Anterior Repositioning Splint to recapture the Disc

Sun, 02/01/2009 - 07:18 — Dr. Pratt

I have a patient that came in with sever pain right tmj. At one point she had a reciprical click on the right. She presented yesterday, the click is now gone. Cone beam ct confirms an anterior displaced disc. Some of my colleagues recommend a Anterior Repositioning split(ARS) to recapture the disc. I dont have much experience ARS and will probably refer. Im looking for opinions on whether ARS work and maybe get some other recommendations?

Orofacial Pain and TMD

Sun, 02/01/2009 - 07:48 — hargitai

Anterior disk displacement without reduction

I wonder if the CC is a result of trauma (hit in face, bit into something wrong) or unknown? An AT (auriculotemporal) nerve block can let you know if the pain is intra or extracapsular. Protective muscle splinting (i.e. co-contraction) could also limit opening and since the ROM is decreased she/ he is avoiding the click by not opening wide enough. The imaging showing the displaced disk does not definitively prove that the disk is the problem. 33% of the adult population has a displaced disk. How would we know he is not among the 33% (I assume there is no old imaging showing a normal disk position). Assuming the the AT block eliminates the pain, we can assume that the pain is intracapsular. TMJ arthrocentesis if performed within the first month or so would be the best bet vice an ARS. Though an ARS in conjunction with the arthrocentesis is reasonable. Good luck with case.

Tue, 04/07/2009 - 05:48 — stanostano

Anterior Disc Replacement Without Reduction

You are not providing enough information. Has her range of motion been affected? Does she deflect or deviate on opening? If she deflects, is it on the side where she is having pain? Is this problem new? If it is new, sometimes the jaw can be manipulated so that the disc will pop back into position. If it is old, use muscle relaxant, splint therapy to treat off the disc, hypomobility exercises once the pain is gone, Alieve, bid for two weeks to treat inflamation. A Flector Patch can be used over the inflamed joint too.
Stanley Markman, DDS
Instructor Orofacial Pain UMDNJ

Tue, 04/07/2009 - 09:07 — Dr. Pratt

Anterior Disc Displacement: Dr. Markman and Dr. Hargatai

Dear Dr. Markman and Dr. Hargatai

Thanks for the insight. I see many of these types of patients but dont have the knowledge to adequately treat and referral is a problem.

Dr. Markman: To answer your questions. It is a new problem, she deviates away from the side she has pain on.

She is on motrin 800 and I am getting a hard splint fabricated.

What muscle relaxant do you recommend?
Can you explain a little bit about hypomobility exercises and flexor patch?

Thanks