AN ALTERNATIVE EXPLANATION FOR THE GENESIS OF CLOSED-LOCK SYMPTOMS IN THE INTERNAL DERANGEMENT PROCESS

被引:74
作者
NITZAN, DW [1 ]
DOLWICK, MF [1 ]
机构
[1] UNIV FLORIDA,DEPT ORAL & MAXILLOFACIAL SURG,GAINESVILLE,FL 32611
关键词
D O I
10.1016/0278-2391(91)90008-A
中图分类号
R78 [口腔科学];
学科分类号
1003 ;
摘要
Clinical and surgical data on 194 operated joints (135 patients) were used to substantiate a new concept challenging the presumed natural history of temporomandibular internal derangement (ID). A number of findings were incompatible with the traditional depiction of a progressive process based on gradual changes in disc position and shape. These findings were a lack of correlation between increasing age and the stages of the process; the percentage of patients in the third stage (closed lock) with limited opening (<25 mm) too severe to be caused solely by a nonreducible, displaced disc; the unexpectedly high incidence (greater than 50%) of normally shaped discs in the third stage of the process. A specific condition of severe and stubborn limited maximal mouth opening caused by total cessation of gliding, liable to occur at any age and unrelated to disc shape or position, which responds successfully to simple treatment by lavage and lysis, pressured injection, or arthrocentesis, was discerned. Lack of gliding was attributed to adherence of the disc to the fossa by a reversible effect such as a vacuum and/or decreased volume of synovial fluid of high viscosity. This condition was deemed worthy of an independent identity, dissociated from disc displacement, as a causative factor in the second and third stages of ID, and particularly as an aid to accurate diagnosis and treatment. © 1991.
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页码:810 / 815
页数:6
相关论文
共 20 条
[1]  
CLARK GT, 1988, TXB OCCLUSION, P271
[2]  
DOLWICK MF, 1979, J ORAL SURG, V37, P793
[3]   INTERNAL DERANGEMENTS OF THE TEMPOROMANDIBULAR-JOINT - FACT OR FICTION [J].
DOLWICK, MF ;
KATZBERG, RW ;
HELMS, CA .
JOURNAL OF PROSTHETIC DENTISTRY, 1983, 49 (03) :415-418
[4]  
FERRAR WB, 1979, J PROSTHET DENT, V41, P548
[5]  
FRANKEL VH, 1980, BASIC BIOMECHANICS S, P70
[6]   THE PROBLEM OF THE CLICKING JAW [J].
IRELAND, VE .
PROCEEDINGS OF THE ROYAL SOCIETY OF MEDICINE-LONDON, 1951, 44 (05) :363-372
[7]   INVESTIGATION INTO THE VALIDITY OF SUB-ATMOSPHERIC PRESSURE RECORDINGS FROM SYNOVIAL-FLUID AND THEIR DEPENDENCE ON JOINT ANGLE [J].
LEVICK, JR .
JOURNAL OF PHYSIOLOGY-LONDON, 1979, 289 (APR) :55-67
[8]   SYNOVIAL CAPILLARY DISTRIBUTION IN RELATION TO ALTERED PRESSURE AND PERMEABILITY IN KNEES OF ANESTHETIZED RABBITS [J].
LEVICK, JR ;
MCDONALD, JN .
JOURNAL OF PHYSIOLOGY-LONDON, 1989, 419 :477-492
[9]  
MURAKAMI KI, 1987, J CRANIOMANDIB PRACT, V5, P17
[10]   ARTHROSCOPIC LAVAGE AND LYSIS OF THE TEMPOROMANDIBULAR-JOINT - A CHANGE IN PERSPECTIVE [J].
NITZAN, DW ;
DOLWICK, MF ;
HEFT, MW .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 1990, 48 (08) :798-801