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Objective:To observe the curative effect of exercise training combined with posture control among patients with displacement of the anterior disc of the temporomandibular joint (TMJ) without reduction.Methods:Forty-four patients with anterior TMJ disc displacement without reduction who had successfully been treated with manual repositioning were randomly divided into a control group and a treatment group, each of 22. Both groups underwent routine exercise training, while the experimental group was additionally provided with posture training five times a week for 4 weeks. After the 4th week of training both groups were evaluated using a visual analogue scale (VAS) and their maximum active mouth opening was compared. Six months later, MRI was performed to observe the disc-condyle relationship of the temporomandibular joint and its position.Results:①After 4 weeks of training, the average VAS scores of both groups were significantly lower than those before the training. The improvement in the treatment group′s average was significantly greater than among the control group. ②After the 4 weeks of training the average maximum active mouth opening of both groups had increased, with the improvement in the treatment group significantly greater. ③Six months later, 19 persons in the treatment group had a normal disc-condyle relationship, significantly more than the 13 in the control group.Conclusions:Posture control training can improve the effectiveness of sports training in maintaining manual repositioning of the TMJ after anterior disc displacement without reduction.
ABSTRACT
Temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDwoR) is a common type of temporomandibular joint disorders. Most patients experience limited mouth opening and joint pain at the same time. The standpoint of physical therapy is the function of the joint instead of the displaced disc. The treatment aims to make symptoms disappeared and joint function regained through 3M techniques, including modality, manual and movement. For ADDwoR patients with limited mouth opening within 2 month, manual therapy may reposition disc and the following splint and movement therapy can maintain disc-condyle relationship. Even so, restoring anatomical relationship is not the end of physical therapy. Enhanced health education and multidisciplinary cooperation are important for successful management of the ADDwoR patients.
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Objective:To provide imaging evidence for the treatment of anterior disc displacement without reduction by the injection of sodium hyaluronate into temporomandibular joint (TMJ).Methods:40 patients with anterior disc displacement without reduction were injected 3 times with sodium hyaluronate into the TMJ.Patient's TMJ and clinical symptoms were examined 3,9 and 12 months after treatment.The clinical parameters of Fricton's Craniomandibular Index(Fricton index),maximal mouth opening(MMO),pain intensity of a visual analog scale(VAS) and CBCT radiographic data of 48 TMJs from 40 patients were analysed.Results:The CBCT images showed that at 9 and 12 months follow-up the surface of the condylus became smooth,the density of the cortical bone and the adjacent subcortical bone increased and osteophyte in condylar head decreased(P =0.026,P =0.001).As for disc displacement without osteoarthritts,9 months after treatment condylus were moved forward(P =0.038).VAS and Fricton index were reduced(P ＜0.05),MMO was increased (P ＜ 0.05).3-12 months after treatment,there was no statistical difference of Fricton index (P ＞ 0.05).Conclusion:Injection of sodium hyaluronate into TMJ can remodel the condylar bone surface but cant make condyle back to the middle of acetabulum.
ABSTRACT
Arthroscopy is useful to detect early changes in the temporomandibular joint (TMJ). Despite great advances in arthroscopy, many arthroscopic surgeries have now been replaced by arthrocentesis. We propose a simple diagnostic and therapeutic method having operative rigid ultra-thin arthroscopy with 16 gauge needle size combined with arthrocentesis.
Subject(s)
Arthrocentesis , Arthroscopy , Methods , Needles , Temporomandibular JointABSTRACT
INTRODUCTION: Limited mouth opening is a representative clinical symptom of temporomandibular disorders (TMD) with anterior disc displacement without reduction (ADDWOR). Various treatment methods have been proposed for patients with ADDWOR. This study examined the clinical effectiveness of template therapy for patients with mouth opening difficulty due to the ADDWOR. MATERIALS AND METHODS: A total of 14 patients (female 12, male 2, average age: 29.1+/-14.4), who had been treated in the template clinic, Sooncheonhyang University Bucheon Hospital, from January of 2006 to December of 2008, were enrolled in this study. The subjects were selected according to the following criteria: more than 2 weeks after the onset of locking, mouth opening range < 35 mm, and confirmed ADDWOR without a synovial pathology by magnetic resonance imaging (MRI). All patients were treated with the template appliance, instructed to wear it while sleeping and exercise for at least 10 hours per day. The maximum mouth opening (MMO) range and pain recognition scores before and after template therapy were recorded and compared. A paired t-test and Wilcoxon's signed rank test were used for statistical analysis. RESULTS: After the periodical follow up, significant improvement in the opening range was observed in the template treatment group. The average MMO range before treatment was 30.2+/-3.5 mm and the average MMO after treatment and follow up was 47.1+/-4.7 mm. The mean amount of mouth opening increment was 16.9+/-5.4 mm (P<0.01) and the pain recognition scores before and after treatment was also improved.(P=0.001) CONCLUSION: The template appliance proved to be efficient for the treatment of TMD with a closed lock and painful joint due to ADDWOR.