Mandibular reduction

Patients who dislocate their mandible often present to the Emergency Department for care. Dislocation can occur after a variety of activities that hyperextend the mandible or open the mouth widely, such as yawning, laughing, or taking a large bite. Anterior dislocation is the most common type, in which the condylar head of the mandible dislocates out of the glenoid fossa anterior to the articular eminence of the temporal bone. These dislocations are often complicated by muscle spasm and trismus, making reduction more difficult. The emergency physician can often reduce the anterior mandibular dislocation with or without procedural sedation or local anesthesia. A variety of methods are available for closed reduction, including the classic approach and various alternatives such as the recumbent, posterior, and ipsilateral approaches, as well as the wrist pivot method, alternative manual technique, and gag reflex induction. This article will review the pathophysiology and clinical presentation of acute mandibular dislocations, as well as discuss the various closed reduction methods available for the practitioner.