Patient unable to close after procedure

[FiXToofs]

I had a patient today that I treated for a couple of fillings. Very quick appt. (less than 30 mins) At the end of the procedure he was unable to close. I could palpate the tmj on his right side and see that it was out of place. Pt is a young male with no history of tmd or tmj problems. What is the protocol for manipulating the jaw back into place. thanks

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[Jone]

if you're asking this now, i'm assuming you sent him home with his jaw permanently open.

I had a patient today that I treated for a couple of fillings. Very quick appt. (less than 30 mins) At the end of the procedure he was unable to close. I could palpate the tmj on his right side and see that it was out of place. Pt is a young male with no history of tmd or tmj problems. What is the protocol for manipulating the jaw back into place. thanks

 

[FiXToofs]

His jaw popped back into place after warm compresses. I am just wondering if there is a standard protocol for this situation.

 

[scalpel2008]

anterior dislocation of the condyle out of the glenoid fossa can range from easy to treat to very difficult. Most of the times you can reduce the joint back into the fossa. you typically apply an inferior and posterior force on the posterior mandibular molars to do this. There's been only one joint that I couldn't reduce but that was a pt with about 15 different total joint recontructions ranging from costochondral grafts to alloplastic implants. He had to be paralyzed in the OR to be reduced. postoperatively NSAIDs and limited mouth opening (esp when yawning etc) and a soft diet for a couple of weeks is recommended. Also, overzealous use of gigantic bite blocks is not recommended in these patients. They either have laxity in their retrodiskal tissue or a flattened articular eminence or both. I've treated a pt whose condition was so bad that she had to have arch bars and elastics so she wouln't talk/yawn and dislocate her condyle becuase every other surgery had failed on her. There are several surgeries that can be done for recurrent dislocaitons but i wont go into too much detail on them. One of them is to just flatten out the articular eminence so you dont get stuck in front of it.

 

[salem7]

I had a patient today that I treated for a couple of fillings. Very quick appt. (less than 30 mins)

I can't get a rubber dam and start check in 30 minutes at my school.

 

[Billy Gilmore]

what is this rubber dam you speak of.... i haven't seen them in the clinics at my school

 

[docj1]

Scalpel2008

I've had the privledge/misfortune of reducing 5 of these in 10 years as a GP. No patients of record, just people who came in wide open. They all reduced, but it was only hours or less. Is there a time frame were it gets more difficult to reduce.

Thanks

 

[scalpel2008]

Scalpel2008

I've had the privledge/misfortune of reducing 5 of these in 10 years as a GP. No patients of record, just people who came in wide open. They all reduced, but it was only hours or less. Is there a time frame were it gets more difficult to reduce.

Thanks

I've never come across a specific window, but I do know that the longer one remains locked open, muscle spasm starts to kick in and then you run into the situation of possibly needing anesthesia and muscle paralyitics to get it reduced.

 

[OMFSCardsFan]

you typically apply an inferior and posterior force on the posterior mandibular molars to do this.

Just to expand on the "how to" if it wasn't totally clear. Stick your thumbs into the patients mouth along the occlusal surfaces of the lower molars. If you can get the end of your thumb along the lower anterior part of the coronoid, it can help. Wrap your fingers around the outside of the patients mandible for support. Push down and rotate the condyle back along it's path, and it'll usually pop back into place without too much trouble. I reduced more on friends' patients while in dental school than I do now in residency...

 

[1992Corolla]

One of them is to just flatten out the articular eminence so you dont get stuck in front of it.

I've had to do this to my typodont a couple of times

J/K