The most common form of internal TMJ dislocation is anterior misalignment or displacement of the articular disc above the condyle. Its symptoms include localized joint pain and popping on the jaw movement. History and physical examination help in the right diagnosis. Treatment involves analgesics, jaw rest, muscle relaxation, physical therapy, and bite splints. Surgery may be required in adverse cases by oral and maxillofacial surgeons like Dr. Anurag Bhargava.
Abnormal jaw mechanics can be due to birth or acquired asymmetries or to the sequelae of trauma or arthritis. If the disc remains anterior, the displacement is said to be without reduction. It may result in restricted jaw opening and pain in the ear and around the temporomandibular joint. If at some point in the joint's excursion, the disc returns to the head of the condyle, the dislocation is termed to be with reduction.
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Symptoms and Treatment of TMJ Disc Dislocation with Reduction
Disc displacement with reduction causes a painless clicking when the mouth is opened. While chewing hard foods one may experience pain.
The diagnosis of disc displacement with reduction needs observation of the jaw when the mouth is opened. When the jaw is opened > 10 mm a click is heard, as the disc pops back over the head of the condyle. The condyle stays on the disc during the further opening. Usually, another more reciprocal click is heard during closing when the condyle slips over to the posterior rim of the disc slips forward.
TMJ Disc dislocation with reduction does not require treatment if the patient can open jaw wide enough without discomfort. If pain persists, mild analgesics can be administered. Some patients benefit from doing slow jaw-motion exercises using commercially available mechanical tools.
If the duration is < 6 months, an anterior repositioning brace may be used to position the mandible forward and on the disc. A brace is a horseshoe-shaped appliance of tough, transparent plastic made to fit compactly over the teeth of one arch. Its chewing surface is made to hold the mandible forward when the patient closes on the brace. In this position, the disc is always on the head of the condyle. The brace is slowly adjusted to allow the mandible to move posteriorly. If the disc stays with the condyle as the superior head of the external pterygoid stretches, the disc is known to be captured. The longer the disc is displaced, the more distorted it becomes and little chance of repositioning to succeed.
Symptoms and Treatment of TMJ Disc Dislocation without Reduction
TMJ Disc dislocation without reduction with the limited opening is uncommon. It is seen that progression to chronic and disabling intracapsular TMJ disease is uncommon. It is often self-limiting or fluctuating over time. Women are more prone to disc displacement without reduction than men. It is more common in young and middle-aged women.
Sign of Disc Displacement without Reduction
- Restriction of movement to the normal joint.
- No intracapsular sounds identified unless chronic and associated with a change in bony surfaces.
- A maximum passive stretch is less than 40 mm including the vertical incisal overlap.
- Deflection of the mandible to the involved joint side on opening and protrusion.
Symptoms Patients Often Face
These are precisely when the closed lock takes place and can relate it to a specific event.
- Pain is often localized to the preauricular area.
- Pain may be described as intense and is closely related to joint movement, particularly at the point limitation of movement.
- If inflammation develops, the pain may be constant and be accentuated by joint movement and joint loading.
- The patient displays worries regarding the sudden decline in mandibular movement as a result of the closed lock.
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- Obtain a thorough medical history, including details related to pain and dysfunction.
- Performed on head, neck, and teeth to rule out local pathology or other sources of pain and to assess joint function.
- The downward force applied to the mandibular incisors produces a minimal increase in the range of opening.
- Difficulty in mouth opening as a result of muscle disorders is usually variable in terms of the range of opening.
- Loading of the involved joint is painful.
- Confirm the diagnosis on a magnetic resonance imaging (MRI) scan of the TMJ.
- Determine whether the disc displacement without reduction with the limited opening is chronic.
- The clinical diagnosis becomes less clear if disc displacement is chronic, as the ligaments become further elongated and the morphology of the disc becomes changed.
Diagnosis of TMJ Disc Dislocation without Reduction
A diagnosis of disc displacement without reduction with the limited opening can be made upon patient history, clinical examination, and related tests.
Treatment of TMJ Disc Dislocation without Reduction
Approaches to acute cases may be different from chronic cases.
A common treatment for acute cases:
When a patient experiences a closed lock for 1 week or less then we refer him to an oral medicine specialist or oral and maxillofacial surgeon.
Consider attempting manual manipulation to regain the normal discondyle relationship. Then the patient could wear an anterior positioning appliance for the first few days followed by nighttime use only. Once stability has come, a stabilization appliance may be considered for nighttime use.
In serious cases, a minimally invasive surgical procedure arthroscopy could be considered to return the disc to a normal functional relationship with the condyle.
Treatment of Chronic Cases
In chronic cases, the oral and maxillofacial surgeon will explore surgical approaches.
For controlling the pain, involve a physical therapist to assist with pain control and regaining range of opening.