A 53yoM presents with bilateral TMJ dislocation which he has had in the past. He receives procedural sedation and multiple attempts at reduction using conventional methods with no success. What can be done now?

Answer: Attempt the wrist pivot method. Mandible is grasped with thumbs under submental area (pointing toward apex) and fingers curved on occlusal surface of inferior molars. While placing upward pressure under the mentum and downward pressure on fingers, pivot wrists using the angle of mandible as a fulcrum to rotate joints back into position.