Subluxation of temporomandibular joint- A clinical view

Abstract

In the temporomandibular joint (TMJ) with physiological disc position, the disc rotates posteriorly on the condyle to the maximum degree and the condyle translates to the maximum degree, which occurs simultaneously at the maximum mouth opening movement. Condylar hypermobility in the position of maximally open mouth leads to the subluxation of the joint, and the two terms can thus be considered synonyms. The predisposition of the morphological relations of the zenith of the articular eminence and the contours of the articular surfaces lead to an excessive anterior displacement of the condyle over the zenith eminence. In addition, the irregular movement of the disc-condylar complex can also occur. The aim of this paper is to explain the hyperextension of TMJ which may, along with anatomical predisposition to the maximally open mouth position, lead to subluxation or luxation of the joint. Subluxation is not associated with a specifi c pathological characteristic of the joint. However, apart from discomfort, a subluxation can also cause pain. The excursory movement of the condyle close to and over the individual opening limit can lead to stiffness of joints and the inability to open the mouth (open lock), which is a prominent clinical sign of TMJ luxation. Electronic axiography can show pathological hyperextension of the condyle, while x-ray diagnostics records the condition of subluxation. A spontaneous luxation is clinically evident and therefore radiological diagnosis is used only to confi rm the condition. Magnetic resonance imaging shows the disc and in the position of the maximally open mouth, thus giving the responses of the disk relation to the hypermobile condyle. Therapeutic modalities include occlusal splints and oral appliances, physiotherapy, and the mouth opening self-control. The goal of the treatment is relaxation of the masticatory muscles, removal of pain in the joint and muscles, and better coordination of movement, particularly in cases when there is a predisposition of spontaneous luxation.

A Novel Method of Temporomandibular Joint Hypermobility Diagnosis Based on Signal Analysis

“…TMJH may also be considered as a non-physiological condition if a patient report chewing muscle disorders as well as TMJ pain and discomfort. The sound that appears in the final stage of opening of the mouth may be a sign of subluxation of the condyle, which moves forward [3]. Repeated episodes of subluxation may result in lengthening of the patient's ligaments, potentially leading to disorders of the disc [4].…”

Orofacial pain – diagnostic and therapeutic challenges

“…Also, his responsibility is co-morbidity of trigeminal neuralgia or pain related to trigeminal neuralgia and many systemic diseases which may induce orofacial pains (TMDs) or whether trigeminal neuralgia is an accompanying condition to the main disease (metabolic and endocrine diseases, rheumatic diseases, etc.) ( 27 , 28 ).…”

Painful clicking jaw: a pictorial review of internal derangement of the temporomandibular joint

“…This condition is commonly associated with internal derangement of the TMJ. If, in addition to hypermobility, MRI shows findings of ID-DJD spectrum as well, it is possible to make more than one clinical diagnosis of TMD in such cases according to DC/TMD criteria [1,27].…”

“…The maximum rotational movement of the disc is achieved before the maximum translation of condyle due to a steep eminence [27] (Figure 18). Other aetiological factors that have been implicated include connective tissue disorders like generalised joint hypermobility, Ehler Danlos syndrome and Marfan syndrome, iatrogenic trauma during dental extractions, intubation under general anaesthesia, endoscopic procedures, and sometimes intrinsic trauma due to yawning, wide mouth opening, seizure disorders, etc.…”