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MandibleDislocation

MandibleDislocation
Author:MeherChaudhry,MDChiefEditor:RickKulkarni,MDmore...
Updated:Mar19,2014

Background
Mandibledislocationisthedisplacementofthemandibularcondylefromthearticulargrooveinthetemporalbone.
Differenttypesofdislocationscanresultfromtraumaticandnontraumaticprocesses.Mostdislocationsare
managedandreducedintheemergencydepartmentwithelectivefollowup.However,somesituationsrequire
immediateconsultationwithanoromaxillofacialsurgeon.Thisarticlefocusesprimarilyonthediagnosisand
managementofmandibledislocationsinadults.

Anatomy
Thetemporomandibularjoint(TMJ)(seetheimagebelow)isthearticularsurfacebetweenthemandibularcondyles
andthetemporalbone.Synovialmembraneslinethespacebetweenthetwobones.Thejointactswithahingeas
wellasaglidingmechanism. [1]

Thetemporomandibularjoint.

Thetemporomandibularligament,sphenomandibularligament,andcapsularligamentsupportthejoint.Blood
supplyisfromthesuperficialtemporalbranchoftheexternalcarotidartery.Branchesfromtheauriculotemporaland
massetericdivisionsofthemandibularnerveinnervatethejoint.
Closingofthemandibleisperformedbythemasseter,temporalis,andmedialpterygoidmuscle.Thejawopensat
thetemporomandibularjointbytractiononthemandibularneckbythelateralpterygoidmuscle.

Pathophysiology
Themandiblecandislocateintheanterior,posterior,lateral,orsuperiorposition.Descriptionofthedislocationis
basedonthelocationofthecondyleincomparisontothetemporalarticulargroove. [1]
Anteriordislocationsarethemostcommonandresultindisplacementofthecondyleanteriortothearticular
eminenceofthetemporalbone.Thesedislocationsareclassifiedasacute,chronicrecurrent,orchronic.
Acutedislocationscanbeseenaftertraumaordystonicreactions,buttheyareusuallyaresultofextreme
mouthopeningsuchaswithyawning,generalanesthesia,dentalextraction,vomiting,orseizures.Anterior
dislocationsafterendoscopicprocedureshavealsobeenreported. [2]
Anteriordislocationsareusuallysecondarytoaninterruptioninthenormalsequenceofmuscleactionwhen
themouthclosesfromextremeopening.Themasseterandtemporalismuscleselevatethemandiblebefore
thelateralpterygoidmusclerelaxesresultinginthemandibularcondylebeingpulledanteriortothebony
eminenceandoutofthetemporalfossa.Spasmofthemasseter,temporalis,andpterygoidmusclescauses
trismusandkeepsthecondylefromreturningintothetemporalfossa.Thesedislocationscanbeboth
unilateralandbilateral. [3]
Acutechronicdislocationsresultfromasimilarmechanisminpatientswithriskfactorssuchascongenitally
shallowmandibularfossa,lossofjointcapsulefrompreviousmandibledislocations,orhypermobility
syndromes.
ChronicdislocationsresultfromuntreatedTMJdislocationsandthecondyleremainsdisplacedforan
extendedtimeperiod.Openreductionisoftenrequired. [4,5,6]
Posteriordislocationstypicallyoccursecondarytoadirectblowtothechin.Themandibularcondyleispushed
posteriorlytowardthemastoid.Injurytotheexternalauditorycanalfromthecondylarheadmayoccurfromthistype
ofinjury. [1,7]
Superiordislocations,alsoreferredtoascentraldislocations,canoccurfromadirectblowtoapartiallyopened
mouth.Theangleofthemandibleinthispositionpredisposesupwardmigrationofthecondylarhead.Thiscan
resultinfractureoftheglenoidfossawithmandibularcondyledislocationintothemiddleskullbase.Furtherinjuries
fromthistypeofdislocationcanrangefromfacialnerveinjury,tointracranialhematomas,cerebralcontusion,
leakageofcerebrospinalfluid,anddamagetotheeighthcranialnerveresultingindeafness. [8]
Lateraldislocationsareusuallyassociatedwithmandiblefractures. [9,1]Thecondylarheadmigrateslaterallyand
superiorlyandcanoftenbepalpatedinthetemporalspace. [10]

Epidemiology
Frequency
Mandibulardislocationsareinfrequentpresentationstotheemergencydepartment.Loweryetalreportedseeing37
dislocationsovera7yearperiodinanemergencysettingwithapproximately100,000annualvisits. [3]Anterior
mandibledislocationsaremostcommonandoftenresultfromnontraumaticcauses.

Mortality/Morbidity
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MandibleDislocation

Significantmorbidityassociatedwithisolatedmandibledislocationsisrare.However,fracturesofthemandible,
maxillofacial,ororbitalbonesareoftenseenwithtraumaticTMJdislocations.
Mandibulardislocationsmaybeassociatedwithchronicrecurrentdislocations,ischemicnecrosisofthecondylar
head,traumaticdamagetothearticulardisk,andmandibularosteomyelitis.Chronicuntreateddislocationscan
resultinpermanentmalocclusion. [9,11,12]
Mortalityincasesofmandibulardislocationisusuallyaresultofconcurrentserioustraumaticinjuriesandnotfrom
thedislocationitself.

ContributorInformationandDisclosures
Author
MeherChaudhry,MDEmergencyMedicine,TeamHealth,UniversityofTennesseeMedicalCenter
MeherChaudhry,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergency
PhysiciansandSocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
Coauthor(s)
AdamJRosh,MDAssistantProfessor,ProgramDirector,EmergencyMedicineResidency,Departmentof
EmergencyMedicine,DetroitReceivingHospital,WayneStateUniversitySchoolofMedicine
AdamJRosh,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergencyMedicine,
AmericanCollegeofEmergencyPhysicians,andSocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
JamesEKeany,MD,FACEPAssociateMedicalDirector,EmergencyServices,MissionHospitalRegional
MedicalCenter,Children'sHospitalofOrangeCountyatMission
JamesEKeany,MD,FACEPisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergency
Physicians,AmericanCollegeofSportsMedicine,andCaliforniaMedicalAssociation
Disclosure:Nothingtodisclose.
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenter
CollegeofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:MedscapeSalaryEmployment
JohnDHalamka,MD,MSAssociateProfessorofMedicine,HarvardMedicalSchool,BethIsraelDeaconess
MedicalCenterChiefInformationOfficer,CareGroupHealthcareSystemandHarvardMedicalSchoolAttending
Physician,DivisionofEmergencyMedicine,BethIsraelDeaconessMedicalCenter
JohnDHalamka,MD,MSisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergency
Physicians,AmericanMedicalInformaticsAssociation,PhiBetaKappa,andSocietyforAcademicEmergency
Medicine
Disclosure:Nothingtodisclose.
ChiefEditor
RickKulkarni,MDAttendingPhysician,DepartmentofEmergencyMedicine,CambridgeHealthAlliance,
DivisionofEmergencyMedicine,HarvardMedicalSchool
RickKulkarni,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanAcademyof
EmergencyMedicine,AmericanCollegeofEmergencyPhysicians,AmericanMedicalAssociation,American
MedicalInformaticsAssociation,PhiBetaKappa,andSocietyforAcademicEmergencyMedicine
Disclosure:WebMDSalaryEmployment
AdditionalContributors
ChristianDMcClung,MD,MPhil(Cantab)StaffPhysician,DepartmentofEmergencyMedicine,LosAngeles
County/UniversityofCaliforniaMedicalCenter
Disclosure:Nothingtodisclose.
EdwardJNewton,MD,FACEP,FRCPCProfessorofClinicalEmergencyMedicine,Chairman,Departmentof
EmergencyMedicine,UniversityofSouthernCaliforniaKeckSchoolofMedicine
Disclosure:Nothingtodisclose.
TomScaletta,MDPresident,SmartER(http://smarter.net)Chair,DepartmentofEmergencyMedicine,
EdwardHospitalPastPresident,AmericanAcademyofEmergencyMedicine
TomScaletta,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergencyMedicine
Disclosure:Nothingtodisclose.

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