The 'Syringe' Technique

A Hands-Free Approach for the Reduction of Acute Nontraumatic Temporomandibular Dislocations in the Emergency Department

Julie Gorchynski, MD; Eddie Karabidian, MSC; Michael Sanchez, MD


J Emerg Med. 2014;47(6):676-681. 

In This Article


There were 31 subjects between the ages of 18 and 65 years that presented to the ED with acute nontraumatic TMJ dislocations during the study period. The mean age was 38 years; there were 20 females and 11 males, with 23 Hispanics, 13 Caucasians, and 2 African-Americans. Comorbidities were not obtained.

The mechanisms of dislocation were due to chewing (n = 19, 61%), yawning (n = 8, 29%), talking/laughing (n = 3, 10%), or recent dental visits (n = 1, 0.03%). Nine subjects had prior TMJ dislocations. The success rate was 97% (30/31). The majority of subjects presented to the ED within an hour of the dislocation (Table 1). Seventy-seven percent (24/31) of the patients' TMJ dislocations were successfully reduced in <1 min. Most of the patients were given an oral nonsteroidal antiinflammatory drug and muscle relaxant after reduction and prior to discharge. None of the subjects had a recurrent dislocation of their TMJ, either by follow-up telephone calls or by ED returns. The one unsuccessful reduction was an edentulous 64-year-old woman who had bilateral TMJ dislocations, and she was unable to effectively grasp and roll either the 5-mL or 10-mL syringe between her gums due to pain. Additional external manual reduction with parenteral analgesia was necessary for successful reduction.

Traumatic TMJ dislocations were originally included in this study, but due to high failure rate using this technique, further traumatic TMJ dislocations were excluded. The apparent difficulty with traumatic TMJ dislocations was the amount of swelling of the soft tissue to the mandibular area and associated trismus and pain. These symptoms interfered with the placement of the syringe. Additionally, the majority of the traumatic TMJ dislocations required intravenous analgesia and many had associated fractures associated with the dislocation.