Jaw Dislocation

Introduction

• Jaw dislocation means dislocation of the lower jaw at the Temporo-mandibular Joint ( TMJ ). Jaw dislocation occurs when the lower jaw becomes dislodged at the Temporo-mandibular Joint (TMJ). This joint is responsible for the movement of the lower jaw during activities like eating and speaking. The upper jaw, on the other hand, remains stationary.
• We have two jaws-upper and lower jaw . During all the movements of the jaw, while eating and speaking, only the lower jaw moves. The upper jaw is fixed and does not move.

Explaining Jaw Dislocation and Its Causes

Jaw Dislocation is a condition where the head of the lower jaw (condyle) moves forward out of its functional position within the skull bone (glenoid fossa of temporal bone).

• The head of the lower jaw moves and lies in front of the articular eminence (a bony area) and gets locked in this position.
• It leads to stretching of the ligaments and severe spasms of the muscles resulting in severe pain in the mouth and the face with the inability to close the mouth .
• The resultant spasm prevents the condyle from returning back to its natural and normal position.

Risk Factors for Jaw Dislocation

Men and women with any of the following characteristics of the TM Joint are more prone to develop dislocation of the jaw-

• An anatomic mismatch between the fossa where the head of the lower jaw (condyle) sits and the articular eminence bone in the front,
• The weak capsule of the joint and
• Weak temporo-mandibular ligaments and
• If the ligaments are torn.

Patients who have had one episode of dislocation are predisposed to recurrence.

Causes Of Jaw Dislocation

• Extreme opening of the mouth during yawning, laughing or vomiting
• After injuries to face during sport
• Dislocation also can result from dystonic reactions to drugs,
• Seizures, or tetanus infection.
• Temporo-mandibular joint disorder (TMJ Disorder) with pain, abnormal jaw movements, and clicks.
• Most dental treatments require the patient to open his or her mouth wide for a long period of time, which makes it likely for the dislocation to occur in susceptible patients.

Types of Jaw Dislocation

Dislocation of the jaw can be acute and sudden or chronic and recurrent .

• If the dislocation is sudden and acute
• If the dislocation is recurrent and chronic

What are the symptoms of dislocation of the jaw?

TMJ Dislocation can be acute and sudden and can result in a locked jaw , or a jaw that sticks out forward

• The mouth remains open and the front teeth do not meet, due to the action of the elevator muscles with or without deviation to one side, and depending on whether the dislocation is one-sided or both-sided.
• The head of the lower jaw (mandible) is not in its usual position and the place is empty.
• A dislocated jaw can interfere with eating and sleeping. It will also feel stiff, swollen, and sore.
• Pain in the TMJ joint that gets worse when the jaw is moved.
• Upper and lower teeth don’t match properly.
• Unable to move the jaw or close mouth properly.
• Difficulty in speaking or swallowing.

Natural Recovery from Jaw Dislocation

TM Joint Dislocation may be reducible if the head of the lower jaw (condyle) returns spontaneously or irreducible when one or both the condyles of the lower jaw remain dislocated.

Diagnosis of Jaw Dislocation

Jaw dislocation is more of a clinical diagnosis. Once you visit us, we will examine you completely but will require the following investigations for confirmation of diagnosis-

• X-rays to See the status of your jaw.
• CT scan to provide detailed images of the bones involved in the joint.
• MRI for detailed analysis of the joint space, joint disk, or surrounding soft tissue. This is usually not done in TMJ dislocations.

Immediate Actions for a Dislocated Jaw

• Seek medical attention straight away if you think you have a dislocated jaw.
• Do not attempt to reduce it on your own.
• On the way to the hospital, hold the jaw in place with your hand or with a loose bandage.
• Never make the bandage too tight — you should be able to remove it easily in case you vomit.

After the jaw is back in place, you can control pain with medicines and a cold pack for 10 to 20 minutes at a time every 2 to 3 hours.

Prevention of Jaw Dislocation

• Use a mouth guard, helmet, or other safety equipment to protect your face during sport.
• Asking the patient to bite on a bite block and ensuring adequate rest during prolonged dental treatment.
• Take treatment for TMJ Disorder (pain, click).
• Do not open your mouth too wide.
• Do not avoid warning signs of dislocation.

How To Prevent Recurrent Jaw Dislocation

• Eat soft foods to chew less.
• Avoid chewing gum, don’t clench your jaw tightly.
• Do not open your mouth too wide.
• Wear a mouthguard at night to prevent grinding teeth
• R elaxation exercises to minimize stress.
• Exercises to strengthen the jaw can also help.

How is Jaw Dislocation treated at Kayakriti?

The treatment is decided in 3 key aspects:

A. Acute and sudden Jaw dislocation which ‘locks’ is an emergency and is reduced with a conservative approach. The Joint will be manipulated back into its correct position either manually or in a few cases by surgery.

• A local anesthetic will be given so as to not feel any pain, and medicines to relax muscles so that the jaw can be moved back into place properly.
• Once the jaw is back in place, it will need to be kept stable with bandages that prevent it from opening the mouth too wide.
• Care should be exerted for a minimum of 6 weeks to not open the mouth wide after the reduction of the jaw.
• The jaw should be supported with a hand every time one sneezes or yawns during this time.

B. Recurrent Jaw dislocation can be prevented with

• Injection of autologous blood into the TM joint.
• Wearing occlusal splints.

C. Treatment of Chronic Recurrent Jaw Dislocation is with Open Joint Surgery-

Open joint surgery is done under general anesthesia and a longer incision is placed within the curvature of your ear which is very well hidden. One of the following procedures can be done for the treatment-

• Removal of the condyle (head of lower jaw).
• Removal of the articular eminence (bony prominence).
• Release of temporalis muscle.

Risks Of Open Surgery For Jaw Dislocation?

Open joint surgery has a longer healing time and a chance of injury to the frontal branch of the facial nerve (temporary paresis of the muscle of the forehead) but still is the surgery of choice in patients with recurrent painful clicks and joint dislocations.