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

Abstract and Introduction


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.


Acute nontraumatic temporomandibular joint (TMJ) dislocations are usually the consequence of excessive mouth opening, for example, tooth extraction, laughing, yawning, or taking a large bite of food. Anterior TMJ dislocations are the most common form in nontraumatic dislocations of the jaw. The emergency physician (EP) routinely relies on the traditional method of intraoral reduction of the TMJ, which commonly requires procedural sedation or substantial intravenous analgesia. The literature reports two alternative methods for the reduction of TMJ dislocations. In 2004, Lori et al. describe a variation of the intraoral approach, and in 2007, Chen et al. describe an extraoral or external approach. Both of these methods require the physician to manually manipulate the mandible.[1,2]


The traditional intraoral approach is time consuming, difficult, and at times, ineffective. It is also not without risk to the patient or the EP.[1,3–6]

Goal of This Investigation

We introduce a simple and novel technique for the reduction of acutely nontraumatic TMJ dislocations using a hands-free approach. This technique is safe, rapid, and effective without the need for procedural sedation or intravenous analgesia.