The “Syringe” Technique: A Hands-Free Approach for the Reduction of Acute Nontraumatic Temporomandibular Dislocations in the Emergency Department

Abstract

, Abstract-Background: The traditional intraoral manual reduction of temporomandibular joint (TMJ) dislocations is time consuming, difficult, and at times ineffective, and commonly requires conscious sedation. Objectives: We describe a novel technique for the reduction of acute nontraumatic TMJ dislocations in the emergency department (ED). Methods: This study was a prospective convenience sample population during a 3-year period at two university teaching-hospital EDs where acute nontraumatic TMJ dislocations were reduced utilizing our syringe technique. Demographics, mechanism, duration of dislocation, and reduction time were collected. Briefly, the ''syringe'' technique is a hands-free technique that requires a syringe to be placed between the posterior molars as they slide over the syringe to glide the anteriorly displaced condyle back into its normal anatomical position. Procedural sedation or intravenous analgesia is not required. Results: Of the 31 patients, the mean age was 38 years. Thirty patients had a successful reduction (97%). The majority of dislocations were reduced in <1 min (77%). The two most common mechanisms for acute TMJ dislocations were due to chewing (n = 19; 61%) and yawning (n = 8; 29%). There were no recurrent dislocations at 3-day followup. Conclusion: We describe a novel technique for the reduction of the acutely nontraumatic TMJ dislocation in the ED. It is simple, fast, safe, and effective. Ó 2014 Elsevier Inc.

Temporomandibular joint dislocation: a retrospective study from a Swiss urban emergency department

“…The balanced gender distribution is in contrast with the international literature, in which female predominance is reported. 5 , 23 On the contrary, the median age seems to be the same as in other studies. 23 …”

“…Other studies have focused on relocation procedures during TMJ dislocation 13 or have proposed new techniques. 23 – 26 We aimed to analyze systematically the patients who presented with TMJ dislocation in our ED, their characteristics, and the treatment methods that they had received.…”

“…A previous study reported that of the 31 patients, only nine (29%) had previously suffered TMJ dislocation. 23 However, they only analyzed acute, nontraumatic patients with TMJ dislocation and as a result, no comparison can be performed.…”

The Treatment of Temporomandibular Joint Dislocation

“…According to the recommendation of the group of authors, attention should be paid that the fingers are placed not on, but lateral to the occlusal surfaces of the mandibular molars when using the modified Hippocratic technique (GoR B; LE V; expert consensus). In recent years, some studies presenting novel reduction methods have been published, but due to the small number of cases and the lack of control groups their statistical power is limited (13,24,25).…”

An Uncommon Upper Gastrointestinal System Endoscopy Complication: Temporomandibular Joint Dislocation

“…A few different methods that have been reported in the current literature for reduction of TMJ dislocation including the extraoral technique, combining the extraintraoral route, the gag reflex procedure, syringe technic. [7][8][9][10] TMJ dislocation can be considered as a complication of the upper gastrointestinal system endoscopy and endoscopists must be susceptible in case of this clinical aspect. Avoiding from the hardened bite and excessive mouth opening is the major preventions for TMJ dislocation during endoscopy.…”