What is a Dislocated Jaw?
Mandible dislocation is where the mandibular condyle moves out of the articular groove in the temporal bone. Think of the jawbone as being hinged at the temple, with a disc (much like a spinal disc) cushioning movement of the hinge in its groove. A dislocated jaw means that the bone has popped out of the groove and is hanging by just one hinge, giving the face a lopsided look and putting extreme stress on the other bones, nerves, disc and tissues in the face. Where a dislocated jaw is the result of an altercation it may be that there is considerable bruising and swelling, creating neck and jaw pain in itself.
Causes of Jaw Dislocation
Not all dislocated jaws are a result of trauma, however, with some patients experiencing repeated dislocations due to a bone or tissue abnormality or degeneration in the jaw. The temporomandibular joint (TMJ) is lined with synovial membranes that keep the bones movements, whether sliding or hinged, fluid and cushioned.The temporomandibular ligament, sphenomandibular ligament and capsular ligament keep the joint supported. Should these ligaments be stretched, become calcified, or suffer in some other way, the TMJ will not move as freely and fluidly as it should and it may even increase the likelihood of jaw dislocation and neck pain.
Why Jaw Dislocations and Neck Pain Can be Connected
In addition to the ligaments and bones making up the temporamandibular joint, there is also a blood supply from the superficial temporal branch of the external carotid artery. Nerves branching off from the auriculotemporal and masseteric divisions of the mandibular nerve are responsible for providing sensation and signals for movement in the joint. Neck and jaw pain may result from damage to these nerves and blood vessels, perhaps from spinal stenosis in the neck, or from another spinal abnormality, growth, ischaemic condition or nerve damage.
Neck Pain Conditions and Jaw Pain
The muscles controlling the movement of the jaw are also a possible cause of jaw and neck pain and dislocation. Extreme cramp in the muscles may pull the joint out of position or weak muscles may result in slippage of the joint if combined with ligament problems. The masseter, temporalis and medial pterygoid muscle are in action when the jaw is closed whereas the lateral pterygoid muscle is responsible for opening the jaw.
Types of Jaw Dislocation
The jaw may dislocate in a variety of ways; anteriorly, posteriorly, laterally or superiorly. The description of the type of dislocation is based on where the condyle ends up in relation to the groove in which it should sit. Dislocations where the condyle is forward of the articular groove are most common, resulting in the jawbone jutting forward. Yawning can result in such dislocations, with some people experiencing chronic, or recurrent jaw dislocations and others an acute episode. Anaesthesia, vomiting, seizures and dental work may also lead to such a dislocation as it is the extreme opening of the mouth that triggers an acute occurrence. A blow to the chin will most likely lead to a posterior dislocation of the jaw with the mandibular condyle forced back and up in the direction of the mastoid. Those experiencing this type of facial trauma may also incur an injury to the external auditory canal as the head of the condyle impacts it.
Chronic Problems with Jaw Dislocation
Jaw dislocation and neck pain may both be due to the degeneration of muscles, ligaments and bone, or through congenital abnormalities in the joint such as shallow mandibular fossa. Disorders which result in hypermobility, such as Ehlers-Danlos syndrome may also lead to patients experiencing multiple jaw dislocations and, over time, repeated damage to the bones, ligaments, synovia and discs in the jaw. Untreated temporomandibular joint syndrome may also result in degeneration of the jaw and a higher propensity for jaw dislocation and neck pain. Surgery may be required to alter the shape and size of the jawbone so as to reduce the risk of dislocation.
Ehlers-Danlos Syndrome and Jaw Dislocations
Mandible dislocations are not a common cause of trips to the ED but where they do occur it is often the case that they are accompanied by fractures of the jawbone or other bones in the face. A blow to the face or some kind of extreme mouth opening is the usual trigger for jaw dislocation, although patients may have injury to the TMJ, hypermobility problems, or previous dislocations that require investigation. Dystonic reactions, along with Marfan syndrome and Ehlers-Danlos syndrome predispose patients to jaw dislocation and such problems may also result in neck pain with jaw pain due to general connective tissue difficulties.
Treating a Dislocated Jaw
There are a variety of ways in which a dislocated jaw can be reduced (restored to its correct position). The choice of manoeuver will depend on the type of dislocation and the physician carrying out the reduction. After a dislocation has been remedied it is recommended that a soft diet be consumed for the first few days to reduce stress on the joint and that wide jaw-opening be avoided for one to two weeks at least. NSAIDs can be helpful in relieving jaw and neck pain after a dislocation as the tissues heal.
Prognosis for Jaw Pain and Neck Pain
Repeated jaw dislocations should prompt a proper investigation into the underlying cause as it may be that tissue degeneration or an unrecognized hypermobility issue is manifesting for the first time. Most cases of jaw pain and neck pain are not due to jaw dislocation but to such things as teeth grinding (bruxism) or temporomandibular joint syndrome but anyone suspecting a jaw dislocation should seek medical attention as, untreated, the jaw and surrounding tissues can incur damage leading to more neck and jaw pain.
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