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Dislocation of jaw
Specialty	Emergency medicine

There can be a dislocation of jaw if a person opens their mouth too wide, particularly when a person attempts to open the jaw widely in an effort to stretch the facial muscles i.e. to relieve tense facial muscles as the wisdom teeth develop and emerge. Dislocation can occur following a series of events if the jaw locks wide open and is unable to close by using the jaw muscles (unassisted) and without excessive force;. As an immediate result of the dislocation, chronic pain can be experienced on both sides of the jaw, combined with an extreme headache and inability to concentrate.

Depending on the severity of the jaw's dislocation, pain relief using paracetamol can assist to alleviate the initial chronic pain, however the effects of long-term use of paracetamol can decline as the condition deteriorates with continued use of the jaw through the day i.e. talking, eating, smoking, drinking, etc.

Anatomy

The joint involved with jaw dislocation is the temporomandibular joint (TMJ). This joint is located where the mandibular condyles and the temporal bone meet. The space between the bones has synovial membranes to allow joint to hinge and glide when the jaw moves. Ligaments that support TMJ are: the temporomandibular ligament, capsular ligament, and sphenomandibular ligament. When the mandible closes it uses the masseter, temporalis, and medial pterygoid muscle; and when it opens the TMJ remains stable on the mandible neck using the lateral pterygoid muscle.

Pathophysiology

Jaw dislocated can happen in the following positions: posterior, anterior, superior and lateral. When the condyle is not aligned with the temporal articular groove dislocation can occur. The most common dislocation is anterior in which the jaw lower moves forward. An example of anterior dislocation is when the mouth closes after opening wide. The action that occurs is the masseter and temporalis muscles pull up on the mandible before the lateral pterygoid muscle can relax to the mandibular condyle is pulled forward and out of the temporal fossa. This type of dislocation can happen bilateral or unilateral. Posterior dislocation is common for people who get injured by being punched in the chin. This may cause the mandibular condyle alignment pushed closer to the mastoid. Superior dislocations are known for happening when a punch occurs to the mouth as its open. Since great force occurs, the angle of the mandible will be pushed upward and move toward the condylar head. Results of this fracture will dislocate the glenoid fossa with the mandibular condyle towards the middle of the skull’s base. Lateral dislocations usually occur with other mandible fractures.

Epidemiology

Mandibular dislocations are infrequent presentations to the emergency department. Anterior mandible dislocations are most common and often result from non-traumatic causes. Mandibular dislocations may be associated with chronic recurrent dislocations, ischemic necrosis of the condylar head, traumatic damage to the articular disk, and mandibular osteomyelitis. Chronic untreated dislocations can result in permanent malocclusion.

Symptoms

The symptoms can be numerous depending on the severity of the dislocation injury and how long the person is inflicted with the injury. Symptoms of a dislocated jaw include a bite that feels “off” or abnormal, hard time talking or moving jaw, not able to close mouth completely, drooling due to not being able to shut mouth completely, teeth feel they are out of alignment, and a pain that becomes unbearable

The immediate symptom can be a loud crunch noise occurring right up against the ear drum. This is instantly followed by excruciating pain, particularly in the side where the dislocation occurred.

Short-term symptoms can range from mild to chronic headaches, muscle tension or pain in the face, jaw and neck.

Long-term symptoms can result in sleep deprivation, tiredness/lethargy, frustration, bursts of anger or short fuse, difficulty performing everyday tasks, depression, social issues relating to difficulty talking, hearing sensitivity (particularly to high pitched sounds), tinnitus and pain when seated associated with posture while at a computer and reading books from general pressure on the jaw and facial muscles when tilting head down or up.

In contrast, symptoms of a fractured jaw include bleeding coming from the mouth, unable to open the mouth wide without pain, bruising and swelling of the face, difficulty eating due to the constant pain, loss of feeling in the face (more specifically the lower lip) and lacks full range of motion of the jaw.

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Template:Http://emedicine.medscape.com/article/823775-overview

1. http://emedicine.medscape.com/article/823775-overview
2. http://emedicine.medscape.com/article/823775-overview
3. http://health.nytimes.com/health/guides/injury/jaw-broken-or-dislocated/overview.html
4. http://health.nytimes.com/health/guides/injury/jaw-broken-or-dislocated/overview.html

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