Special Operations Forces Medical Handbook

5-18

of lower molar; bad taste in mouth

Objective: Signs
No fever, purulent exudates or other signs of systemic infection; visible open wound without clot

Assessment:
Differential Diagnosis - abscess, trauma, osteomyelitis (systemic signs)

Plan:
Antibiotics are rarely indicated.

1. Local anesthesia


2. Irrigation of extraction site with warm saline in syringe


3. Cut approximately 1 1⁄2- 2 inch strip of iodoform gauze and apply 1 to 2 drops of (IRM liquid) eugenol.
   Place this eugenol/gauze gently into affected socket


4. Change medicated gauze daily until symptoms are gone (usually 3 to 5 days)


5. May also administer a NSAID for pain

Barodontalgia (Toothache induced with change in pressure.) See Aerospace Medicine section.

Injuries of The Jaw See Trauma chapter on CD-ROM: Maxillofacial Trauma.

8. DISLOCATION OF THE TEMPOROMANDIBULAR JOINT(S)
   COL Glenn Reside, DC, USA
   Dislocation of the Temporomandibular Joint (TMJ) occurs frequently, usually caused by mandibular hypermo-
   bility but can also be caused by trauma. The mandibular condyle translocates anteriorly in front of the articular
   eminence and becomes locked in that position. Muscle spasm may then prevent the patient from closing
   the jaw into normal occlusion. Dislocation may be unilateral or bilateral and may occur spontaneously after
   opening the mouth widely while yawning, eating, or during a dental procedure. Dislocation of the TMJ is usually
   painful, is not self-reducing, and usually requires professional management. Subluxation is a displacement of
   the condyle that is self-reducing and requires no medical management. Dislocations should be reduced as
   soon as possible.

Subjective: Symptoms
Pain in the preauricular area, accompanied by drooling and difficulty talking

Objective: Signs
Tender, bony prominence in preauricular area(s); malaligned dental bite; mouth locked in an open position

Assessment:
Differential Diagnosis - fractured mandible, tumor

Plan:

Treatment
Primary: Manually reduce the dislocated TMJ as soon as possible by moving the dislocated mandibular condyle
inferiorly and posteriorly from in front of the articular eminence and then superiorly into the glenoid fossa.

1. Get behind the patient. If the patient is sitting in a chair, their head should be at the level of your waist. If
   the patient is lying down on their back on the ground, you should sit on the ground at the patient’s head
   and cradle their head in your lap.


2. Wrap your thumbs in gauze or a small towel (to avoid being bitten) and put them inside the patient’s mouth
   behind the last molar on each side of the lower jaw. All four ngers of each hand should be placed along
   the inferior border of the mandible with the forengers near the chin and the little ngers near the angles
   of the mandible. Stabilize the patient’s head against the back of the chair or your torso if the patient is
   sitting or in your lap if the patient is supine.


3. Apply rm, continuously increasing pressure downward (inferiorly) and backwards (posteriorly) on the