The standard intraoral technique for reduction of the anteriorly dislocated TMJ is designed to push the mandible inferiorly and posteriorly back into the mandibular fossa. This can be done from either an anterior or posterior approach.
When manipulating the mandible with an intraoral technique, the thumbs should be positioned behind the patient’s last molars. Thick gloves must be worn to ensure protection against a human bite occurring when the mouth snaps close due to muscle spasm. A bite block may also be used.
To facilitate reduction, it is common practice to administer an opioid analgesic and sedative agent such as midazolam, although reduction using propofol bolus has also been described [15].
If the standard technique fails, other techniques have also been described involving intra-articular injection of local anaesthetic [12], extraoral techniques [16,17] and a wrist pivot method [2]. On rare occasions, general anaesthesia may be required using either a closed or open reduction.
Dislocations to the posterior, medial or lateral side are usually associated with a fracture of the mandible and should be referred to a maxillofacial surgeon for reduction.
There are blog posts and videos available for revision, linked in the reference section [19, 20].
Learning Bite
The operator must protect themselves against a human bite occurring while reducing an anterior dislocation of the mandible.