The next time you have a patient with a dislocated jaw, hand them a 5cc or 10 cc syringe and tell them to stop, drop, bite and roll!
Two Texas hospital Emergency Departments have recently combined to perform a study on a novel technique for reducing non-traumatic temporomandibular dislocations in the ED. The study was limited in that it had a small sample size of 31 patients, however, the results are impressive. Of the 31 patients, 30 had successful reductions, and of the 30, 71% were obtained within less than a minute. Another advantage is that this procedure does not call for sedation.
1. Select either a 5cc or 10 cc syringe based off of how wide they are able to open their mouth on the affected side.
2. In the seated position, have the patient bite down gently on the affected side with the syringe seated between the posterior upper and lower molars
3. Have the patient gently roll the syringe back and forth using his teeth and jaw muscles
4. This fulcrum motion should be enough to gently glide the mandible posteriorly and back into its home!
The authors in the study recommend this for bilateral dislocations as well, doing one side at a time.
This differs significantly from the typical manual reduction that often requires analgesia, and at times, multiple attempts (see diagram below for typical reduction technique)
Gorchynski J, Karabidian E, Sanchez M. The Syringe Technique: A Hands-Free Approach for the Reduction of Acute Nontraumatic Temporomandibular Dislocations in the Emergency Department. J Emerg Med. 2014 Sep 29