Surgery for internal derangements of the temporomandibular joint.

Three hundred and twenty-seven reconstructive arthroplasties and disk repositionings have been performed during the past 6 years at Montgomery Baptist Medical Center for patients with internal derangements of the TMJ. By our evaluation, 94% are remarkably successful, 4% are marginally successful, 1% are not improved, and less than 1% are failures. On the basis of these experiences, we believe that the surgical technique of reconstructive arthroplasty and disk repositioning has a definite place in the treatment of patients with internal derangements of the TMJ.     

Radiographic and surgical evaluation of internal derangements of the temporomandibular joint

A prospective study of 287 patients who underwent temporomandibular surgery for disc dysfunction was conducted. The patients were evaluated by combinations of polydirectional tomography, microfocus magnification, and arthrographic radiographic modalities. Abnormalities of the hard and soft tissue structures of the joints were determined radiographically and compared with the findings of surgical examination. Polydirectional tomography and microfocus magnification compared favorably with each other, as well as in their ability to show the actual abnormalities. Arthrography had a high degree of correlation with actual pathologic disc alterations, except for the 15% incidence of false-positive findings of perforation. The combination of either polydirectional tomography or microfocus magnification with arthrography is recommended for complete evaluation of the painful temporomandibular joint that shows evidence of limited range of motion.     

Separation of internal derangements of the temporomandibular joint using sound analysis

This clinical-arthrographic investigation compares power spectral analysis of temporomandibular joint sounds with different arthrographic characteristics of intracapsular dysfunction. The quantitative comparison of specific parameters of the sound power-spectrum waveform may provide a sensitive and accurate noninvasive tool for diagnosis and treatment.     

Sound analysis of temporomandibular joint internal derangements with phonographic recordings

STATEMENT OF PROBLEM: Temporomandibular joint (TMJ) sound recordings could be analyzed to assess the state of TMJ internal derangements. PURPOSE: The aim of the study was to assess the value of sound analysis in the diagnosis of the type of the TMJ internal derangements. MATERIAL AND METHODS: After clinical and radiologic examinations, phonographic sound recordings on mandibular excursions were obtained in 52 patients with TMJ internal derangements and 12 control individuals. Sound correlations were made on the basis of opening-closing, protrusive-retrusive, and lateral excursions of the mandible. RESULTS: Clicking was a consistent finding of anterior disc displacement with reduction, whereas crepitation was found in varying degrees in anterior disc displacement and osteodegenerative arthritis. Silent TMJs were the feature of normal TMJs, except for the situations of acute lock. Although in 29 TMJs opening click was followed by a closing click (reciprocal clicking), 46 TMJs with opening click also had clicking on protrusion. On the other hand, 19 TMJs with opening click also had clicking on ipsilateral motion, and 40 TMJs with opening click had clicking on contralateral motion of the mandible. The sound patterns were found to be similar in opening-protrusive clicks and opening-contralateral clicks. The lack of protrusive clicking in the presence of opening click was considered an indication of late disc reduction on opening. Crepitation was observed in advanced cases of TMJ internal derangements. CONCLUSION: Within the limitations of this study, the results suggest that TMJ sound analysis on mandibular excursions was indicative for diagnosis and establishment of severity of TMJ internal derangements. Clicking and crepitation may be looked on as signs of abnormal joint disorder, clicking indicating anterior disc displacement with reduction, and crepitation, indicating progression from anterior disc displacement without reduction to osteodegenerative arthritis.     

Chewing movements altered in the presence of temporomandibular joint internal derangements

Aims:

The objectives were to find specific factors that are mathematically distinct between the chewing timings, movement pattern shapes, variability, and movement velocities of: (1) normal asymptomatic subjects and (2) a group of subjects with verified temporomandibular joint (TMJ) internal derangements.

Methodology:

Left- and right-sided chewing movement recordings of 28 subjects (34·5±14·0 years) were randomly selected from a large database of patients exhibiting verified unilateral or bilateral TMJ internal derangements. The chewing movements of an age- and gender-matched control group of 20 asymptomatic subjects (32·5±11·6 years, P>0·60) with verified normal TMJ function were also recorded. Means and standard deviations of the opening, closing, turning point, terminal chewing position, and velocity patterns were calculated. A two-tailed Student’s t-test with unequal variances was used to compare the parameters between the two groups (alpha?=?0·05).

Results:

The dysfunctional group functioned significantly slower and with greater variability than the control group. The vertical dimension was consistently smaller in the dysfunctional group (P<0·00001). The terminal chewing position was significantly less precise in the dysfunctional group (vertical: P<0·002 and lateral: P<0·037). The maximum lateral width was significantly less (P<0·0071), and the peak and the average velocities were significantly lower (P<0·00001 for both) in the dysfunctional group.

Conclusions:

This group of dysfunctional subjects exhibited significantly slower, smaller, and more variable chewing patterns than the control group. The functional pattern of mastication appears to be significantly altered in the presence of an internal derangement of the TMJ.     

Internal derangements of the temporomandibular joint

This article discusses several types of internal derangements of the temporomandibular joint. It includes definitions, clinical characteristics, and management options. Nonsurgical and surgical treatment strategies are discussed taking into consideration the latest evidence-based literature.     

A radiologic and anatomic study of internal derangements of the temporomandibular joint

Fifteen temporomandibular joints (TMJs) in unfixed cadavers were examined clinically and then arthrograms were made. Eleven of the TMJ disks were mechanically displaced anteriorly before the arthrograms were made. The joints were removed, fixed, frozen, and sectioned perpendicular to the long axis of the condyle in 2 mm slices. The arthrograms of the joint were compared with arthrograms of each individual section and the original tissue slices to determine whether there was a definite correlation with true anatomic relationships. Because of the complexity of the internal morphology of the hard and soft tissues in the TMJ, no accurate or consistent conclusions about the actual physical relationships could be made by means of arthrogram.     

Computerized axial tomography in the diagnosis of internal derangements of the temporomandibular joint

Fourteen patients with a history of pain, clicking and locking of the temporomandibular joint were assessed clinically and by using computerized axial tomography (CAT). The findings of the clinical and CAT scan assessment were correlated and compared with surgical observations. Computerized axial tomography scanning proved to be a highly accurate method of assessing meniscal position. With the advent of more sophisticated methods of CAT scanning, it provides an accurate, non-invasive method of assessing the temporomandibular joint and providing a basis for more effective treatment planning of problems related to internal derangements.     

Internal derangements of the temporomandibular joint: description of clinical syndromes

Clinical findings and diagnostic criteria for internal derangements of the temporomandibular joint are outlined. Pathophysiology is discussed, including the role of predisposing factors and the relationship with myofascial pain-dysfunction syndrome.     

The lower space arthrographic and MR imaging of internal derangement of the temporomandibular joint

The clinical and arthrographic findings were evaluated on the basis of surgical procedures, performed on 120 symptomatic TMJs of 100 patients. The pre-operative arthrographic findings had significant correlation with surgical findings with respect to the presence of disc displacement, adhesion, and perforation. The MR findings of 10 TMJs of 5 patients were observed and studied. The diagnostic usefulness of MR imaging was considered and evaluated by observing the MR imagings of symptomatic TMJs.     

Bilateral internal derangements of temporomandibular joint: evaluation by magnetic resonance imaging

Two hundred eleven patients with signs and symptoms of temporomandibular joint (TMJ) internal derangements were referred for magnetic resonance imaging. Both TMJs of each patient were routinely evaluated in this prospective investigation. With 422 joints examined, 29% (61) of the patients had bilaterally normal findings, 21% (45) of the patients had one normal side and one abnormal side, and 50% (105) of the patients showed bilateral internal derangements. This clinical study demonstrated a high likelihood of bilateral internal derangements in patients with symptoms of TMJ internal derangements.