I think there will a rebound lat pterygoid spasm that will pull the disc behind and more medially and that expain the pain patient esperience due to extensive traction of the bilaminar elastic zone
Look up the numerous works of Dr. Bill Farrar and Dr. Bill McCarty. Not sure if their book is still in print. ALso MRI info from Rick Katzberg, Ross Tallents, Per Lennert Westesson and others. Anika Isberg-Holm book on Temporomandibular Joint Clicking, Karolinska Institute, Stockholm, 1980. Then they used high speed CineRadiography on fresh autopsy specimens. I worked with Dr Farrar and McCarty in the late 1970s and 1980s. McCarty preformed some of the first flouroscopic arthrograms (after Noorgard and Clide Wilkes) and I directly witnessed Open TMJ surgery on "live" patients. The Lateral aspect of the Disc rotates medially and as the ligaments stretch or tear it slides off the lateral pole of the condyle. The joint space narrows in the lateral aspect of the joint first. This shows in MRI and now also can be seen with ConeBeam CT fro the Coronal view. The lateral view can show posterior displacement of the condyle as the disc migrates forward. But the "joint space" may look posterior towards the lateral pole and more centered towards the middle to medial part of the joint, because the disc rotates towards the medial aspect. A single lateral tomogram of the TMJ is not adequate since you may not know which aspect of the joint you are evaluating. The best way to understand this is to see it for yourself on live patients who are undergoing open joint surgery and the jaw manipulated open and closed and you will see how the disc and condyle actually move. A dried up cadaver does not give you the real story.
Flouroscopic arthrograms do show the live joint in motion and now with Cine MRI we may be able to evaluate this without radiation.
Hope this helps.
Dr Bill Harrell
This is very fine and helpful in cases of derangement but still if complete condylar displacement happened that meaning travel in front of articular emeinence .where is the position of the disk will be?
Your talking about condylar subluxation. The disc does not totally displace, usually continues to displace deeply to the medial, the coll ateral ligaments stretch , the disc thins allowing the condyle to sublux. Sometimes when theses joints are opened, you can hardly find the disc tissue, it has been traumatized so bad. It was thought , before arthrograms were done, that the condyle over rode the disc, that is rare.
Your reply is the nearest reply to my think
thanks a lot
fantastic and great
The management of TMJ dislocation is customized as per the underlying cause. Hypermobility or subluxation can be managed by the use of autologous blood, sclerosing agents, and capsulorrhaphy. Manual reduction is sufficient in case of acute dislocation. Chronic protracted and chronic recurrent dislocationsare among the most difficult to manage. Surgical intervention is required to treat these properly.
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