Luxación mandibular aguda: técnicas de reducción manual y secuencia de manejo en el Servicio de Urgencia

Abstract

Introduction: The objective of the present study is to carry out an updated review on the methods of manual reduction of acute mandibular dislocation to propose a management sequence in the emergency department. Material and methods: The review included studies on manual techniques for reducing acute mandibular dislocations. The search was performed in Spanish and English in june 2020 and included the electronic databases PubMed and Scielo, complemented by cross-references. Articles on surgical treatment of recurrent, chronic and reduced dislocations under general anesthesia were excluded. Results: The search yielded 334 results, finally 29 studies were included. To date, 13 manual reduction techniques different from the conventional method have been described. The effectiveness of the conventional method is close to 86 %, the wrist pivot method 96.7 % and the extraoral method is less effective with a success rate between 55.2 and 66.7 %. A treatment sequence is proposed including the most relevant aspects found in the literature. Conclusion: The best manual reduction technique is one that provides greater comfort to the professional, produces less pain and is associated with a higher success rate. Studies comparing different techniques with a trained operator are lacking considering patient, technique and operator comfort variables. It is essential to know the techniques presented, this allows them to be used in cases where other techniques fail, minimizing the use of adjuvants and more complex maneuvers, such as regional blocks or general anesthesia.