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

OBJECTIVE: To report a modified and optimized patient-guided maneuver for the rapid and physiological reduction of temporomandibular joint (TMJ) dislocation. METHODS: 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. RESULTS: 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. CONCLUSION: 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. CLINICAL SIGNIFICANCE: 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.