structural breakdown of the articular surfaces. Typically with crepitus and opening usually < 35
Based solely on the information provided above, what are the possible diagnoses for this patient
Anterior disc displacement without reduction With limited opening (closed lock) of the left TMJ
Left masticatory myalgia
Left arthralgia
Describe your diagnostic approach and the investigatinos required to determine the cause of his restricted mouth opening
Palpation of TMJs for joint sounds, characterizing timing (opening click, closing click, crepitus)
Palpation of the TMJs (lateral pole and posterior attachment) and masticatory muscles (masster, termporalis, medial and latery ptrygoid) for tenderness
MRI of TMJs
Name 3 distinct subtypes of internal derangement of the TMJ
Disc displacement with reduction
Disc displacement with reduction wiht intermittent locking
Disc displacement without reduction with limited opneing (closed lock
Key diagnostic features of above subtypes
Disc displacement with reduction
Reproducible clicking/popping on opening . Normal opening wiht ipsilateral deviation that corrects
Disc displacement with reduction with intermittent locking
episodes of intermittened locking on a background of clicking, the jaw can be freed by a small movement restoring normal opening
Closed lock
loss of prior click and a limited opneing (<35-40 mm ) with uncorrected ipsilateral deflection and restricted contralateral excursion
Management options
First line
Patient education and reassurance
soft diet and parafunctional habit control
avoid clenching, jaw bracing, gum and wind instruments
Thermotherapy and physiotherapy
heat/ice, jaw exercises, tongue to roof controlled opening to correct deviation
What factors may affect this patient’s overall prognosis
Severity and chronicity of the disorder at presentation
Patient compliance/adherence to self-management
Psychosocial comorbidities (anxiety, depression, pain catastrophising) and genetic predisposotoin