TMJ Pain With Internal Derangement


TMJ Pain WIth Internal Derangement

Internal derangement means exactly what it sounds like, there is a derangement or abnormality inside the TMJ.  Specifically this is referring to the cartilage disk between the two opposing bony surfaces of the joint.  In a properly functioning joint, the cartilage disk moves with the joint surfaces to constantly stay in between the two bony surfaces.  When this disk becomes malpositioned and no longer functions as it is supposed this is referred to as internal derangement (ID). ID may be a result of abnormal joint anatomy, repetitive habits which cause constant micro-trauma, major trauma, bite abnormalities, jaw abnormalities.


Internal Derangement With Reduction

Typically the derangement begins with the disk pushed forward so it is not in between the bone surfaces when the jaw is at rest.  As the jaw begins to open and space is created between the two joint surfaces the disk will then pop back into its normal position this is referred to as reduction or recapture of the disk.  Of course, as the jaw begins to close eventually there will not be enough space for the disk and it will be pushed forward again. This cycles continues and tends to get progressively worse.  Individuals will typically experience a “pop” when the disk reduces.  This abnormal disk function produces pain and damage for two reasons.  Firstly, the disk is attached to tissue so when it is displaced in the forward position this tissue behind the disk gets caught between the joint surfaces and becomes inflamed.  Secondly insufficient protection from the disk leads to premature breakdown of the bone surfaces.   


Internal Derangement Without Reduction

Individuals may proceed from having a reducing disk to a non-reducing disk.  This is the scenario when the disk is displaced in the forward position and does not “reduce” with mouth opening as described above.  The disk stays in its abnormal position and prevents the mouth from opening fully.  This is referred to as a “closed lock” as the jaw is unable to fully open and is somewhat locked closed. This is opposed to an “open lock” which occurs when the jaw becomes dislocated and is stuck in the open position.  Internal derangement without reduction is a more concerning situation than when reduction is present because function becomes mechanically impaired.


Treatment for Internal derangement begins with making a proper diagnosis not only of internal derangement but, more importantly, determining the cause of the ID. Treatment is directed at attempting to rectify any issues which may have caused the ID or are making it worse.  Conservative treatment may provide relief, however typically some form of minimally invasive or traditional surgical intervention is eventually required to provide relief.


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