The use of only one hand for the reduction of a temporomandibular joint dislocation: a technique suitable for self-reduction

We read with interest the case report on temporomandibular joint (TMJ) dislocation by Baur et al. We believe that a surgical intervention is one of the options for the long-term dislocation case. However, once an acute dislocation of the TMJ has been established, attempts at manual reduction should be made as soon as possible. Previously reported methods of manual reduction, including Hippocrates’ method, require the operator to use both hands, and the skill of the operator in performing the reduction is essential. In recent years we have used a reduction method that requires the use of only one hand for acute unilateral and bilateral TMJ dislocations. This reduction method, which requires minimal force, is easier than previously reported methods. Almost all patients will be able to reduce the dislocated TMJ easily themselves using this technique, after brief instructions.

At reduction, the patient does not need to assume a special position; the reduction can be made in either a supine or sitting position. The patient is asked to relax and open the mouth slightly. The thumb of the operator is placed over the occlusal surface of the posterior mandibular teeth on the affected side of the mandible, or, for the edentulous patient, over the alveolar ridge. The hand used for the procedure should be the opposite one to the affected side; for example, for a TMJ dislocation on the left side, the operator uses the thumb of the right hand. The remaining fingers, middle finger and/or medical finger, are placed under the inferior border of the chin. Next, the patient is asked to close their mouth slowly. Simultaneously, the operator twists his/her wrist and pushes upward on the chin with the middle finger and/or medical finger using the thumb as a fulcrum ( Fig. 1 ). With this one-hand action as the leverage, a large downward momentum is generated on the TMJ. For a bilateral dislocation, one side, typically the more affected one, should be reduced first. In many cases, the other side of the bilateral dislocation will be reduced automatically following the first side reduction.

Fig. 1
One-hand reduction method. A large downward momentum is generated on the TMJ by pushing the chin upward. Dotted line: virtual axis of rotation.

Once the reduction is obtained, the patient is asked whether they would like to learn this technique. If so, the patient is then instructed on the use of this procedure, as described above, using the figure ( Fig. 1 ). Afterwards, the patient is asked to open and close their mouth slowly. While the mouth is closing, the operator pulls the patient’s chin forward, easily reestablishing the dislocation of the TMJ. Next, the patient attempts the TMJ reduction by following the method as instructed ( Fig. 2 ). Typically, the self-reduction is made within one or two attempts.

Jan 19, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on The use of only one hand for the reduction of a temporomandibular joint dislocation: a technique suitable for self-reduction
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