JAW DISLOCATION, TEMPORO-MANDIBULAR JOINT |
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General Information
DEFINITION--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.
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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.
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.
RISK INCREASES WITH
Contact sports such as boxing.
Previous jaw dislocation or sprain.
Repeated injury to the temporo-mandibular joint.
HOW TO PREVENTFor participation in contact sports, wear protective equipment, including a mouthpiece and helmet.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment. This may include manipulating the joint to reposition the bones.
Surgery (sometimes) to restore the joint to its normal position. Acute or recurring dislocations may require surgical reconstruction or replacement of the joint.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the jaw.
POSSIBLE COMPLICATIONS
Temporary or permanent damage to nearby nerves or major blood vessels, causing numbness and impaired circulation.
Shock or loss of consciousness.
Obstruction of the airway and inhalation of mucus and blood into the lungs, leading to pneumonia. This occurs most often with dislocation and fracture.
Excessive internal bleeding around the dislocation site.
Proneness to recurrent jaw dislocations, particularly if a previous dislocation has not healed completely.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the joint may require immobilization for 2 to 8 weeks with a special device fitted by your doctor or dentist. Complete healing of injured ligaments requires a minimum of 6 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Don't panic--try to stay calm. You will not be able to talk. Write messages on paper.
Don't push or force your mouth or try to make it close. Your mouth cannot close in a normal way until the dislocation is corrected.
Keep warm with blankets to decrease the possibility of shock.
Ice helps stop internal bleeding. Prepare an ice pack of ice cubes or chips wrapped in plastic or a container. Place a towel over the injured area to prevent skin damage. Apply ice for 20 minutes, then rest 10 minutes until you obtain medical treatment.
Go to the nearest dental office or hospital emergency room for help.
CONTINUING CARE
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, heating 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.
R It is probably easier for someone else to perform the relocation than for you to do it.
MEDICATIONYour 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.
ACTIVITYNo restrictions except those imposed by a mouth appliance. Resume your normal activities gradually over several days. After the dislocation has been corrected, use caution when opening your mouth. Be careful when you yawn, take large bites, yell or scream during excitement, call someone loudly or sing.
DIETIf 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.
REHABILITATIONRehabilitation exercises must be individualized. Follow your doctor's or surgeon's directions.
CALL YOUR DOCTOR IF
You have difficulty moving your jaw after injury.
Any part of the face becomes numb, pale, or cold after injury. This is an emergency!
Soft diet causes intestinal upset or constipation.
Jaw dislocations that you can "pop" back into normal position occur repeatedly.
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