Temporomandibular Joint (TMJ) internal derangement - 謝明吉、姜厚任 顎顏面 美學 重建 專科診所-風華整形聯合診所
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Physiology and pathology of the TMJ
Temporomandibular Joint (TMJ) internal derangement
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Temporomandibular Joint (TMJ) internal derangement

TMJ internal derangement literally refers to all kinds of pathological changes that may affect the smooth movement of TMJ. TMJ internal derangement is also called disc derangement because disc displacement is the major cause of disturbances of TMJ movements.
 

TMJ disc derangement refers to the dislocation of TMJ articular disc that in severe cases is coupled with deformation or damage of the articular disc. The possible causes of TMJ internal derangement include trauma (Isberg A, 1986), joint ligamentous laxity (Johansson AS, 1991), influence of hormones (Isberg A, 1998. LeResche L, 1997), bruxism (Milam SB, 1998) and altered joint lubrication system (Nitzan DW, 2001; Nitzan DE, 2006))。
 

Every person more or less has varying level (slight to severe level) of TMJ internal derangement, but most people show only mild symptoms, like TMJ clicking. Hence the diagnosis and stage differentiation of TMD highly depends on self-reported clinical signs, physical examination and imaging examination. As the disease progresses, other signs like TMJ clicking and popping, TMJ pain and limited mouth opening may show up. Nowadays the assessment of TMJ disc position inside the joint is mainly based on MRI. TMJ disc derangement is classified into 4 stages:

        
  1. Joint in-coordination
  2.     
  3. Disc displacement with reduction
  4.     
  5. Disc displacement without reduction
  6.     
  7. Anchored disc phenomenon

 


 

Early stage of TMJ internal derangement can be well managed with rest to reduce TMJ forces and loading, combined with medications, occlusal splint and physical therapy. According to The AAOMS Parameters of Care 2012--TMJ Surgery, for patients diagnosed with TMJ disc displacement by imaging examination or arthroscopy who show poor response to conservative treatments, who have persistent moderate to severe TMJ pain, and who have functional restriction, surgical intervention is required to improve the condition of TMJ internal derangement.

 

 

Results of surgery vary among patients. Please consult your doctor.
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Copyright © 2007-2017 

All Written Contents and Pictures Created by Dr. Adrian M. Hsieh and Dr. Scott H. Jiang

 

 

 

 

Results of surgery vary among patients. Please consult your doctor.