Mandibular Dislocation Reduction

[Groove]

Just thought I'd share a very cool technique that I adopted about a year ago and works so much better than intra-oral techniques for mandibular reduction. I've had 2 of these in the past year (second one last night, bilateral dislocation) and can't believe I didn't know about this technique or that more hasn't been written about it. Unlike the video though, all of my patents required sedation and don't seem to be able to tolerate reduction while awake but it still goes incredibly smooth. It's literally just as easy as the video. After discovering this, I feel like I did back when I discovered the Captain Morgan hip reduction technique years ago. Enjoy!

Trick of the Trade: Extra-oral reduction technique of anterior mandible dislocation

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[Dr Mantis Toboggan]

Rolling syringe method is also pretty money. I’ve also seen a few people who can dislocate/relocate their jaws at will in order to try and get that sweet sweet propofol. Nothing really helps those types except a swift kick out of the ED.

Reducing a Dislocated Jaw- A new way to do it. - Resus

Just thought I'd share a very cool technique that I adopted about a year ago and works so much better than intra-oral techniques for mandibular reduction. I've had 2 of these in the past year (second one last night, bilateral dislocation) and can't believe I didn't know about this technique or that more hasn't been written about it. Unlike the video though, all of my patents required sedation and don't seem to be able to tolerate reduction while awake but it still goes incredibly smooth. It's literally just as easy as the video. After discovering this, I feel like I did back when I discovered the Captain Morgan hip reduction technique years ago. Enjoy!

Trick of the Trade: Extra-oral reduction technique of anterior mandible dislocation

 

[Angry Birds]

Rolling syringe method is also pretty money. I’ve also seen a few people who can dislocate/relocate their jaws at will in order to try and get that sweet sweet propofol. Nothing really helps those types except a swift kick out of the ED.

Reducing a Dislocated Jaw- A new way to do it. - Resus

Any video of this rolling syringe technique ?

 

[thegenius]

The rolling syringe looks fabulous. Don't even have to touch the patient.

Hell you can send them home with a ****ing 10 cent syringe!

 

[thegenius]

Homeboys 2 thousand years ago were doing this

https://www.resus.com.au/wp-content/uploads/2015/02/illus-224-5-b.jpg

LOL

They are naked and the guy with the dislocated jaw is trying to say "Sweet Jesus what in the world are you doing?!?!?!"

 

[RustedFox]

Homeboys 2 thousand years ago were doing this

https://www.resus.com.au/wp-content/uploads/2015/02/illus-224-5-b.jpg

LOL

They are naked and the guy with the dislocated jaw is trying to say "Sweet Jesus what in the world are you doing?!?!?!"

I'm at work now, and I laughed so hard the charge RN came back to see what the commotion was about.

 

[gamerEMdoc]

Huge fan of the extra-oral rotational reduction technique. I haven't stuck my fingers in someones mouth the reduce a jaw since I found this. It works so well, and typically without any sedation. Never heard of the syringe rolling technique, but I'll definitely try it out next time.

 

[BoardingDoc]

Huge fan of the extra-oral rotational reduction technique. I haven't stuck my fingers in someones mouth the reduce a jaw since I found this. It works so well, and typically without any sedation. Never heard of the syringe rolling technique, but I'll definitely try it out next time.

No idea what I'm doing wrong here. Have tried this twice (without sedation both times). Neither time worked. Ultimately would up giving prop and sticking my thumbs in their mouth.

 

[Hamhock]

No idea what I'm doing wrong here. Have tried this twice (without sedation both times). Neither time worked. Ultimately would up giving prop and sticking my thumbs in their mouth.

Did you cover your thumbs with tongue depressors (taped on) to protect them?
HH

 

[Angry Birds]

No idea what I'm doing wrong here. Have tried this twice (without sedation both times). Neither time worked. Ultimately would up giving prop and sticking my thumbs in their mouth.

I feel this way about a lot of such techniques. There is always some finesse required.

 

[Groove]

No idea what I'm doing wrong here. Have tried this twice (without sedation both times). Neither time worked. Ultimately would up giving prop and sticking my thumbs in their mouth.

The video on my first link shows them using it on the guy without sedation. In my experience with the technique, none of my patients could tolerate it without sedation. I'd recommend sedating them first and then try it. I differ from the person doing the video in that I put steady pressure on the coronoid until it is reduced and then hold it while I press on the contralateral side. It pops right in (assuming anterior subluxed, no complicating fractures, etc..). It literally takes me 10 seconds. I have PTSD with the intra-oral thumb technique after getting bitten one time.

 

[Rendar5]

I will try this sometime. I have about 50% success rate by placing a splint of taped together tongue depressors into their mouth as a bite block. It lets them relax their muscles and I’ve had people spontaneously reduce without direct manipulation after a couple minutes. Never read about it in the us but saw it work on a a show about emergency medicine in England on the learning channel or something like that.

 

[gamerEMdoc]

I have reduced jaws in patients wide-awake with no pain medicine using the rotation method. I’ve also failed using this method on someone recently who couldn’t tolerate the pain. We gave her a little bit of ketamine, and then popped her jaw in place in a second using this method. I guess sometimes maybe you do need to still sedate the person, but regardless, you never have to stick your fingers in their mouth.

 

[BoardingDoc]

Did you cover your thumbs with tongue depressors (taped on) to protect them?
HH

I generally just wrap several layers of gauze around the thumbs and tape it on. I find it gives me as much protection from a bite and allows for better dexterity than the tongue depressor method. I think I'll try sedating the next one I get and giving the extra-oral method a try again once they're out. Always looking for alternate methods.

 

[gamerEMdoc]

I approach it just like a shoulder. Reassure the patient, attempt the least painful way of reducing without sedation. Most of the time you'll find success and save on nursing resources by not having to sedate, but if you don't, don't force it, give the patient some ketamine, and then retry and it'll go right in.

 

[RustedFox]

I generally just wrap several layers of gauze around the thumbs and tape it on. I find it gives me as much protection from a bite and allows for better dexterity than the tongue depressor method. I think I'll try sedating the next one I get and giving the extra-oral method a try again once they're out. Always looking for alternate methods.

Wrap several layers of 4x4 gauze around your thumbs, then place thumbs into gloves 2-3 sizes too big for your hands. Ta-daaa. Mickey Mouse thumbs. No bitey.

 

[thegenius]

There are comments on this topic to suggest people have done a bunch of these.

I've only done 1 in residency. That guy was in EtOH withdraw so I did it after many doses of IV valium. Maybe heard about another at one point over the past 4.5 years.

 

[bravotwozero]

been an attending for 3 years now. Didn't see a single case in residency, or afterwards. A colleague on shift with me did one, that's about as much exposure I've had. Don't think these are very common.

 

[BoardingDoc]

been an attending for 3 years now. Didn't see a single case in residency, or afterwards. A colleague on shift with me did one, that's about as much exposure I've had. Don't think these are very common.

It's definitely hit or miss. Most of the docs in my shop have seen several to the point that I think most of us have tried the extra-oral technique above. I'd guess I've done 5 or 6 including residency. That's averaging ~1/yr.

 

[WilcoWorld]

Me too - never had one.

If I ever get one I'll try extraoral technique w/o sedation, and if that fails I'll have the patient roll a syringe while I set up for the sedation.

 

[gamerEMdoc]

Me too - never had one.

If I ever get one I'll try extraoral technique w/o sedation, and if that fails I'll have the patient roll a syringe while I set up for the sedation.

I've done 2 this year. It's definitely not that common. But if I see "jaw dislocation" on the tracking board in the waiting room, I'm jumping on that chart the second it comes back.

 

[bbc586]

Haven't done one yet but looking forward to trying it! Did 3-4 in residency with intra-oral technique. One ended up having to have jaw wired because he'd wake up and it would immediately dislocate again x 3.

 

[Groove]

There are comments on this topic to suggest people have done a bunch of these.

I've only done 1 in residency. That guy was in EtOH withdraw so I did it after many doses of IV valium. Maybe heard about another at one point over the past 4.5 years.

I've prob seen 6 in 10 years. 3 of those years without seeing any. 2 were in the same year. It's hit or miss depending on your population and also depending on whether you are looking for them. If I see "jaw" anything, I sign up for it hoping it's going to be a dislocation.

 

[deuist]

I tried all of the awake methods described in this thread a few days ago. None of them worked. I ended up giving sedation. They were worth a shot, but when muscle tension is too much for my meager hands, only sedation will do.