Trick of the Trade: Stabilizing mandibular relocations

Three weeks ago, I talked about more safely reducing mandibular dislocations. After successful completion of the procedure, how do you make sure that the patient doesn’t re-dislocate the mandible? You definitely should tell the patient to keep their jaw closed as much as possible for the next 24 hours and avoid opening the mouth widely (eg. yawning/laughing).

How do you immobilize the mandible? Especially for the chronic dislocators, presumably with more lax TMJ ligaments, you should think about immobilization. This can be done with a head bandage which goes under the chin. You can use kerlix rolls or an ACE wrap.

Despite your best bandaging efforts, what can you do if your discharged patient returns from the ED parking lot with a recurrent dislocation?

Trick of the Trade: Stabilizing mandibular relocations

Apply a semi-rigid cervical collar

Instead of “pulling up” the chin to stabilize the TMJ, a semi-rigid cervical spine collar can be used to “push up” the chin instead. This photo shows an Aspen collar, but you can use any of the semi-rigid collars you have available.