Mandible, or TMJ, dislocations occur when the patient excessively opens the mouth, such as in a yawn. They are typically bilateral and are difficult to relocate because of masseter and medial pterygoid muscle spasm. You can relocate the condyles back into the TMJ space with gentle but firm intraoral pressure inferiorly and posteriorly. Often it requires some sedation to help relax the muscles of mastication.

Trick of the Trade

Tire out the muscles of mastication

Thanks to Dr. Sa’ad Lahri (Cape Town, South Africa), I viewed this innovative trick in relocating a TMJ dislocation, posted by the BBC on YouTube. The basic principle is that you slightly over-exaggerate the dislocation to stretch the muscles even more. This was done using a stack of tongue blades. This constant stretch of the muscles for a few minutes will cause them to be relaxed when you remove the tongue blades. This provides a small window of time when you can relocate the mandible.

Has anyone else tried this before? I haven’t and can’t personally vouch for it, but I’ll be trying it on the next opportunity that I have. It’d be nice not to have to sedate the patient unnecessarily.

Poor patient — this video has gotten over 1.3 million views…

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD