Improving medical students

How to Fix a Dislocated Jaw

Posted by medliorator on November 1, 2007

it was a jaw dislocation – the jaw slips out of socket, usually after a big yawn, and the end result is you can’t close your mouth. Even though it was the first time I’d actually seen it, it was an easy diagnosis to make, since the patient was staring at me like I’d just dropped my scrub pants and peed on the bed.

I quickly leafed through an emergency textbook, out of sight from the patient (who wants to see their doctor doing that?), to confirm what I thought I knew — wrap some gauze around your thumbs, put them on the back bottom teeth, and push down hard.

Gloves on, gauze wrapped, fingers in mouth, and I started pushing.

Hmm, the textbook didn’t mention what to do when the patient screams and grabs your wrists. I thought some medicines for pain and muscle spasm were in order.

4 milligrams of versed, 100 micrograms of fentanyl, and some beads of sweat on my part later, though, she was still sitting there mouth gaping open.

Time to bring out the big guns, a conscious sedation. Usually I use etomidate, but one of its side effects can be masseter spasm, which would make reduction all but impossible. So instead I went with propofol, a med I used extensively in residency but not since for a couple of reasons including I don’t think we’re really supposed to.

Usually you give a slug of this and people immediately go out, sometimes so deeply that they stop breathing momentarily. But with her, nothing, she just continued to stare at me as alert as if we were chatting at a coffee house. IV’s working, fluids are running wide open — what is it with this girl? Another big slug, and finally her eyes start to go heavy. And then they reopen, but her eyes are distant now, and looking around the room at me, the nurse, and the respiratory tech she says in a perfect stoner voice “hey ya’ll wanna get somethin to eat after this?”

I’d never seen anyone react to propofol like that before. I stuck my thumbs in her mouth one last time and clunk back in place it went, her mouth now closed. Stepping back to admire my work, she — with all of her sedating meds on board — started to unleash a giant yawn. No, I yelled, and quickly put one hand on the top of her head and the other under her chin, pushing her mouth back shut. Fortunately it didn’t pop out again, and I wrapped her head up in a bandage for good measure.

Shut my Trap [Ten out of Ten]

8 Responses to “How to Fix a Dislocated Jaw”

  1. A.K.Afridi said

    I need to know how one can do that by him/herself?

  2. J. Tollman said

    “I need to know how one can do that by him/herself?” I imagine this request was time-specific and this may be too late to help but here’s what I did.

    Please note, this is not a medical opinion, it is just my personal experience.

    I woke up one morning, yawned and dislocated my jaw. It was very painful and I could not close my mouth. After the initial panic had passed I tried to close my mouth by pushing the jaw under the chin in an upwards ditrection. This was a bad idea. It hurt loads and didn’t move a millimeter. After a bit of thought, I tried pulling the jaw down (I just grabbed my lower front teeth and pulled gently but forcefully). There was a lot of pain but something shifted and my jaw popped back in. The popping bit was extremely painful and hurt for a few weeks later.

    I would recommend seeing a doctor rather than doing it yourself!

  3. Carl Lim said

    There are 4 members in my family of 8 children including myself who has this hereditary loose jaw that dislocates. The many times it happened at the dentist’s, he was able to fix it immediately. However, once it happened while opening too wide while at home past midnight. After 3 unsuccessful attempts at 3 different private clinics, I was at the A&E and after sedation, awoke to realise the reduction and jaw immobilised with a bandage to top of head. Following the reference to the dental department from the A&E the next day, I was given an insight of how to fix the problem with a synthetic skull complete with movable mandible.
    We should have someone attend to us while we sit low with head against a support like a wall at a level below the elbow of the aider/attendant. The thumbs presses against the molars at the back of mandible, the other fingers curled below the chin and using controlled body weight to press down the mandible and a little pushing inward toward the patient so that it pops back into the socket of upper jaw. Go to a professional if there is an option !

  4. Jessica said

    Okay I read the article & I read the comments because I tend to pop my jaw out of place quite often and always have problems with it. Today I ate some skittles and my stupid jaw popped out of place but I would rather not go to the hospital for it so I tried J. Tollman’s pulling on the bottom teeth option and it worked perfectly. Thanks.

  5. Great article, loved reading it…

  6. jill siler said

    Okay. I tried as it has been REALLY painful at times(even stabs in my right ear–seems the right side is the most effected. I tried the lower teeth system and OMG!!! I’m going to need some professional help and possibly, preferably, to be unconscious Can a walk-in clinic doctor do this?

  7. James said

    I did this today…yawned and dislocated the left side of my jaw,I slammed my mouth shut hoping to pop it all back into place and then it was stuck shut,so a trip to the hospital was in order….where I had 2 doctors holding my down and one pulling my jaws apart, and all they gave me was a paracetamol…its still not right though, can only open my mouth half way, they said the disc between the jaws may have slipped and thats why I can only open it half way….but ive got some painkillers and anti-inflamitories so hopfully it’ll sort itself out in the next few days..If not back to hospital I shall go..

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