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Temporomandibular joint (TMJ) dislocation management for sports medicine professionals

This is an excerpt from Acute and Emergency Care in Sports Medicine 2nd Edition by Katie Walsh Flanagan,Patrick Sexton.

Dislocation of the Temporomandibular Joint

Dislocation of the temporomandibular joint (TMJ) can be unilateral or bilateral as well as chronic or acute. Dislocation involves the disarticulation of the mandibular condyle and the temporal bone. Anterior dislocation is most common; other types of dislocation, including posterior dislocation, are mostly associated with trauma.⁸⁶ The MOI includes a blow to the contralateral mandible, especially when the patient is chewing or talking, because the joint is less stable when the jaw is open. Another MOI is over-opening the mouth, such as with an exaggerated yawn.

Risk Factors

Dislocation of the TMJ is related to structural deficits (e.g., a shallow joint, arthritis, dental age) or neuromuscular dysfunction (e.g., capsular or ligamentous laxity, muscle spasm).²⁵ Other causes include forceful yawning or laughing, excessive or prolonged vomiting, seizures, and dental work. The condition has also been associated with facial dystonia and Marfan syndrome. Risk factors for sports-related mandibular dislocations were listed previously, in the Risk Factors subsection of the Mandibular Fractures section.

Signs and Symptoms

The most common clinical sign of TMJ dislocation is an inability to close the mouth, often called open lock. Other symptoms include pain, difficulty speaking, difficulty swallowing, and drooling. TMJ dislocation can present with malocclusion, as can a mandibular fracture.

Field Assessment Techniques

A TMJ dislocation is typically obvious to the HCP. The patient is unable to move their mandible and communicates with a barely open mouth by moving the lips only. Upon palpation of bilateral TMJs, the deformity is apparent. Palpation continues along the ramus bilaterally to the center for crepitus, deformity, or swelling. The HCP uses gloved hands to move the lips to assess for upper or lower dental or mouth bleeding. The maxilla is also palpated for pain and swelling to determine whether the force of the injury also injured the maxilla.

Immediate Management Techniques

To differentiate between a true TMJ injury and a mandibular injury, the HCP should palpate the TMJ for crepitus, deformity, or dislocation. Pain and movement of the mandible itself may indicate the presence of a fracture. Pain only at the TMJ may indicate the presence of a dis-location. Lateral movement of the jaw may reduce the dislocation, but referral to a physician is still indicated. An inability to open or fully close the mandible warrants prompt referral.

Transportation Criteria and Techniques

If a patient is having challenges breathing or swallowing with a mandibular dislocation, transport the patient for additional medical care. Keep in mind that some mandibular injuries create bleeding from the lower rows of teeth, and patients cannot adequately swallow with an open mouth. They may prefer to sit up and lean forward, or have a gauze pad to drool into, which will assist in keeping the airway free of blood. Patients with a suspected mandibular dislocation and associated airway challenges should be transported in a semirecumbent or upright seated position to support breathing. Travel via ambulance is recommended so the HCP can provide breathing assistance via transport to the hospital.

More Excerpts From Acute and Emergency Care in Sports Medicine 2nd Edition

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