Comparison of magnetic resonance imaging findings in patients with intermittent closed lock and acute closed lock of the temporomandibular joint: a cross-sectional retrospective study.

OBJECTIVE: This study aimed to estimate the disc status in intermittent closed lock (ICL) and permanent closed lock (CL) temporomandibular disorders (TMDs) to test the hypothesis that the disc morphology and degree of anterior disc displacement affect the outcomes of these disorders. MATERIALS AND METHODS: All patients were clinically examined according to the Diagnostic Criteria for Temporomandibular Disorders Axis I protocol, and magnetic resonance imaging (MRI) confirmed ICL and CL. Fifty-six joints of 56 patients with ICL and 110 joints of 110 patients with acute CL with a locking period of less than 3 months were included. Patients with acute CL were further classified into two groups: those with CL that could be successfully manipulated (CLs group) and those with acute CL without the possibility of unlocking (CLu group). MRI was used to assess the degree of anterior displacement, lateral displacement of the disc, disc deformity, and joint effusion. MRI findings were compared among the joints in the ICL, CLs, and CLu groups. RESULTS: The degree of anterior displacement and disc deformity prevalence significantly differed among the ICL, CLs, and CLu groups. No significant intergroup differences were observed in terms of lateral displacement or joint effusion. CONCLUSIONS: These results suggest that anteriorly displaced discs and deformation of discs associated with TMD progression affect disc reducibility.

Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of 'locking duration'.

Temporomandibular joint (TMJ) 'closed lock' (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be 'acute' or 'chronic' depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid-August 2013 were conducted for English-language studies of any design investigating the effects of non-surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor-quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high-quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by 'unlock' mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.

Role of Arthrocentesis in the Management of Acute Closed Lock of TM Joint: A Pilot study.

The following study was conducted in Meenakshi Ammal Dental College on 32 patients. The objective of our study was to assess the efficacy of arthrocentesis for the management of acute closed lock of TMJ. All patients presented with a history of sudden and persistent difficulty in mouth opening and associated TMJ pain. A total of 27 female and 5 male patients were treated using arthrocentesis and lavage under local anesthesia. Patients were assessed for pain and jaw function using visual analogue scales, VAS I (Fig. 4b), VAS II (Fig. 4c), respectively and mouth opening MMO (Fig. 4a) for a period of 6 months. Our results showed satisfactory relief in pain and improved mouth opening in 30 patients. The results proved that arthrocentesis is a very useful technique for treatment of acute closed lock of TMJ. However to arrive at a definitive conclusion a long term evaluation is required.