Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation

Abstract Disc displacement with reduction (DDWR) is one of the most common intra-articular disorders of the temporomandibular joint (TMJ). Factors related to the etiology, progression and treatment of such condition is still a subject of discussion. This literature review aimed to address etiology, development, related factors, diagnosis, natural course, and treatment of DDWR. A non-systematic search was conducted within PubMed, Scopus, SciELO, Medline, LILACS and Science Direct using the Medical Subjective Headings (MeSH) terms "temporomandibular disorders", "temporomandibular joint", "disc displacement" and "disc displacement with reduction". No time restriction was applied. Literature reviews, systematic reviews, meta-analysis and clinical trials were included. DDWR is usually asymptomatic and requires no treatment, since the TMJ structures adapt very well and painlessly to different disc positions. Yet, long-term studies have shown the favorable progression of this condition, with no pain and/or jaw locking occurring in most of the patients.

Myofascial trigger points in patients with temporomandibular joint disc displacement with reduction: a cross-sectional study

Abstract Objective The objective of this retrospective study was to evaluate the impact of myofascial trigger points (MTrPs) in patients with articular disc displacement with reduction (DDWR) and to identify which clinical variables are associated with the concomitant presence of DDWR and MTrPs. Material and Methods 130 patients were selected that sought treatment due to joint pain, with ages ≥18 years, of both genders, with DDWR confirmed by magnetic resonance imaging. The sample was divided into two groups: Group 1, patients with DDWR and MTrPs (N=101); and Group 2, patients with DDWR and no MTrPs (N=29). Information on gender, age, pain duration, pain scores, and maximal interincisal distance (MID) were collected. The logistic regression model was used and the odds ratios (OR) was calculated (p<0.05). Results Group 1 presented statistically significant higher mean pain scores (p=0.007), and smaller MID (p=0.0268) than Group 2. OR were significant for the pain scores (1.429), MID (0.937) and gender (women) (2.810). Conclusions Patients with DDWR and MTrPs had increased pain scores and a MID decrease compared to patients with DDWR and no MTrPs. The variables pain scores, MID, and gender (women) showed a significant association with the concomitant presence of DDWR and MTrPs.

Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement

Abstract Objective: To evaluate the effect of bite positions characterizing different splint treatments (anterior repositioning and stabilization splints) on the disc-condyle relation in patients with TMJ disc displacement with reduction (DDwR), using magnetic resonance imaging (MRI). Material and Methods: 37 patients, with a mean age of 18.8±4.3 years (7 male and 30 females) and diagnosed with DDwR based on the RDC/TMD, were recruited. MRI metrical analysis of the spatial changes of the disc/condyle, as well as their relationships, was done in three positions: maximum intercuspation (Position 1), anterior repositioning splint position (Position 2), and stabilization splint position (Position 3). Disc/condyle coordinate measurements and disc condyle angles were determined and compared. Results: In Position 1, the average disc-condyle angle was 53.4° in the 60 joints with DDwR, while it was −13.3° with Position 2 and 30.1° with Position 3. The frequency of successful "disc recapture" with Position 2 was significantly higher (58/60, 96.7%) than Position 3 (20/60, 33.3%). In Positions 2 and 3, the condyle moved forward and downward while the disc moved backward. The movements were, however, more remarkable with Position 2. Conclusions: Anterior repositioning of the mandible improves the spatial relationship between the disc and condyle in patients with DDwR. In addition to anterior and inferior movement of the condyle, transitory posterior movement of the disc also occurred.

The relationship between temporomandibular dysfunction and head and cervical posture

OBJECTIVE: This study aimed to evaluate the possibility of any correlation between disc displacement and parameters used for evaluation of skull positioning in relation to the cervical spine: craniocervical angle, suboccipital space between C0-C1, cervical curvature and position of the hyoid bone in individuals with and without symptoms of temporomandibular dysfunction. MATERIAL AND METHODS: The patients were evaluated following the guidelines set forth by RDC/TMD. Evaluation was performed by magnetic resonance imaging for establishment of disc positioning in the temporomandibular joints (TMJs) of 30 volunteer patients without temporomandibular dysfunction symptoms and 30 patients with symptoms. Evaluation of skull positioning in relation to the cervical spine was performed on lateral cephalograms achieved with the individual in natural head position. Data were submitted to statistical analysis by Fisher's exact test at 5%significance level. To measure the degree of reproducibility/agreements between surveys, the kappa (K) statistics was used. RESULTS: Significant differences were observed between C0-C1 measurement for both symptomatic (p=0.04) and asymptomatic (p=0.02). No statistical differences were observed regarding craniocervical angle, C1-C2 and hyoid bone position in relation to the TMJs with and without disc displacement. Although statistically significant difference was found in the C0-C1 space, no association between these and internal temporomandibular joint disorder can be considered. CONCLUSIONS: Based on the results observed in this study, no direct relationship could be determined between the presence of disc displacement and the variables assessed.

Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI

The aim of this study was to assess the shape of the temporomandibular joint (TMJ) articular eminence and the articular disc configuration and position in patients with disc displacement. TMJ magnetic resonance images (MRI) of 14 patients with bilateral disc displacement without unilateral reduction were analyzed. Articular eminence morphology was characterized as box, sigmoid, flattened, or deformed. Articular disc configuration was divided into biconcave, biplanar, biconvex, hemiconvex or folded, and its position, as "a" (superior), "b" (anterosuperior), "c" (anterior) or "d" (anteroinferior). The images were divided and the sides with disc displacement with reduction (DDWR) and without reduction (DDWOR) were compared. Regarding articular eminence shape, the sigmoid form presented the greatest incidence, followed by the box form, in the DDWR side, although this was not statistically significant. In the DDWOR side, the flattened shape was the most frequent (p = 0.041). As to disc configuration, the biconcave shape was found in 79 percent of the DDWR cases (p = 0.001) and the folded type predominated in 43 percent of the DDWOR cases (p = 0.008). As to disc position, in the DDWR side, "b" (anterosuperior position) was the most frequent (p = 0.001), whereas in the DDWOR side, "d" (anteroinferior position) was the most often observed (p = 0.001). The side of the patient with altered disc configuration and smaller shape of TMJ articular eminence seems to be more likely to develop non-reducing disc displacement as compared to the contralateral side.

Objetivou-se avaliar a morfologia da eminência e a configuração e a posição do disco da articulação temporomandibular (ATM) em pacientes com deslocamento de disco. Foram analisadas imagens por ressonância magnética (IRM) da ATM de 14 pacientes com deslocamento de disco bilateral, sem redução unilateral. A morfologia da eminência articular foi caracterizada como caixa, sigmóide, aplainada e deformada. A configuração do disco articular foi dividida em bicôncava, biplanar, biconvexa, hemiconvexa e dobrada e a sua posição em "a" (superior), "b" (ântero-superior), "c" (anterior) e "d" (ântero-inferior). As imagens foram divididas e comparadas entre o lado com deslocamento de disco com redução (DDCR) e o lado sem redução (DDSR). Quanto à forma da eminência articular, a forma sigmóide foi a mais incidente, seguida da caixa, no lado com DDCR, embora esta diferença não tenha sido estatisticamente significante. No lado com DDSR, a forma aplainada foi a mais freqüente (p = 0,041). Na configuração do disco, a forma bicôncava foi observada em 79 por cento dos casos de DDCR (p = 0,001) e a dobrada em 43 por cento dos casos de DDSR (p = 0,008). Em relação à posição do disco, a posição "b" (ântero-superior) foi a mais freqüente no lado com DDCR (p = 0,001), enquanto que no lado com DDSR, foi a "d" (ântero-inferior) (p = 0,001). O lado do paciente com alteração na configuração do disco e uma forma menor da eminência articular da ATM parece ter mais chance de desenvolver o deslocamento do disco sem redução quando comparado ao outro lado.

Increase of condylar displacement between centric relation and maximal habitual intercuspation after occlusal splint therapy / Aumento do deslocamento condilar entre relação central e máxima intercuspidação habitual após terapia com placa oclusal

O presente estudo avaliou os deslocamentos condilares entre a máxima intercuspidação habitual (MIH) inicial e a relação central (RC), registrada após o uso de placa oclusal desprogramadora por período médio de 7,8 ± 2,1 meses antes do tratamento ortodôntico. A amostra consistiu de 22 indivíduos, 11 do gênero masculino e 11 do feminino, com média de idade de 14,2 ± 1,4 anos, com maloclusão de Classe II2, sem sinais e sintomas aparentes de disfunção temporomandibular (DTM). Os deslocamentos condilares foram medidos com aproximação de décimos de milímetro, por meio do indicador de posição axial Panadent. As médias originais dos deslocamentos verticais dos lados direito e esquerdo e correspondentes desvios padrões mediram 4,24 ± 2,53 e 3,86 ± 2,72 mm, respectivamente. Devido à correlação negativa significante observada entre esses deslocamentos e os fatores relativos à idade da amostra, os mesmos foram corrigidos estatisticamente para 2,74 ± 2,00 e 2,44 ± 1,93 mm. No plano horizontal, os deslocamentos médios foram de û0,72 ± 1,53 mm no lado direito e û0,51 ± 1,98 no esquerdo. A média no plano transversal foi de 0,03 ± 0,87 mm. A comparação destes valores com aqueles observados em grupos não desprogramados e publicados na literatura indica que o uso das referidas placas resulta em deslocamentos condilares médios maiores, especialmente no sentido vertical, entre as posições de RC e de MIH, o que contribuiu para um diagnóstico ortodôntico mais preciso.

Acromio-clavicular dislocation with fracture of coracoid process

We describe a rare case of acromioclavicular dislocation with fracture of the coracoid process. The associated fracture was missed at first presentation. The present report should further heighten awareness of this possible combination of injuries. Computed topography helps in identification and also classification of the coracoid lesion, an important part of the management decision making process

Resonancia magnética en la displasia acetabular / Magnetic resonance imaging of congenital hip dysplasia

La Resonancia Magnética es de gran utilidad en aquellos casos de displasia acetabular y luxación, en los cuales el tratamiento conservador no ha dado resultados y se requiere conocer la causa que impide el moldeamiento o la reducción de la articulación coxofemoral. Se analizan los antecedentes, la anatomía, fisiopatología y utilidad de la Resonancia Magnetíca

Patela alta diagnóstico clínico/radiográfico y tratamiento quirúrgico / Patella alta. Clinical-radiographical diagnosis and surgical treatment

Los diversos grados de displasia del mecanismo extensor se manifiestan clínicamente por dolor patelofemoral y en los casos más severos se acompañan de luxación patelar. Presentan todos ello en grado variable alteraciones de los tejidos blandos y trastornos esqueléticos. Para determinar la altura de la patela existen varios métodos radiográficos, siendo el más conocido el de Insall-Salvati. Este y otros métodos presentan varias desventajas, no así el índice de Caton, el cual resultó preciso y confiable. en el Hospital "Lomas Verdes" se operaron 38 rodillas entre agosto de 1992 y noviembre de 1993 con un índice de Caton de 1.10 o mayor. Para determinar la cantidad requerida de transposición distal de la tuberosidad tibial, empleamos el método matemático de Aglietti. Con la técnica quirúrgica descrita en el presente trabajo, en todas las rodillas operadas logramos ubicar a la patela dentro de los rangos de normalidad del índice de Caton. En la revisión a los cuatro meses de postoperatorio todas las osteotomías habían consolidado, la mayoría había recuperado completamente los arcos de movilidad y la potencia del cuadriceps. Todos los pacientes reportaron disminución importante del dolor patelofemoral y a la fecha no se ha presentado ninguna recurrencia de luxación patelar. La técnica radiográfica de Caton y el método matemático de Aglietti permiten planificar el descenso de la tuberosidad tibial de una manera precisa

Natural course of spontaneously reduced lumbo-sacral fracture-dislocation--a case report

We present a case of lumbosacral fracture-dislocation, which was spontaneously reduced during radiological examination. Such rapid reduction is, however, not reliable for long-term stability. We would like to report this case briefly because spontaneous reduction of lumbosacral fracture-dislocation has not been reported previously.

Luxofracturas del cuello del pie / Luxofractures of the foot's neck

Con el proposito de identificar un procedimiento quirurgico efectivo para el manejo de las luxofracturas del cuello del pie, restableciendo su mecanica en un tiempo minimo y evitando secuelas (rigidez articular, atrofia muscular y artrosis postraumatica) se revisan la evolucion del manejo medico y operatorio y la anatomia funcional de la articulacion. Se estudian 42 casos que llegaron al servicio de urgencias desde enero de 1980 hasta enero de 1982: 30 hombres y 12 mujeres entre 15 y 61 anos, con luxofractura de cuello del pie por trauma. El 33.3 por ciento en eversion y el 47.6 por ciento en aduccion-inversion. 4 de ello tenian traumas multiples asociados. En el examen de ingreso se buscaron lesiones cutaneas que contraindicaran la cirugia inmediata. Por Rx se descartaron arrancamientos corticales y fx. marginales y se clasificaron las lesiones segun los criterios de Weeber-Dannis. 7 pacientes tuvieron fracturas sindesmales que se redujeron quirurgicamente y se fijaron con tornillo de esponjosa 4mm; 16, presentaron fx transidesmales que fueron reducidas de manera similar y se fijaron con tornillos de cortical de 3.5mm o con placa de tercio de cana aplicando compresion interfragmentaria; 19 con fx srprasindesmales se manejaron con la misma tecnica complementada con tornillo de situacion. Todos se inmovilizaron con ferula posterior corta de yeso, recibieron antibioticos profilacticos y medidas antiedema. Permanecieron hospitalizados de 3 - 5 dias, a los 20 dias iniciaron movimientos activos con apoyo parcial y se retiro el material de osteosintesis antes de permitir apoyo total (6 sem). Los resultados fueron satisfactorios clinica y ..