Mandibular Reduction Without Losing Your Precious Thumbs
A patient with a nontraumatic anterior dislocation of the mandible can be a rewarding encounter as these patients arrive with significant discomfort and can frequently be discharged pain-free following reduction. However, the classic technique raises some issues:
- Due to spasm of the masseter muscle, it requires a great amount of inferior and posterior force
- Procedural sedation is often required with in order to allow for appropriate relaxation
- It requires the provider to place their thumbs inside the patients oral cavity, putting themselves at risk for injury after reduction when patients reflexively bite down
Luckily, there are newer techniques available to try. The “syringe” technique offers a hands-free approach to mandibular reduction without the use of procedural sedation!
- 5 or 10 mL syringe is placed between the posterior molars on the affected side
- Patient is instructed to attempt to bite down gently
- Have the patient slowly roll the syringe back and forth
- The mandible will self reduce by gliding into proper position
This technique utilizes the syringe as a rolling fulcrum to slide the mandible posteriorly. With the gliding motion, the displaced condyle will slip back into proper anatomical position with the patients own muscles providing the strength for repositioning. In their study, Gorchysnki et al. reported successful reduction in 30 of 31 patients, with no sedation or IV analgesia required. The majority (77%) of dislocations were reduced in less than one minute.
Pedigo, R.A. Dental Emergencies: Management Strategies That Improve Outcomes. EB Medicine: Emergency Medicine Practice. 2017;19(6), 16-17.
Gorchynski J, Karabidian E, Sanchez M. The “syringe” technique: a hands-free approach for the reduction of acute non-traumatic temporomandibular dislocations in the emergency department.
J Emerg Med. 2014;47(6):676-681. Schraga, Erik D. Reduction of Mandibular Dislocation. Medscape. Updated: Apr 03, 2017. http://emedicine.medscape.com/article/149318-overview