Temporomandibular Joint Disk Fracture: A Case Report

Abstract

A case of a patient with a fracture of the temporomandibular joint (TMJ) disk is reported. The patient presented with posterior bilateral open-bite and difficulty to chew due to lack of contact between the posterior teeth. Diagnosis of disk fracture of the right TMJ was made based on magnetic resonance imaging (MRI), with posterior displacement of the posterior fragment of the disk, causing the posterior open-bite, and anterior displacement of the anterior fragment of the disk. TMJ manipulation failed to reposition the posterior fragment of the disk, and the patient refused to undergo TMJ arthroscopy to try to remove it. After four months, the posterior open-bite was reduced, probably because of remodeling of the posterior TMJ capsule and extrusion of the molars and premolars. Contact with the patient was lost after that time.

Fracture of the articular disc in the temporomandibular joint: two case reports

“…Considerable joint effusion was also observed on MRI in the present two cases, a finding that was also reported by Melis et al 11 It has been suggested that joint effusion represents an inflammatory response; 26,27 therefore, these findings suggest a possible relationship between disc fracture and inflammation. Morphological change can also be contributed by the inflammatory cascade, leading to subsequent degenerative changes in the TMJ, such as increased surface roughness, depleted lubricant and, ultimately, increased friction.…”

“…When the articular surface is roughened by degenerative changes in the condylar head, the disc may be much more prone to abrasion even during routine activities owing to the increased friction between the disc and bony structures of the TMJ, such as the glenoid fossa and condyle. 25 Considering the lack of trauma history and the pronounced occlusal attrition in the present two cases, we suspect that the hypothesis of Melis et al 11 is the aetiology, that is, microtrauma may have triggered the disc fractures by causing mechanical damage to the intermediate portion of the TMJ disc.…”

“…Only three known cases, including the two cases in the present report, of disc fracture in the TMJ have been described; the first case report was published by Melis et al 11 Because of the extreme rarity of TMJ disc fracture, little information has been established on the condition, including diagnostic criteria. Of the available diagnostic modalities, MRI has widely been considered the gold standard for examining the disc and surrounding tissues owing to its non-invasiveness and high soft-tissue resolution.…”

“…These symptomatic profiles were consistent with those in the previous report. 11 The altered occlusal pattern seems to depend on the affected site. Disc fracture is thought to cause acute occlusal change mainly by displacement of the posterior fragment behind the condylar head, which prevents the condylar head from returning to its normal closed position.…”

“…10 Recently, the first known case of posterior displacement of the posterior disc fragment following TMJ disc fracture was reported; the fracture reportedly caused development of an anterior open bite. 11 Disc fracture is the complete separation of the disc, whereas in disc perforation, the disc sustains only a partial tear but maintains its integrity. 10 The clinical presentation and cause of disc fracture is not clearly established, as it is described little beyond one previous report.…”