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Internal Derangements of the Temporomandibular Joint: Pathological Variations

Internal Derangements of the Temporomandibular Joint: Pathological Variations Abstract • A retrospective analysis of 540 operated cases (740 joints) of internal derangements of the temporomandibular joint was carried out. Observations of this patient population provided the basis for describing pathological variations of internal derangements. Radiologic studies, including tomograms and arthrograms or magnetic resonance scans, and surgical/pathological findings were correlated with clinical data in each case. It was found that clinical manifestations varied in a characteristic way and were directly related to the degree of pathological change and time course. Various stages of internal derangements were identified. Pathophysiological mechanisms responsible for the observed changes, as well as clinical signs and symptoms and causal factors, were discussed. Internal derangements are organic lesions that appear to be progressive and are probably of traumatic origin. The view is given that internal derangements represent the basic pathological entity responsible for clinical manifestations of what has been known as the temporomandibular joint pain-dysfunction syndrome or similarly described conditions. Effective clinical management takes on new importance because progression to advanced degenerative states may occur. (Arch Otolaryngol Head Neck Surg 1989;115:469-477) References 1. Wilkes CH: Arthrography of the temporomandibular joint in patients with the TMJ pain-dysfunction syndrome . Minn Med 1978;61:645-652. 2. Wilkes CH: Structural and functional alterations of the temporomandibular joint . Northwest Dent 1978;57:287-294. 3. Farrar WB, McCarty WL Jr: Inferior joint space arthrography and characteristics of condylar paths in internal derangements of the TMJ . J Prosthet Dent 1979;41:548-555.Crossref 4. Katzberg RW, Dolwick MF, Bales DJ, et al: Arthrotomography of the temporomandibular joint: New technique and preliminary observations . AJR 1979;132:949-955.Crossref 5. Katzberg RW, Dolwick MF, Helms CA, et al: Arthrography of the temporomandibular joint . AJR 1980;134:995-1003.Crossref 6. Rasmussen OC: Semiopaque arthrography of the temporomandibular joint . Scand J Dent Res 1980;88:521-534. 7. Blaschke DD, Solberg WK, Sanders B: Arthrography of the temporomandibular joint: Review of current status . J Am Dent Assoc 1980;100:388-395. 8. Westesson P-L, Omnell KH, Rohlin M: Double-contrast tomography of the temporomandibular joint . Acta Radiol 1980;21:777-784.Crossref 9. Murphy WA: Arthrography of the temporomandibular joint . Radiol Clin North Am 1981; 19:365-378. 10. Bronstein SL, Tomasetti KJ, Ryan DE: Internal derangement of the temporomandibular joint: Correlation of arthrography with surgical findings . J Oral Maxillofac Surg 1981;39:572-584. 11. Eriksson C, Westesson P-L: Clinical and radiological study of patients with anterior disc displacement of the temporomandibular joint . Swed Dent J 1983;7:55-64. 12. Westesson P-L, Bronstein SL, Liedberg J: Internal derangement of the temporomandibular joint: Morphologic description with correlation to joint function . Oral Surg Oral Med Oral Pathol 1985;59:323-331.Crossref 13. Bessette R, Katzberg R, Natiella JR, et al: Diagnosis and reconstruction of the human TMJ after trauma or internal derangement . Plast Reconstr Surg 1985;75:192-203.Crossref 14. Schellhas KP, Wilkes CH, Heithoff KB, et al: Temporomandibular joint: Diagnosis of internal derangements using magnetic resonance imaging . Minn Med 1986;69:516-519. 15. Schellhas KP, Wilkes CH, Omlie MR, et al: Temporomandibular joint imaging: Practical application of available technology . Arch Otolaryngol Head Neck Surg 1987;113:744-748.Crossref 16. Schellhas KP, Wilkes CH, Fritts HM, et al: Temporomandibular joint: MR imaging of internal derangements and postoperative changes . AJNR 1987;8:1093-1101. 17. Schellhas KP, Wilkes CH, Omlie MR, et al: The diagnosis of temporomandibular joint disease: Two compartment arthrography and MR . AJNR 1988;9:579-588. 18. Katzberg RW, Schenck JF, Roberts D, et al: Magnetic resonance imaging of the temporomandibular joint meniscus . J Oral Maxillofac Surg 1985;59:332-335. 19. Katzberg RW, Bessette RW, Tallents RH, et al: Normal and abnormal temporomandibular joint: MR imaging with surface coil . Radiology 1986;158:183-189.Crossref 20. Farrar WB, McCarty WL: The TMJ dilemma . J Ala Dent Assoc 1979;63:19-26. 21. Rasmussen OC: Description and progress of symptoms in a longitudinal study of temporomandibular arthropathy . Scand J Dent Res 1981;89:196-203. 22. Katzberg RW, Keith DA, Guralnick WC, et al: Internal derangements and arthritis of the temporomandibular joint . Radiology 1983:146: 107-112.Crossref 23. Westesson P-L, Rohlin M: I nternal derangement related to osteoarthrosis in temporomandibular joint autopsy specimens . Oral Surg Oral Med Oral Pathol 1984;57:17-22.Crossref 24. Westesson P-L: Structural hard-tissue changes in temporomandibular joints with internal derangements . Oral Surg Oral Med Oral Pathol 1985;59:220-224.Crossref 25. Debont LGM, Boering G, Liem RSB, et al: Osteoarthritis and internal derangement of the temporomandibular joint: A light microscopic study . J Oral Maxillofac Surg 1986;44:634-643.Crossref 26. Schwartz L: A temporomandibular joint pain-dysfunction syndrome . J Chronic Dis 1956; 3:284-293.Crossref 27. Laskin DM: Etiology of the pain-dysfunction syndrome . J Am Dent Assoc 1969;79:147-153. 28. Guralnick W, Kaban LB, Merrill RG: TMJ afflictions . N Engl J Med 1978;299:123-129.Crossref 29. Roberts CA, Tallents RH, Katzberg RW, et al: Comparison of internal derangements of the TMJ with occlusal findings . Oral Surg Oral Med Oral Pathol 1987;63:645-650.Crossref 30. Stringert HG, Worms FW: Variation in skeletal and dental patterns in patients with structural and functional alterations of the temporomandibular joint: A preliminary report . Am J Orthod Dentofacial Orthop 1986;89:285-297.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Internal Derangements of the Temporomandibular Joint: Pathological Variations

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1989.01860280067019
Publisher site
See Article on Publisher Site

Abstract

Abstract • A retrospective analysis of 540 operated cases (740 joints) of internal derangements of the temporomandibular joint was carried out. Observations of this patient population provided the basis for describing pathological variations of internal derangements. Radiologic studies, including tomograms and arthrograms or magnetic resonance scans, and surgical/pathological findings were correlated with clinical data in each case. It was found that clinical manifestations varied in a characteristic way and were directly related to the degree of pathological change and time course. Various stages of internal derangements were identified. Pathophysiological mechanisms responsible for the observed changes, as well as clinical signs and symptoms and causal factors, were discussed. Internal derangements are organic lesions that appear to be progressive and are probably of traumatic origin. The view is given that internal derangements represent the basic pathological entity responsible for clinical manifestations of what has been known as the temporomandibular joint pain-dysfunction syndrome or similarly described conditions. Effective clinical management takes on new importance because progression to advanced degenerative states may occur. (Arch Otolaryngol Head Neck Surg 1989;115:469-477) References 1. Wilkes CH: Arthrography of the temporomandibular joint in patients with the TMJ pain-dysfunction syndrome . Minn Med 1978;61:645-652. 2. Wilkes CH: Structural and functional alterations of the temporomandibular joint . Northwest Dent 1978;57:287-294. 3. Farrar WB, McCarty WL Jr: Inferior joint space arthrography and characteristics of condylar paths in internal derangements of the TMJ . J Prosthet Dent 1979;41:548-555.Crossref 4. Katzberg RW, Dolwick MF, Bales DJ, et al: Arthrotomography of the temporomandibular joint: New technique and preliminary observations . AJR 1979;132:949-955.Crossref 5. Katzberg RW, Dolwick MF, Helms CA, et al: Arthrography of the temporomandibular joint . AJR 1980;134:995-1003.Crossref 6. Rasmussen OC: Semiopaque arthrography of the temporomandibular joint . Scand J Dent Res 1980;88:521-534. 7. Blaschke DD, Solberg WK, Sanders B: Arthrography of the temporomandibular joint: Review of current status . J Am Dent Assoc 1980;100:388-395. 8. Westesson P-L, Omnell KH, Rohlin M: Double-contrast tomography of the temporomandibular joint . Acta Radiol 1980;21:777-784.Crossref 9. Murphy WA: Arthrography of the temporomandibular joint . Radiol Clin North Am 1981; 19:365-378. 10. Bronstein SL, Tomasetti KJ, Ryan DE: Internal derangement of the temporomandibular joint: Correlation of arthrography with surgical findings . J Oral Maxillofac Surg 1981;39:572-584. 11. Eriksson C, Westesson P-L: Clinical and radiological study of patients with anterior disc displacement of the temporomandibular joint . Swed Dent J 1983;7:55-64. 12. Westesson P-L, Bronstein SL, Liedberg J: Internal derangement of the temporomandibular joint: Morphologic description with correlation to joint function . Oral Surg Oral Med Oral Pathol 1985;59:323-331.Crossref 13. Bessette R, Katzberg R, Natiella JR, et al: Diagnosis and reconstruction of the human TMJ after trauma or internal derangement . Plast Reconstr Surg 1985;75:192-203.Crossref 14. Schellhas KP, Wilkes CH, Heithoff KB, et al: Temporomandibular joint: Diagnosis of internal derangements using magnetic resonance imaging . Minn Med 1986;69:516-519. 15. Schellhas KP, Wilkes CH, Omlie MR, et al: Temporomandibular joint imaging: Practical application of available technology . Arch Otolaryngol Head Neck Surg 1987;113:744-748.Crossref 16. Schellhas KP, Wilkes CH, Fritts HM, et al: Temporomandibular joint: MR imaging of internal derangements and postoperative changes . AJNR 1987;8:1093-1101. 17. Schellhas KP, Wilkes CH, Omlie MR, et al: The diagnosis of temporomandibular joint disease: Two compartment arthrography and MR . AJNR 1988;9:579-588. 18. Katzberg RW, Schenck JF, Roberts D, et al: Magnetic resonance imaging of the temporomandibular joint meniscus . J Oral Maxillofac Surg 1985;59:332-335. 19. Katzberg RW, Bessette RW, Tallents RH, et al: Normal and abnormal temporomandibular joint: MR imaging with surface coil . Radiology 1986;158:183-189.Crossref 20. Farrar WB, McCarty WL: The TMJ dilemma . J Ala Dent Assoc 1979;63:19-26. 21. Rasmussen OC: Description and progress of symptoms in a longitudinal study of temporomandibular arthropathy . Scand J Dent Res 1981;89:196-203. 22. Katzberg RW, Keith DA, Guralnick WC, et al: Internal derangements and arthritis of the temporomandibular joint . Radiology 1983:146: 107-112.Crossref 23. Westesson P-L, Rohlin M: I nternal derangement related to osteoarthrosis in temporomandibular joint autopsy specimens . Oral Surg Oral Med Oral Pathol 1984;57:17-22.Crossref 24. Westesson P-L: Structural hard-tissue changes in temporomandibular joints with internal derangements . Oral Surg Oral Med Oral Pathol 1985;59:220-224.Crossref 25. Debont LGM, Boering G, Liem RSB, et al: Osteoarthritis and internal derangement of the temporomandibular joint: A light microscopic study . J Oral Maxillofac Surg 1986;44:634-643.Crossref 26. Schwartz L: A temporomandibular joint pain-dysfunction syndrome . J Chronic Dis 1956; 3:284-293.Crossref 27. Laskin DM: Etiology of the pain-dysfunction syndrome . J Am Dent Assoc 1969;79:147-153. 28. Guralnick W, Kaban LB, Merrill RG: TMJ afflictions . N Engl J Med 1978;299:123-129.Crossref 29. Roberts CA, Tallents RH, Katzberg RW, et al: Comparison of internal derangements of the TMJ with occlusal findings . Oral Surg Oral Med Oral Pathol 1987;63:645-650.Crossref 30. Stringert HG, Worms FW: Variation in skeletal and dental patterns in patients with structural and functional alterations of the temporomandibular joint: A preliminary report . Am J Orthod Dentofacial Orthop 1986;89:285-297.Crossref

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Apr 1, 1989

References