習慣性顎関節前方脱臼に保存的治療を行った１症例　関節円板協調失調との関連

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  • Conservative treatment of a patient with habitual anterior dislocation of the temporomandibular joint. Relation to incoordination of the disc.
  • Relation to incoordination of the disc
  • 関節円板協調失調との関連

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The purpose of this article is to report the clinical course of a case with habitual anterior dislocation of the TIV1J treated by occlusal treatment, and to investigate the etiology of anterior dislocation of the TMJ from its arthrographic findings.<BR>The patient was 31-year-old woman who suffered from frequent opening lock symptom which began at dental treatment 7 weeks before the first visit to our hospital. The frequency became greater gradually. The clinical diagnosis was habitual anterior dislocation of the bilateral TMJ. At first visit, bilateral dislocation without self-reducing occurred every time her mouth opened more than 28 mm interincisally. There was marked tenderness of the temporal, masseter, and lateral pterygoid muscles at mouth closing which suggested disturbance of coordination between masticatory muscles. It was thought that such myalgia were due to malocclusion in which central occlusion had been unstable and vertical dimension of occlusion had decreased as a result of repeated prosthetic treatments. The arthrotomogram showed that bilateral condyles fixed at extra-fossa position located anterior to the anterior bands of the discs and that the condyles were normally under the discs at mouth closing. Video fluorographic observation revealed that the anterior bands of dislocated discs mechanically obstructed posterior translation of the condyles. This abnormal disc movement corresponding to that of incoordination of the disc suggested that the critical disc incoordination resulted in the dislocation. It seemed that the factor to separate dislocation from disc incoordination is the degree of incoordinative activity of masticatory muscles, especially between the lateral pterygoid muscle and closing muscles.<BR>Treatment was focused on elimination of the myospasm by means of a occlusal splint based on that hypothesis. After application of a splint, dislocation has disappeared completely even after prolonged maximal mouth opening up to 49 mm, and tenderness of masticatory muscles disappeared.<BR>Those clinical findings have established the concept that anterior dislocation of the TMJ is fundamentally a muscular problem: incoordination of the muscles induces incoordination of the disc resulting in dislocation. If the incoordination of the muscles is too great, the condyle is not able to be reduced into the fossa beyond the anterior band, and is resticted at an extra-fossa position. Similar to internal derangements of the TMJ, some anterior dislocation might well fall into the category of abnormal disc movement.

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