Automobilization intervention and exercise for temporomandibular joint open lock

Training of the lateral pterygoid muscle in the treatment of temporomandibular joint disc displacement with reduction: A randomised clinical trial

BACKGROUND

Disc displacement with reduction (DDwR) therapy should be performed only when pain or discomfort is presented. Data on treatment options for painful DDwR are very limited.

OBJECTIVE

The aim was to investigate whether isometric training of the lateral pterygoid muscle (LPM) is equivalent to stabilisation appliance therapy with regard to the treatment of painful DDwR. The training program is based on the science of Janda.

METHODS

This was a prospective, randomised study with a comparative treatment group. Sixty patients (≥18 years) with DDwR and pain were randomly assigned to two groups: (1) muscle training and (2) stabilisation appliance. The following variables were recorded at baseline examination and after 2, 4 and 6 months: changes in orofacial pain, clicking sounds of the temporomandibular joint (TMJ), force degrees for the lateral movement of the mandible and interincisal opening distance. p values of <.05 were considered statistically significant but 95% confidence intervals were also presented.

RESULTS

A decrease in orofacial pain intensity was seen in both groups (p < .0001). Registered TMJ clicking disappeared after 6 months of treatment in 37% (n = 11) of the patients in the training group and in 27% (n = 8) of the appliance group (p = .0009 and p = .0047). Muscle training showed 27 improvements in Janda force degrees at the end of the study (p < .0001).

CONCLUSION

Muscle training and appliance therapy improved mouth opening and reduced pain intensity in both patient groups. Muscle training might be a promising option in the treatment of patients suffering from painful DDwR.

The Retrospective Study of Magnetic Resonance Imaging Signal Intensity Ratio in the Quantitative Diagnosis of Temporomandibular Condylar Resorption in Young Female Patients

According to the literature, there is no reliable and quantitative method available for the diagnosis and prognosis of early or potential temporomandibular joint (TMJ) condylar resorption (CR) thus far. The purpose of this study was to raise a new noninvasive method to quantitatively evaluate condylar quality using the signal intensity ratio (SIR) on magnetic resonance imaging (MRI) in order to assist in the diagnosis of TMJ CR. A retrospective exploratory study was performed to compare the condyle-to-cerebral cortex signal intensity ratios (SIR) on MRI among young female patients. We included 60 patients, and they were divided into three groups: the bilateral normal TMJ group (group 1), the bilateral TMJ anterior disc displacement (ADD) but without CR group (group 2), and the bilateral TMJ anterior disc displacement (ADD) with CR group (group 3). The SIR difference between the three groups was analyzed by the Kruskal–Wallis test (K-W test). The sensitivity, specificity, accuracy, and area under curve (AUC) were calculated by the receiver operating characteristic (ROC) curves. There was high consistency between the surgeon and the radiologist in the evaluation of the magnetic signal intensity with intraclass correlation coefficients of 0.939–0.999. The average SIR was 1.07 in the bilateral normal TMJ group (group 1), 1.03 in the ADD without CR group (group 2), and 0.78 in the ADD with CR group (group 3). It could be found by the K-W test that group 3 was significantly different from group 1 and group 2 (p < 0.05), while there was no significant difference between group 1 and group 2. The optimal critical SIR value was 0.96 for the diagnosis of CR according to the ROC curves and Youden index (p < 0.001, AUC = 0.9). The condyle-to-cerebral cortex SIR can be used as a noninvasive diagnostic tool for the quantitative evaluation of condylar quality and diagnosis and prognosis of CR. SIR ≥ 0.96 indicates a healthy condyle, while SIR < 0.96 is considered the optimal critical value for the diagnosis of CR. These findings are important for personalized and accurate treatment and prognosis prediction.

Temporomandibular joint dislocation: a retrospective study from a Swiss urban emergency department

Purpose

Temporomandibular joint (TMJ) dislocation is an uncommon and debilitating condition of the facial skeleton. The condition may be traumatic or nontraumatic, in an acute or chronic form, and with bilateral or monolateral expression.

Patients and methods

In this study, conducted from May 2012 to July 2016, we retrospectively analyzed TMJ dislocations treated in the Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, by focusing on the following parameters: age, gender, reason, localization, frequency, and therapy.

Results

Thirty-two patients were included. The mean age was 42.06 years and there was no predominant gender. Most cases of TMJ dislocation were nontraumatic (93.7%). Dislocations were mostly bilateral (59.4%) and appeared in a chronic situation and with repetitive events (62.5%). Thirty-one patients received conservative treatment, which consists of reposition of the TMJ with (38.7%) or without (61.3%) analgosedation. Only one patient needed surgical reposition due to previous surgical treatment.

Conclusion

This is the first attempt to evaluate TMJ dislocations in Switzerland in an acute hospital setting. To our knowledge, there are no other studies that systematically analyze these injuries by focusing on the patients’ characteristics. Surgical reposition is only indicated in complicated and very rare situations. Conservative approaches are commonly used and should be exhausted before any surgery.

Posterior disc displacement of the temporomandibular joint: A rare case report

BACKGROUND

Posterior disc displacement (PDD) of the temporomandibular joint (TMJ) is quite rare. The normal position of a disc is slightly anterior to the condyle, so the chances of disc displacement to the posterior direction are low.

CASE PRESENTATION

A 71-year-old Japanese female reported with a chief complaint of lack of occlusion on the right-side molar teeth. Clinical examination revealed lack of occlusal contact in the right posterior region, nearly normal range of mouth opening (41.0 mm), masseter muscle tenderness, and deviation to the left on opening. MRI of the right TMJ showed PDD in both the open- and closed-mouth position and joint effusion. Conservative treatment with a non-steroidal anti-inflammatory drug, stretch exercise with fingers, and stabilization splint improved symptoms for 9 months.

CONCLUSION

Conservative treatment was effective in managing the patient. A follow-up for 9 months with a repeat MRI was undertaken to monitor the progress.

Magnetic Resonance Imaging (MRI) Evaluation for Anterior Disc Displacement of the Temporomandibular Joint

Background

Magnetic resonance imaging (MRI) is the criterion standard imaging technique for visualization of the temporomandibular joint (TMJ) region, and is currently considered the optimum modality for comprehensive evaluation in patients with temporomandibular joint disorder (TMD). This study was aimed at finding the value of MRI in pre-clinical diagnosis of TMJ disc displacement.

Material/Methods

Patients primarily diagnosed as having anterior disc displacement by clinical symptoms and X-ray were selected in the present study. MRI was used to evaluate surrounding anatomical structures and position, as well as morphological and signal intensity change between patients and normal controls.

Results

Posterior band position was significantly different between the patient group and control group. At the maximum opened-mouth position, the location of disc intermediate zone returned to normal. At closed-mouth position, the thickness of anterior and middle, but not posterior, band increased. The motion range of the condyle in the anterior disc displacement without reduction (ADDWR) patient group was significantly less than the value in the anterior disc displacement with reduction (ADDR) patient group and the control group. Whether at closed-mouth position or maximum opened-mouth position, the exudate volume in the patient group was greater than in the normal group.

Conclusions

MRI can be successfully used to evaluate multiple morphological changes at different mouth positions of normal volunteers and patients. The disc-condyle relationship can serve as an important indicator in assessing anterior disc displacement, and can be used to distinguish disc displacement with or without reduction.

A Missed Case of Occult Bilateral Temporomandibular Dislocation Mistaken for Dystonia

A 24-year-old male with a history of psychiatric disorder and no prior significant temporomandibular joint (TMJ) pathology presented to the emergency department for “lockjaw.” Plain film X-rays of the mandible were read as unremarkable by an attending radiologist, leading to the initial diagnosis of medication-induced dystonic reaction. Following unsuccessful medical treatment a maxillofacial computed tomography (CT) was ordered. CT confirmed bilateral dislocation, illustrating the importance of clinical judgment, and limitations of certain radiographic images. The authors believe this case to be the first reported case in the medical literature of bilateral anterior TMJ dislocation with a false negative X-ray.

Effects of controlled condylar rotation exercise on symmetrical mouth opening in patients with temporomandibular disorder

[Purpose] The purpose of this study was to determine the effects of a 4-week program of active condylar rotation exercise on the extent of the lateral mandibular shift during mouth opening in patients with temporomandibular disorder. [Subjects and Methods] Patients with temporomandibular disorder (n = 12; 7 men and 5 women) were recruited. The active range of temporomandibular motion was recorded using 3-dimensional ultrasound-based motion analysis. The paired t-test was used to assess changes in lateral mandibular shift before and after active condylar rotation exercise. [Results] The degree of the lateral mandibular shift during mouth opening and the mouth opening-lateral mandibular shift ratio were significantly lower after active condylar rotation exercise than before the exercise. [Conclusion] Active condylar rotation exercise may effectively reduce the degree of the lateral mandibular shift during mouth opening to produce symmetrical mouth opening in patients with mild temporomandibular disorder.

Temporomandibular joint effusion and its relationship with perceived disability assessed using musculoskeletal ultrasound and a patient-reported disability index

The relationship between effusion of the temporomandibular joint (TMJ) and patient-reported disability is poorly researched. This pilot study explored the link between TMJ inflammation as measured by ultrasound and patient disability assessed by the Steigerwald Maher TMD Disability Index (SMTDI). The study design used a prospective correlational approach involving a sample with TMJ dysfunction (TMD). Twenty-four patients were recruited from the European School of Osteopathy and a Kent dental practice. Participants completed the SMTDI to determine the level of TMD (symptomatic score >20). A SonoSite SLA "Hockey Stick" [13-6 MHz] musculo-skeletal transducer was placed over the TMJ in a transverse direction and effusion was calculated indirectly by measuring capsular width. An upper left quadrant protocol was used throughout. A regression analysis was run with participants' gender, age and capsular width as predictor variables modelled against reported SMTDI. Larger capsular widths were found to be significant predictors of SMTDI scores (r = 0.803, p < 0.0001). The patient profile matched with the previous studies and the TMD sufferer population, indicating external validity. Results suggest that the SMTDI could be integrated into practice life as a quick, accessible and easy tool to monitor patients' progress and assess levels of inflammation, without the need for repetitive imaging. The study design proved reproducible and a larger scale study is indicated.