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Jaw Dislocation, Temporomandibular Joint

Injury and displacement of the end of the lower jaw from its normal niche in a small depression at the base of the skull.

BODY PARTS INVOLVED

• Skull.
• Lower jaw (mandible).
• Soft tissue surrounding the dislocation, including nerves, tendons, ligaments, muscles, and blood vessels.

Causes

• Direct blow to the jaw.
• Any action that forces the mandible open wider than its normal range on either side. Muscle spasm follows immediately.This can occur with yawning, yelling or taking a very large bite.
• End result of a severe Jaw sprain.

Signs & Symptoms

• Inability to close the mouth.
• Excruciating pain in the jaw at the time of injury.
• Visible deformity if dislocated bones lock in the dislocated position. If they spontaneously reposition themselves, no deformity will be apparent, but damage will be the same.
• Tenderness over the dislocation.
• Swelling and bruising around the jaw.
• Numbness or paralysis in muscles of the face, jaw and neck from pressure, pinching or cutting of blood vessels or nerves.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Continue ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
• After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use hot compresses, heat lamps, pads, or heat ointments and liniments.
• If you have recurrent jaw dislocations, you can learn to reposition the jaw. Ask your doctor or dentist for instructions.Use the following points as reminders:

1. Place your index finger on your back lower teeth (or gums in this area if you have no teeth).
2. At the same time, place both thumbs under the center of your chin.
3. Push the fingers down while simultaneously raising upward with the thumbs.The proper motion is more of a rotating movement than a straight one. It should be gentle-not fast or jerking.

Note: It is probably easier for someone else to perform the relocation than for you to do it.

MEDICATION

Your doctor may prescribe:

• General anesthesia or muscle relaxants to make jaw manipulation easier.
• Acetaminophen or aspirin to relieve moderate pain.
• Narcotic pain relievers for severe pain.

Physical therapy and mechanical devices

Patients who have difficulty with bruxism are usually treated with splints. A plastic splint called a nightguard is given to the patient to place over the teeth before going to bed. Splints can also be used to treat some cases of internal derangement by holding the jaw forward and keeping the disc in place until the ligaments tighten. The splint is adjusted over a period of two to four months.

TMJ can also be treated with ultrasound, electromyographic biofeedback , stretching exercises, transcutaneous electrical nerve stimulation , stress management techniques, or friction massage.

Home Diet

If a mouth appliance is necessary, drink a full liquid diet until the appliance can be removed. If no appliance is necessary, eat a soft diet for a few days until discomfort decreases. Avoid chewy foods that require big bites for a while. Include extra protein, such as meat, fish, poultry, cheese, milk and eggs.

Prevention Tips

For participation in contact sports, wear protective equipment, including a mouthpiece and helmet.