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Volume 2 Issue 5
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S
upporting
Y
our
P
ractice
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How to Manage
“
CLOSEDLOCK” DISC
DISPLACEMENTWITHOUTREDUCTION
WITHLIMITEDOPENING
Point of Care
“Closed lock:”disc displacement without
reduction with limited opening
• Functional disorder of the temporomandibular joint (TMJ) included
within the broad category of derangements of the condyle disc complex.
• In the closed-jaw position, the disc is anterior to the condylar head, and the
disc does not reduce with jaw opening. Medial and lateral displacement of
the disc may also be present. This disorder is associated with limited jaw
opening because the disc mechanically obstructs translation of the condyle.
• Derangements of the condyle disc complex are considered a subgroup of
temporomandibular disorders (TMDs).
Presentation
Population
•
More common in young and middle-aged adults.
•
Approximately twice as common in women than men.
•
Often remitting, self-limiting or fluctuating over time.
•
Disc displacement without reduction with limited opening is relatively
uncommon.
•
Progression to chronic and disabling intracapsular TMJ disease is un-
common.
Signs
•
Maximum assisted opening (passive stretch) is less than 40 mm, includ-
ing the vertical incisal overlap.
•
Deflection of the mandible to the ipsilateral (involved joint) side on
opening and protrusion.
•
Restriction of movement to the contralateral (normal joint) side.
•
No intracapsular sounds (click or pop) identified unless chronic and
associated with change in bony surfaces.
Symptoms
•
Patients often report:
• Precisely when the “closed lock” occurred and can relate it to a
specific event.
• History of intracapsular sounds (click or pop), but this sound has
ceased.
•
Pain may or may not be present. If present, pain is often localized to the
preauricular area.
•
Pain may be described as sharp, sudden and (sometimes) intense and
is closely associated with joint movement, particularly at the point of
limitation of movement.
Dental Emergency
Scenario
Gary D. Klasser
DMD, Cert Orofacial
Pain
Dr. Klasser is associate
professor, Louisiana
State University School of
Dentistry, department of
diagnostic sciences, New
Orleans, LA, USA.
Joel B. Epstein
DMD,MSD, FRCD(C),
FDS RCSE
Dr. Epstein is consulting
staff in the division of
otolaryngology and head
and neck surgery at the City
of Hope Comprehensive
Cancer Center in Duarte,
California, and Cedars-
Sinai Medical Center in
Los Angeles, and maintains
an oral medicine practice
in Vancouver, BC.
gklass@lsuhsc.eduThe authors have no declared
financial interests.
This article has been peer reviewed.