Rapid reduction of temporomandibular joint dislocation with a modified and optimized patient-guided technique: a retrospective case series

To report a modified and optimized patient-guided maneuver for the rapid and physiological reduction of temporomandibular joint (TMJ) dislocation. A retrospective case series was conducted at a single Emergency Department from January 2017 to December 2022. The study evaluated 83 consecutive patients with acute TMJ dislocation treated with a modified and optimized patient-guided technique. The maneuver follows a two-step sequence: Step 1 involves concurrent mouth opening and head extension; Step 2 involves mouth closing and head flexion while the clinician applies gentle, sustained downward traction. Reduction time was recorded by an independent observer. The overall success rate for achieving anatomical goals was 100%. Specifically, for simple dislocations (n = 81), a 100% reduction success rate was achieved within a mean time of 150 s. For dislocations complicated by condylar fractures (n = 2), the maneuver was 100% successful in achieving temporary palliative alignment, which served as a crucial bridge to definitive surgical intervention. No iatrogenic injuries or complications were observed in either group. This patient-guided approach utilizes active patient movement to facilitate reduction with minimal force. It appears to reduce iatrogenic risk and improve patient tolerance compared to traditional high-force maneuvers. While 100% success was observed in this series, the results are limited by the single-center, single-operator design. Further multi-center prospective trials are necessary to validate these findings and assess long-term outcomes. The patient-guided technique provides a controlled, less traumatic alternative for TMJ reduction, potentially reducing the need for anesthesia and improving the overall patient experience in emergency settings.