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Case Reports
, 44 (2), 20140218

Fracture of the Articular Disc in the Temporomandibular Joint: Two Case Reports

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Case Reports

Fracture of the Articular Disc in the Temporomandibular Joint: Two Case Reports

S-Y An et al. Dentomaxillofac Radiol.

Abstract

Disc fracture of the temporomandibular joint (TMJ) is a little-known pathological condition owing to its extreme rarity. We report two cases of elderly patients who were diagnosed with disc fracture of the TMJ based on MRI, and we review related reports. On physical examination, an incomplete bite and mild joint pain were observed on the affected side in both patients. An MRI showed a complete fracture in the intermediate zone of the articular disc in the TMJ; the posterior fragment was displaced posteriorly, causing occlusal change in the closed position of the condyle and an incomplete bite. Conservative treatment including manual manipulation, physical therapy and oral appliance had no effect on the occlusal abnormality. Although the inciting cause of the disc fracture remained unclear, the degenerative changes in the joint may have been a factor by increasing the brittleness and reducing the elasticity of the disc.

Keywords: disc fracture; mandibular condyle; temporomandibular joint disorders.

Figures

Figure 1
Figure 1
Case 1. (a) Panoramic radiograph and (b) the four temporomandibular joint panoramic views. Cortical outline of the condyles and the range of mouth opening are relatively normal. L, left side.
Figure 2
Figure 2
Case 1. Clinical photograph on initial examination. A slight gap is present between the maxillary and mandibular anterior teeth in the closed position.
Figure 3
Figure 3
Case 1. (a–c) MR images of the right and (d–f) left temporomandibular joints (TMJs). Proton density-weighted MRI (a, d) and T2 weighted MRI (b, e) in the closed position, and proton density-weighted MRI (c, f) in the open position. The discs (arrowheads: anterior fragment, arrows: posterior fragment) in both TMJs are completely separated at the intermediate zone. While the anterior fragment is anteriorly displaced from its normal position, the posterior fragment is displaced posteriorly behind the condylar head. Flattening of the condylar head and joint effusion are evident in both TMJs.
Figure 4
Figure 4
Case 2. (a) Panoramic radiograph and (b) the four temporomandibular joint panoramic views. Degenerative change is evident in the left condyle.
Figure 5
Figure 5
Case 2. Clinical photography on initial examination. Occlusal contact is absent between the left posterior teeth in the closed position.
Figure 6
Figure 6
Case 2. (a–c) MR images of the right and (d–f) left temporomandibular joints. (a, d) Proton density-weighted MRI, (b, e) T2 weighted MRI in the closed position and (c, f) proton density-weighted MRI in the open position. The disc (arrowheads: anterior fragment, arrows: posterior fragment) on the left side is completely separated at the intermediate zone. There is flattening and the osteophyte formation in the left condyle.

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