Evaluation of temporomandibular joint internal derangement.

The incidence of internal derangement of the temporomandibular joint has been documented in patients with temporomandibular disorders. However, the detection and diagnosis of a displacement of the temporomandibular joint disc in relation to internal derangement is not always accurate, and it varies according to the method of examination. A prospective clinical investigation of 26 patients (45 temporomandibular joints) with signs and symptoms of temporomandibular joint pain and dysfunction was completed to examine the accuracy of clinical examination, sagittal recording device tracings, arthrography, and magnetic resonance imaging in detecting internal derangement in the temporomandibular joint. A group of 16 asymptomatic control subjects (32 temporomandibular joints) was examined for the presence of internal derangement by the methods under consideration. Incidence of bilateral internal derangement in the temporomandibular joints of the symptomatic patients was also assessed. Findings obtained through clinical examination and sagittal recording device tracings agreed most often with the arthrographic findings of internal derangement. Magnetic resonance imaging often failed to detect the presence of arthrographically detected internal derangement. Internal derangement was identified bilaterally in a significant number of patients, despite the absence of bilateral symptoms. This incidence varied according to the technique used. In the control group, 9% of the temporomandibular joints that had been assessed as normal according to clinical examination and sagittal recording device tracings were found to have internal derangement according to magnetic resonance imaging.

Characteristics and response to treatment of posttraumatic temporomandibular disorder: a retrospective study.

Temporomandibular disorders (TMDs) are likely the most common cause of persistent pain in the head and neck. Treatment for TMDs can be quite varied although, in general, favorable treatment outcome is reported to be on the order of 75-80%, regardless of treatment approach. However, it has been reported that patients suffering from posttraumatic TMDs, and, in particular, patients who have been involved in motor vehicle accidents (MVAs), do not respond as well to therapy. Therefore, this study was undertaken to elucidate some of the historical and clinical features of posttraumatic TMDs and to compare this with the features of TMDs that developed independent of identifiable trauma. Furthermore, a comparison between recovery rates in the two populations was undertaken as well as a comparison of the treatment modalities used in the two groups. Fifty-two posttraumatic TMD patients were compared to an age- and sex-matched population of "routine" TMD patients whose conditions developed independent of trauma. Treatment, consisting of various accepted modalities, ranged from 3 to 5 years after the MVA, with progress assessed at each visit. The data indicate that 48% of posttraumatic TMD and 75% of TMD patients reported recovery with treatment (p less than 0.001). The posttraumatic TMD patients required significantly more treatment than the control TMD population. The findings suggest further that 60% of MVA TMD patients suffer from symptoms suggestive of affective disorder compared to only 14% of TMD patients. In view of the above, it appears that posttraumatic TMD patients do not respond to therapy as well as the control subjects. While the mechanisms underlying this finding are not clear, it could be related to a difference in underlying pathophysiology. The data showing that posttraumatic TMD patients develop significantly more symptoms suggestive of affective disorders than control TMD patients could imply that there is a relationship between these findings that requires further study.