Special Operations Forces Medical Handbook

5-19

retromolar area with the thumbs and upward pressure on the chin with your forengers. As the condyle
passes the crest of the TMJ eminence it will slide easily into proper position in the glenoid (mandibular)
fossa.

4. After the dislocation is reduced it is imperative to maintain pressure on the chin to hold the teeth together
   because the patient frequently will reexively open their mouth and dislocate again. The muscles of
   mastication are frequently in spasm while the mandible is dislocated and will forcefully close the mouth
   when the condyle is replaced into the glenoid fossa. Protect your thumbs from being bitten.
   Alternate: If the muscles of mastication are in such spasm that you cannot manually manipulate the condyle,
   sedate the patient with a muscle relaxant such as diazepam (Valium) or midazolam (Versed) prior to reducing
   the dislocation. In extremely rare cases the patient may require general anesthesia in conjunction with the
   reduction. If the patient tends to reexively open the mouth and cause repeat dislocations, apply a dressing over
   the top of the head and under the jaw to inhibit the motion of the mandible.
   Primitive: Warm, moist heat to the sides of the face to relax the temporalis and masseter muscles and allow the
   patient to reduce the dislocation by himself.

Patient Education
General: Activity: Avoid trauma to the mandible.
Diet: Avoid opening mouth too wide while chewing. Cut food into small pieces. Chew a soft diet until the
preauricular tenderness resolves.
Medications: Over-the-counter analgesics, such as acetaminophen or ibuprofen, can be used.
Prevention and Hygiene: Avoid opening mouth wide while yawning, talking, eating, etc.
No Improvement/Deterioration: Refer to an oral and maxillofacial surgeon.

Follow-up Actions
Evacuation/Consultation Criteria: Evacuation is not usually necessary. If you are unable to achieve a
proper reduction or if the patient presents on multiple occasions requiring emergent reduction, refer the patient
to an oral and maxillofacial surgeon for evaluation and treatment.

III. DENTAL ANTIBIOTICS

A. Administer oral doses for 7-10 days duration. Administer IV antibiotics as needed and switch to oral
drugs based on these criteria:

1. Intercisal opening (distance between upper and lower front teeth when mouth is open) greater than
   20mm


2. Normal temperature


3. Patient can eat a normal/acceptable diet


4. No fluctuant area at affected site
   B. Oral dosages (in order of preference):


5. PEN VK
   a. Adults - normal loading dose is 1 gm then followed by 500 mg q 6 hours
   b. Children (< 25kg) 500 mg followed by 250 mg q 6 hours


6. Erythromycin
   a. Adults - 1gm normal loading dose then followed by 500 mg q 6 hours
   b. Children - (<25kg) 500 mg followed by 250 mg q 6 hours


7. Clindamycin (Cleocin)
   a. Adults - 600 mg loading dose followed by 300 mg q 6 hours
   b. Children - (<25kg) 300 mg followed by 150 mg q 6 hours
   C. IV Dosages (in order of preference):


8. Aqueous PEN G
   a. Adults - 2 million units q 4-6 hours