Christopher A. Roberts

The clinical predictability of internal derangements of the temporomandibular joint

The value of clinical parameters as predictors of the arthrographic findings in patients with temporomandibular joint (TMJ) pain and dysfunction was examined in this study. We developed a series of simplified clinical prediction rules based on previous studies correlating clinical signs and symptoms with arthrographic diagnosis of the condition of the TMJ meniscus. One hundred eighty-six patients with signs and symptoms of TMJ dysfunction were clinically examined before TMJ arthrography. Arthrograms were performed on 246 joints (126 unilateral, 60 bilateral). The rules predicted 91 of the 246 joints to be normal when actually 59 were shown to be normal arthrographically. The rules slightly underpredicted those patients with positive arthrographic findings for internal derangements. Although there were some individual variations in the predictability of unilateral versus bilateral arthrograms (patients), there was very little overall difference, 58% and 60%, respectively. This study confirms previous suggestions that clinical findings alone are not consistently accurate in diagnosing the exact type of TMJ internal derangements depicted by arthrographic criteria.

Comparison of internal derangements of the TMJ with occlusal findings

Two hundred five patients were examined because of temporomandibular joint pain and dysfunction. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). No significant differences were found between arthrographic groups with respect to Angle classification, horizontal and vertical overlap, posterior tooth wear, missing posterior teeth, cuspid-protected occlusion, balancing-side contacts, deflective occlusion, and clenching of the teeth. Tilted teeth on the contralateral side were more common in cases of reducing meniscal dislocation than in cases of normal meniscus position or of nonreducing meniscal dislocation.

Use of protrusive splint therapy in anterior disk displacement of the temporomandibular joint: A 1- to 3-year follow-up

Sixty-eight patients, who were determined clinically (by the presence of audible and palpable-joint sounds) and arthrographically to have meniscus displacement with reduction, had protrusive splints constructed, and the results were evaluated for a minimum of 1 year to a maximum of 3 years. Eighteen additional patients, arthrographically determined to have meniscus displacement with reduction, served as a nontreatment group for comparison. Odds ratios were calculated to compare the proportions of subjects who experienced follow-up symptoms on the two regimens. Results indicated that with splint therapy there was a statistically significant reduction of the intensity of jaw joint pain, temporal headache, ear pain, and pain in front of the ear, and there was a decrease in the probability of a closed lock condition developing. Splint therapy is less likely to reduce frontal headache, neck pain, and clenching of teeth.

Mandibular range of motion versus arthrographic diagnosis of the temporomandibular joint

The range of mandibular movements has been correlated with arthrographic findings of the temporomandibular joint in 205 patients. Abnormalities of meniscus position and function have been found to influence mandibular movements in characteristic patterns. However, altered mandibular movements alone are insufficient for a definitive clinical diagnosis of the specific type of internal derangement of the temporomandibular joint.

Correlation of clinical parameters to the arthrographic depiction of temporomandibular joint internal derangements.

This prospective clinical investigation of 188 patients with signs and symptoms of temporomandibular joint (TMJ) pain and dysfunction examines the correlation between clinical signs and symptoms versus the arthrographic characteristics of intracapsular disease related to displacement of the meniscus. An attempt has been made to establish which specific clinical signs and symptoms, as determined by arthrography, best predict the condition of the joint. Our findings suggest that most of the clinical signs and symptoms are not sufficiently reliable in themselves to permit prediction of the condition of the meniscus. Those clinical parameters that did show a strong correlation were tested in combinations using stepwise discriminant analysis to evaluate clinical tendencies. Thus, patients with normal meniscal position and function were often noted to have normal mandibular ranges of movement, no joint noises on opening and closing of the jaw, and no tomographic evidence of degenerative joint disease. Subjects with meniscal displacement with reduction were often found to have joint clicking, deviation of the jaw upon opening, and an absence of degenerative joint disease by multidirectional tomography. Patients who had meniscal displacement without reduction were often found to have limitation in jaw movement, crepitation on opening and closing of the jaw, and associated degenerative changes on multidirectional tomograms. If specific treatment plans are to be tailored for different stages of TMJ internal derangements, clinical findings alone or clinical findings in conjunction with plain radiographs of the TMJ are not consistently accurate.

Comparison of arthrographic findings of the temporomandibular joint with palpation of the muscles of mastication

Abstract Two hundred five patients were examined for temporomandibular joint pain and dysfunction and specifically for tenderness to muscle palpation. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Significant findings were ascertained for the middle portion of the temporal muscle in “normal” patients versus “with and without meniscus reduction” patients. The superficial masseter muscle was more tender in “normal” patients and in “reducing meniscus” patients than in “without meniscus reduction” patients. The medial pterygoid muscle was more tender in “normal” patients and in “without meniscus reduction” patients than in “reducing meniscus” patients. Though there are some significant findings with respect to muscle palpation, by itself muscle palpation is not a specific indicator of temporomandibular joint internal derangement.

Clinical and arthrographic evaluation of the location of temporomandibular joint pain

Two hundred five patients were prospectively examined for temporomandibular joint pain. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Pain in the ear occurred more frequently in arthrographically normal patients and in nonreducing meniscus patients compared with reducing meniscus patients. The location of pain in front of the ear, in the temples, or in the neck or the degree of pain intensity did not correlate to specific meniscal abnormalities. No correlation between the distribution and the character of headaches was observed. Pain characterization alone does not clinically separate meniscal abnormalities.

Arthrographically assisted splint therapy: A 6-month follow-up

After repositioning splint therapy, 51 patients were evaluated for a minimum of 6 months. Forty-five (88%) of the patients were considered to have been treated successfully, whereas six (12%) patients required surgery to correct meniscal displacement. A detailed analysis of signs and symptoms before and after splint treatment is in progress.