39
Volume2 Issue5
|
S
upporting
Y
our
P
ractice
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How toManage
“
CLOSEDLOCK”DISC
DISPLACEMENTWITHOUTREDUCTION
WITHLIMITEDOPENING
Point ofCare
“Closed lock:”discdisplacementwithout
reductionwith limitedopening
• 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 reducewith jaw opening.Medial and lateral displacement of
the discmay also be present. This disorder is associatedwith limited jaw
opening because the discmechanically obstructs translation of the condyle.
• Derangements of the condyle disc complex are considered a subgroup of
temporomandibular disorders (TMDs).
Presentation
Population
•
Morecommon inyoungandmiddle-agedadults.
•
Approximately twiceas common inwomen thanmen.
•
Often remitting, self-limitingor fluctuatingover time.
•
Discdisplacementwithout reductionwith limitedopening is relatively
uncommon.
•
Progression tochronicanddisabling intracapsular TMJdisease isun-
common.
Signs
•
Maximumassistedopening (passive stretch) is less than40mm, includ-
ing thevertical incisal overlap.
•
Deflectionof themandible to the ipsilateral (involved joint) sideon
openingandprotrusion.
•
Restrictionofmovement to thecontralateral (normal joint) side.
•
No intracapsular sounds (clickor pop) identifiedunless chronicand
associatedwithchange inbony surfaces.
Symptoms
•
Patientsoften report:
• Preciselywhen the “closed lock” occurred and can relate it to a
specificevent.
• Historyof intracapsular sounds (clickor pop), but this soundhas
ceased.
•
Painmayormaynot bepresent. If present, pain isoften localized to the
preauricular area.
•
Painmaybedescribedas sharp, suddenand (sometimes) intenseand
is closelyassociatedwith jointmovement, particularlyat thepoint of
limitationofmovement.
DentalEmergency
Scenario
GaryD.Klasser
DMD,CertOrofacial
Pain
Dr.Klasser is associate
professor, Louisiana
StateUniversity School of
Dentistry, department of
diagnostic sciences,New
Orleans, LA,USA.
JoelB.Epstein
DMD,MSD,FRCD(C),
FDSRCSE
Dr. Epstein is consulting
staff in the division of
otolaryngology andhead
andneck surgery at theCity
ofHopeComprehensive
CancerCenter inDuarte,
California, andCedars-
SinaiMedicalCenter in
LosAngeles, andmaintains
an oralmedicine practice
inVancouver, BC.
Theauthorshavenodeclared
financial interests.
Thisarticlehasbeenpeerreviewed.
