title: The "syringe" technique: a hands-free approach for the reduction of acute nontraumatic temporomandibular dislocations in the emergency department.
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.
  
  
  OBJECTIVE
  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 follow-up.
  
  
  CONCLUSIONS
  We describe a novel technique for the reduction of the acutely nontraumatic TMJ dislocation in the ED. It is simple, fast, safe, and effective.
authors.affiliation: Department of Emergency Medicine, Emergency Medicine Residency, JPS Health Network, Fort Worth, Texas.
authors.forename: Julie
authors.initials: J
authors.lastname: Gorchynski
authors.affiliation: Department of Biology, Graduate Studies, California State University Northridge, Northridge, California.
authors.forename: Eddie
authors.initials: E
authors.lastname: Karabidian
authors.affiliation: Department of Emergency Medicine, University of Texas Health Sciences Center, San Antonio, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Sanchez
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy*; D008297:Male; D008349:Manipulation, Orthopedic / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D013594:Syringes; D013705:Temporomandibular Joint Disorders / Q000628:therapy*; D055815:Young Adult
keywords: TMJ; acute; dislocation; emergency department; nontraumatic; procedures; reduction; temporomandibular