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Intraarticular disorders of the temporomandibular joint
Last reviewed: 23.04.2024
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Intra-articular disorders - a forward displacement of the articular disk in relation to the condylar process. Symptoms: localized joint pain and jaw movement restrictions. The diagnosis is established on the basis of anamnesis and special research methods. In the treatment prescribe analgesics, rest of the jaw, muscle relaxation, physiotherapy treatment and bite plate. If treatment is unsuccessful, surgery may be necessary. Early treatment significantly improves the result.
The anterior head of the lateral margin of the jaw muscle can displace the articular disc when an abnormal mechanical movement of the jaw occurs. Abnormal jaw movement can occur due to congenital or acquired asymmetries, either as a result of trauma or arthritis. If the disk remains in front, the violations remain unchanged. Limitation of the movement of the jaw (bound jaw) and pain in the ear and around the joint are noted. If at the time of motion the disc returns to the head region of the condyle, this is considered without a reduction. Violations with a decrease are observed in some cases in about 1/3 of the population. All kinds of internal disorders can cause capsulitis (or synovitis), which implies inflammation of the tissues surrounding the joint (tendons, ligaments, adjacent tissues, capsule). Capsules can also develop spontaneously or as a result of arthritis, trauma, infection.
[Symptoms and signs of intraarticular disorders of the temporomandibular joint
Disorders with a decrease are usually accompanied by a crunch or snap when the mouth is opened. Pain may be present, especially when chewing hard food. Patients usually think that others hear sounds when they chew. Indeed, although to the patient the sound seems louder, others can also sometimes hear them.
Violations without a reduction are usually not accompanied by sounds, but the maximum opening of the mouth along the midline between the incisors from the normal 40-45 mm decreases to less than 30 mm. Pain and discomfort when biting - common complaints. With capsulitis, localized pain, soreness and, sometimes, restriction of opening are noted.
Diagnosis of intraarticular disorders of the temporomandibular joint
Diagnosis of violations with a decrease is observed when the jaw moves to open the mouth. When the mouth is open more than 10 mm, there is a click or crunching or clicking when the disc moves over the head of the condyle. During further movement, the condyles remain on the disk. Usually a second click is heard when closing, when the condyle slides over the back surface of the disc and the disc slides forward (mutual click).
Diagnosis of violations without reduction is observed when opening the mouth as widely as possible. The degree of opening is measured, and a slight depression then allows the mouth to open a little wider. Normally, the mouth opens at 45-50 mm, if the disc is broken, the opening will be about 20 mm. Closing or extending the jaw causes pain.
Diagnosis of capsulitis is based on an anamnesis of a trauma or infection with mild soreness of the joint, with the exception of cases when pain occurs in the treatment of the syndrome of maxillofacial pain, disc disorders, arthritis and asymmetries. However, capsulitis can be observed with all the diseases mentioned.
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Treatment of intraarticular disorders of the temporomandibular joint
A decrease with a decrease does not require treatment if the patient can open the mouth widely enough (about 40 mm or at the height of the index, middle and ring fingers) without discomfort. If there is pain, moderate analgesics are prescribed, such as NSAIDs (ibuprofen 400 mg orally every 6 hours). If the pain occurred less than 6 months ago, the anterior dissection plate can be used to shift the lower jaw forward and onto the disc. The plate is made of acrylic plastics and in shape resembles the dentition of one of the jaws. Its chewing surface is made in such a way that when the jaws are closed, the lower jaw extends forward. In this position, the disc is always on the head of the condyle. If the disc remains with the condyle on the posterior surface of the head of the condyle next to the pterygoid ligament, then the joint disc is clamped in this position. The larger the disc is displaced, the more it deforms and the less likely it is to return to its habitual position. Surgical movement of the disc can be performed, however with varying success.
Changes in the joint without bias do not require intervention, except for the appointment of analgesics. The plate can help if the articular disc is slightly altered, but prolonged use can lead to irreversible changes in the structure of the jaws. In some cases, it is recommended to slowly pull the disc out of its position, which usually opens the mouth. Various arthroscopic and open surgical interventions can be performed if conservative treatment is ineffective.
When capsulites are initially prescribed NSAIDs, jaw rest and muscle relaxation. If this treatment is not successful, glucocorticoids can be injected into the joint, or arthroscopic drainage and spirals are used.