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Article in Press: Corrected Proof Michael Gottlieb MD 
and Brit Long MD
Annals of Emergency Medicine, Copyright © 2022 American College of Emergency Physicians
Introduction
Temporomandibular joint (TMJ) dislocation is an important condition to diagnose and manage in the emergency department (ED), with a lifetime prevalence of 5% to 8% and an estimated incidence approaching 25 out of 100,000 people per year. The TMJ is a hinge and gliding joint with a dense fibrocartilaginous disc lying between the condyle and glenoid fossa. Dislocation occurs when the condylar process of the mandible is displaced from its normal location in the glenoid fossa of the temporal bone and becomes locked in an abnormal position, resulting in muscle spasm and preventing mouth closure. Anterior dislocation is the most common form and will be the focus of this article. Lateral, posterior, and superior joint dislocations are much rarer and more commonly associated with high-energy trauma resulting in facial fractures. Bilateral dislocation is more common than unilateral dislocation. , In an anterior dislocation, the head of the mandible slips out of the mandibular fossa and is locked anterior to the articular eminence, resulting in spasm of the masseter, pterygoid, and temporalis muscles. , Nontraumatic TMJ dislocations can be classified as acute, chronic recurrent, or chronic. Anterior TMJ dislocation can occur spontaneously with any movement that results in extreme opening of the mouth, including chewing, kissing, singing, vomiting, and yawning. , , , Risk factors include conditions resulting in increased ligament laxity (eg, Ehlers-Danlos, Marfan syndrome), prior TMJ dislocation, medications with dystonic reactions (eg, haloperidol, metoclopramide, prochlorperazine), procedures (eg, intubation, endoscopy), seizures, and neurodegenerative conditions (eg, multiple sclerosis, Huntington disease). , , It is important for clinicians to be aware of the approach to the management of these patients. This article is not intended to be a comprehensive review of all the aspects of the evaluation and management of patients with an anterior TMJ dislocation; instead, it seeks to distill key facets of management based upon the current literature and years of practice.
