The temporomandibular joint (TMJ) is a synovial joint that unlike other joints in the body are capable of movement in all three dimensions.
Different etiologic factors like trauma, local and systemic diseases, autoimmune disease and occlusion make create condition of discal displacement.
The superior retrodiscal ligament is quite susceptible to injury. Permanent injury to this retrodiscal tissue makes difficult to the disc to return to the physiological position that is over the condyle.
This joint TMJ (Temporomandibular Joint) has a complex biomechanics.
In a very simplify definition DISC DISPLACEMENT WITH REDUCTION means that the disc is anterior from normal to the condyle in the mandibular fossa, while the condyle can be or not simultaneously positioned posteriorly from its normal position when the teeth are in habitual occlusion.
When the mouth opens the normal and healthy disc condyle relationship is restored.
I am not going to enter here in classifications that are widely published in literature.
When we face an articular disc displacement with reduction, the question is: RECAPTURE OR NOT RECAPTURE?
Is disc recapture one of the goals that I need to achieve?
When we treat this joint arthropathy we need to formulate some propositions.
1) First of all to make a differential diagnosis: What lead to this disk to be displaced?
2) The goal always is to give to our patient a quality of life. And if exists inflammation to solve it. Today MRI has excellent parameters to see that. But again to know what is causing that inflammation. Is it local it is systemic?
3) WHEN WE CAN recapture the disc, and that is DIAGNOSIS, we need to understand that to return the anatomical joint elements to a healthy and physiological position is ALWAYS VALUABLE. Remember anatomy is the platform where physiology functions.
4) TO PROVE THAT WE RECAPTURE THE DISC, we need the comparison of the MRI before and after treatment.
The aim of this post is images comparison, for that I choose expressive images.
Is just to compare the changes in the soft tissues and also in the hard tissues.
One of the MRI slices before and after treatment, in cases of TMJ Pathologies in children and teenagers. The most important in this slice is not only the disc recapture but the positive remodeling of the mandibular head where was visible the osseous irregularity.Female patient 14 years old.
April 2012 – TMJ Pathologies in children the overlooked diagnosis 2012 IAO (International Association for Orthodontics Annual Meeting 3th Place Award-Table Clinics- San Juan, Puerto Rico
The teenager didn’t has pain in the joint, only pain in the shoulders and clicks!
Joint decompression. Mandible reinstatement with the neuromuscular physiologic technique. Allow disc recapture.
Logically differential diagnosis permits the favorable prognostic, not all arthropathy will permit this result, but this is a part of the initial diagnosis.
Female patient 52 years old consults in the clinic with complaints of many years of head ache, ache in the temples, and in the back of the head. Shoulder ache, blocked ears sensation, popping in both temporomandibular joints.
She presented limitation of mouth opening and difficult for mastication. She used pain killers and anti inflammatory that didn’t alleviated her symptoms.
Joint decompression. Mandible reinstatement with the neuromuscular physiologic technique. Allow disc recapture. Today asymptomatic.
Direct traumatism, provoking a distention of the medial ligament. External disc luxation.
TMJ pathologies, differential diagnosis and treatment in children and teenagers.
9 years old female patient
Main complaints: Pain in the right ear, headache principally on the right side. Pain in the back of the neck, principally on the right side.
Pain in the shoulders principally on the right side. TMJ pain, more in the right side. Pain when chewing.
Blocked right ear sensation. Pain when opening and closing the mouth. She fell in the swimming pool and hurt her chin.
She begun to have symptomatology only four months later; initially the pain was at the beginning of the night . Afterwards the pain was continuous .Before coming to the consultation she was medicated by various colleagues with: Anti –inflammatory and pain killers that didn´t work.
The images that were solicited by the colleagues, like panorex and CT didn´t showed relevant information. Even in the MRI the sagital slices, didn’t determinate a proper information for the symptomatology ONLY IN THIS CASE THE FRONTAL SLICE
Mandible reinstatement with the neuromuscular physiologic technique. Allow disc recapture.
Patient today asymptomatic
One of the slices of the MRI before and after treatment, in a male patient 34 years old. The patient presented frontal head ache, pain in the back of the neck, pain in the back of the eyes, pain in temporal muscles, and difficulty for hard food mastication.
Is very important to consider not only the recuperation of the relation of the disc with the mandibular head but also the positive remodeling of the mandibular head.