A case series of closed reduction for acute temporomandibular joint dislocation by a new approach.
OBJECTIVE
The management of acute temporomandibular joint dislocation relies on the traditional method, which involves intraoral manipulation of the mandible on both sides of the patient. Often, intravenous sedative or analgesic agents are needed to facilitate closed reduction. In this report, the authors introduce a new approach called the ipsilateral approach, in which extraoral or intraoral manipulation of the dislocated side is performed to accomplish closed reduction, without using sedatives or analgesics. Three methods, namely, extraoral, intraoral and combined, are described.


METHODS
A prospective observational study was performed to investigate this ipsilateral approach. Six medical officers were recruited to attend to patients with acute temporomandibular joint dislocation. The following protocol was used: (1) Try the extraoral method in all patients first. (2) If it fails, use the intraoral method. (3) If both fail, attempt using a combined method. (4) If all fail, perform the traditional method as usual.


RESULTS
A total of 24 episodes of temporomandibular joint dislocation were examined, out of which 13 were successfully reduced by the extraoral method. Of the remaining 11 episodes, 10 were successfully reduced by the intraoral method, the last case being reduced by the combined method. None of them requires sedation or analgesia.


CONCLUSIONS
This ipsilateral approach, using extraoral and intraoral methods, is cost-effective, simple and convenient for the management of acute temporomandibular joint dislocation.
Shun
Thomas Au Tak
TA
Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, PR China. atsthomas04@yahoo.com.hk
Wai
Wong Tai
WT
Chiu
Lau Chor
LC
D004636:Emergency Service, Hospital; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy*; D008349:Manipulation, Orthopedic / Q000379:methods*; D011446:Prospective Studies; D012008:Recurrence; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology / Q000628:therapy*