizing the Risk of Future Episodes
After the joint has been successfully repositioned, the immediate focus shifts to protecting the TMJ to allow the stretched ligaments and surrounding tissues to heal. This post-reduction period typically requires the patient to maintain a soft or liquid diet for several days to a week, minimizing the strain on the recovering joint. Avoiding any activity that requires wide-mouth opening, such as yawning, shouting, or large bites, is instructed for approximately one to two weeks.
To further stabilize the jaw and limit movement, a specialized bandage, sometimes referred to as a Barton bandage, may be applied around the head and under the chin for a short time. For patients who experience recurrent dislocations, long-term preventative strategies are necessary to address chronic joint laxity. These can include physical therapy to strengthen the muscles, or the use of custom-fitted oral splints to restrict excessive jaw movement.
Advanced Treatments for Chronic Recurrence
Advanced treatments for chronic recurrence may involve non-surgical interventions like injecting botulinum toxin into the jaw muscles to reduce the force of spasm. In some cases, a small injection of the patient’s own blood or a sclerosing solution into the joint capsule is performed to encourage scarring and tighten the overly loose ligaments. If these measures fail, surgical options, such as tightening the joint capsule or altering the bony structures to block forward movement, may be considered by an oral and maxillofacial surgeon.