Mandibular Dislocation

What is a mandibular dislocation?

A mandibular dislocation is the movement of your mandible (lower jaw) out of place. When you have a mandibular dislocation, your lower jaw does not go back in place on its own. Normally, your upper and lower jaw bones meet in front of your ears, at the temporomandibular joint (TMJ). This joint is like the hinge of a door that lets you open or close your mouth. Your jawbones are held together and supported by ligaments and muscles. With mandibular dislocation, one or both sides of your lower jaw may be moved away from the TMJ. Your lower jaw may have moved forward, backward, up or down, or to the side. A mandibular dislocation may occur suddenly and may become chronic (long-lasting) and happen again and again.

What causes a mandibular dislocation?

Any of the following may cause, or increase your risk of having a mandibular dislocation:

• Opening the mouth too wide: This may happen when you laugh, yawn, sneeze, take large bites, or vomit (throw up). Some open mouth or dental (teeth) procedures may weaken the muscles around your TMJ and lead to dislocation.
  
  
• Teeth problems: These include having teeth that are worn out, missing, or not lined up correctly.
  
  
• Trauma: Mandibular dislocation may be caused by a blow (hit) to your chin while your mouth is open. This occurs most often in car, motorcycle, or bicycle accidents.
  
  
• Unstable joint: You may have a dislocation if your upper and lower jaw bones do not fit together well. This may happen if your jaw ligaments are weak or your jaw muscles become too tight. Weak muscles or ligaments may be caused by frequent seizures (convulsions). Side effects of certain medicines may also cause your ligaments and muscle to be weak.

What are the signs and symptoms of a mandibular dislocation?

You may have any of the following:

• Dimpling in front of your ear.
  
  
• Drooling.
  
  
• Lockjaw, not able to close or open your mouth, or cannot move your lower jaw from side to side.
  
  
• Pain and swelling in front of your ear.
  
  
• Teeth that do not line up right.
  
  
• Trouble speaking, eating, or drinking.
  
  
• Unequal sides of your face.

How is a mandibular dislocation diagnosed?

Your caregiver will take your detailed history, including what happened before your jawbone went out of place. Let your caregiver know if your jawbone has dislocated before. Also let your caregiver know if other procedures have been tried to treat your problem. Your caregiver will carefully check your jaw and face. He will look for signs of a mandibular dislocation or other problems, such as a broken bone. You may also have any of the following:

• Computed tomography scan: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your jaw. It may be used to look at your bones and muscles. You may be given dye before the pictures are taken to help your caregiver see the pictures better. The dye is usually given through an IV. An IV is a tube placed in your vein for giving medicine or liquids. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
  
  
• Jaw x-ray: This is a picture of your jaw. It is used to check your bones and tissues. A jaw x-ray lets your caregiver look for out of place or broken bones. It also allows your caregiver to see how your jaw is healing. You may need more than one x-ray of your jaw.

How is a mandibular dislocation treated?

You may need any of the following:

• Medicines: Medicine may be given before your caregiver puts your jawbone back into the right position.
  
  
  • Anesthesia: This medicine puts you to sleep so you are comfortable while your jawbone is put in place. It may be a shot of numbing medicine or may be given IV. It may also be given as a gas that you breathe while you are asleep. Your caregiver will work with you to decide which anesthesia is best for you.
    
    
  • Muscle relaxer: This is medicine to help your tight jaw muscles relax.
    
    
  • Sedative: This medicine is given to help you stay calm and relaxed.
  
  
• Fixation devices: Wires or elastic bands may be used to prevent you from moving your jaw.
  
  
• Manual reduction: This is a procedure to put your jawbone back to its normal position. Your caregiver will push down your lower back teeth while pulling your chin up. Remove your dentures if you are wearing any before having this procedure. You may need a fixation device after your manual reduction.
  
  
• Sclerosing agent: This is a special chemical given as a shot into your TMJ. This helps tighten your jaw and prevents it from moving too much. You may need a fixation device after the use of a sclerosing agent.
  
  
• Physical therapy: This may be needed if you have had many jaw dislocations. A caregiver will work with you to help make the muscles around your jawbones stronger. This may help to stop your jawbone from dislocating again.
  
  
• Surgery: You may need surgery if other treatments have been tried and have not worked. It may also be needed if you have had your lower jaw out of place for a long time. Surgery may be done to tighten the ligaments around your TMJ and make it more stable. Changes in your jaw muscles may also be done to make them less tight. Your caregiver may cut or remove a part of your jaw to return bones to their normal position. Plates or screws may be used to hold your jawbones together.

What can I do to help treat my mandibular dislocation?

• Activities: After having a reduction, exercise your jaw by opening and closing your mouth many times a day. If possible, avoid activities that cause you to open your mouth widely, such as yawning and laughing. Support your jaw whenever you do these activities. A bandage may be wrapped around your head and jaw if you had a chronic dislocation. This may help stop your jaw from opening too wide and having another dislocation. You may also use a head-chin strap. Follow your caregiver's instructions about activities that may be helpful.
  
  
• Diet: You may need to stay on a soft diet for some time after your jaw is put back in place. Soft foods include applesauce, baby food, bananas, cooked cereal, cottage cheese, eggs, gelatin, pudding, and yogurt.
  
  
• Ice: Apply an ice pack over your TMJ area for up to 48 hours. Do not apply ice directly to the skin. Packages of small vegetables in a thin towel can be used instead of an ice pack.

When should I call my caregiver?

Call your caregiver if:

• Your symptoms do not get better, or get worse.
  
  
• You have questions about your condition, treatment or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your jawbone moves out of place again.
  
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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