62.6 Dislocation of the jaw

When a patient dislocates his jaw, his mandibular condyles slip forward in their sockets over the articular eminences of his temporomandibular joints. This can happen when he laughs or yawns, or is hit in the face with his mouth open. The mouth of a patient with a dislocated jaw remains permanently half open in an anterior open bite. Swallowing is difficult, so that saliva dribbles from the corners of his lips. When you examine him, you find a small depression over his temporomandibular joints. If his mandible dislocates one side only, it deviates away from the midline.

THERESA was cultivating her fields in Zaire when she yawned and dislocated her jaw. She had been told that patients had to pay at the Catholic hospital, and as she had no money, she had to wait some weeks to sell some produce before she could go there. The doctors there failed, because her dislocation was no longer recent, so she waited a few more weeks, sold some more produce, and tried the Protestants. Her dislocation was now even older, and they too failed, so she now walks about with her mouth permanently open. LESSONS Dislocations of the jaw are much easier to reduce if they are done early. The tragedy of this patient is that both hospitals would have treated her for free, if she had come early and told them she could not pay.

Figure 62.13: REPLACING A DISLOCATED JAW Most patients don’t need an anaesthetic. If necessary, give a patient pethidine or diazepam.