顎関節脱臼の初期対応アルゴリズム

昔ながらの整復方法

wrist pivot法

オトガイ部の親指は上方に押し上げると同時に、下顎臼歯に添えた指を下方に押し下げる。

注射器を用いた整復方法

a：奥歯で注射器（口の大きさにより10ccないし20ccのプラスチックシリンジなど）をくわえ、自分でごろごろ回転させるように下顎を動かす（ラクダの横方向の咀嚼動作の縦方向版のようなイメージ）ことにより、前方に脱臼していた下顎関節突起（M）が側頭骨関節結節（T）を乗り越えながら、咀嚼様動作で稼働している咬筋群に引かれて後方に修復される。
b：正常な顎関節で注射器を噛んだ場合
M：下顎骨関節突起
T：側頭骨関節結節
出典
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1: The "syringe" technique: a hands-free approach for the reduction of acute nontraumatic temporomandibular dislocations in the emergency department.
著者: Julie Gorchynski, Eddie Karabidian, Michael Sanchez
雑誌名: J Emerg Med. 2014 Dec;47(6):676-81. doi: 10.1016/j.jemermed.2014.06.050. Epub 2014 Sep 30.
Abstract/Text: BACKGROUND: The traditional intraoral manual reduction of temporomandibular joint (TMJ) dislocations is time consuming, difficult, and at times ineffective, and commonly requires conscious sedation.
OBJECTIVES: We describe a novel technique for the reduction of acute nontraumatic TMJ dislocations in the emergency department (ED).
METHODS: This study was a prospective convenience sample population during a 3-year period at two university teaching-hospital EDs where acute nontraumatic TMJ dislocations were reduced utilizing our syringe technique. Demographics, mechanism, duration of dislocation, and reduction time were collected. Briefly, the "syringe" technique is a hands-free technique that requires a syringe to be placed between the posterior molars as they slide over the syringe to glide the anteriorly displaced condyle back into its normal anatomical position. Procedural sedation or intravenous analgesia is not required.
RESULTS: Of the 31 patients, the mean age was 38 years. Thirty patients had a successful reduction (97%). The majority of dislocations were reduced in <1 min (77%). The two most common mechanisms for acute TMJ dislocations were due to chewing (n = 19; 61%) and yawning (n = 8; 29%). There were no recurrent dislocations at 3-day follow-up.
CONCLUSION: We describe a novel technique for the reduction of the acutely nontraumatic TMJ dislocation in the ED. It is simple, fast, safe, and effective.

Copyright © 2014 Elsevier Inc. All rights reserved.
J Emerg Med. 2014 Dec;47(6):676-81. doi: 10.1016/j.jemermed.2014.06.05...

仰臥位で脱臼整復を試みる方法

a：歯科用の椅子を倒して仰臥位にし、医師は頭側に座る。
b：（奥歯というより）下顎骨枝の前方のへりに親指を置き、力を加えていく。口腔内の視野が保たれ上下の歯列が確認でき、口の閉まりの不具合や整復の過程も確認できる。
出典
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1: The Supine Position Technique Method Is Better Than the Conventional Method for Manual Reduction of Acute Nontraumatic Temporomandibular Joint Dislocation.
著者: Jiantao Xu, Shutian Dong, Haihua Zhou, Mirinal Somar, Kun Lv, Zubing Li
雑誌名: J Craniofac Surg. 2016 Jun;27(4):919-22. doi: 10.1097/SCS.0000000000002645.
Abstract/Text: OBJECTIVE: To comparatively assess the effectiveness of the supine position technique versus the conventional method, for the manual reduction of acute nontraumatic temporomandibular joint (TMJ) dislocation.
METHODS: This randomized single blind trial included a total of 40 patients, aged 18 to 80 years presenting with acute nontraumatic TMJ dislocation. Based on the randomization procedure, patients were treated with either conventional method or the supine position technique method. The visibility of dynamic occlusion during jaw manipulation, operation time, and visual analogue scale scores for pain perception were comparatively studied.
RESULTS: All patients with dislocated mandible were successfully managed. Unlike the conventional technique, the ability to monitor the dynamic occlusion during jaw manipulation was possible only in the supine position method group. The operation time (P < 0.05) and visual analogue scale scores for pain perception (P < 0.01) during the treatment were significantly reduced in the supine position technique group. No accidental finger biting was reported in any groups.
CONCLUSIONS: Reduced operation time and reduced pain perception indicated that the supine position technique method might be a more viable alternative to the conventional method of reduction of acute nontraumatic TMJ dislocation.
J Craniofac Surg. 2016 Jun;27(4):919-22. doi: 10.1097/SCS.000000000000...

口腔外法でのその他の方法

a：口を開け閉めしながら外側に突出した関節突起を手で確認する。
b：内側に強く押し、後下方に優しく引くようにする。
c：矢印の方向に関節突起が向かうように押し動かす。
出典
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1: Extraoral autoreduction of temporomandibular joint dislocation: a preliminary clinical study.
Am J Emerg Med. 2015 Apr;33(4):588-9. doi: 10.1016/j.ajem.2015.01.011. Epub 2015 Jan 16.

顎関節脱臼の初期対応アルゴリズム

昔ながらの整復方法