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Are you unable to open your mouth to eat? Can you only get 1 finger inbetween your front teeth? You may have a “Fixed Disc Displacement”

July 17th, 2017

 

Temporomandibular Dysfunction –options for fixed closed lock of TM Joint (jaw)

Possible history: For years you have had a click in one of your TM Joint while eating /yawning. You may have had a deflection when you open your mouth for months.

Suddenly after eating hard/chewy food, a night’s sleep, and or yawning, your mouth is unable to open more than 1 finger which is placed between your front teeth.

It would be a good idea to seek medical treatment for this immediately . As a first step the dentist might suggest any of the following strategies:(brux/night guard, muscle relaxants, soft diet and physical therapy). If this does improve vertical opening the clinical diagnosis could be:

“An acute persistent closed lock of the Temporomandibular Joint”. This is caused by a dislocation of the articular disc without reduction, often accompanied with pain, reduced chewing ability and extreme reduction in vertical maximum mandibular opening to 25mm.

Action: Immediately get a referral to an Oral & Maxillofacial surgeon from your dentist or doctor and also seek out a physiotherapist specializing in TMD.

An MRI can help confirm a fixed disc displacement.

Consultation with a Maxillofacial surgeon:

Possible options could be given:

1.Physiotherapy. This should provide:-education on cause and management of dysfunction in TM Joint, stress management techniques, soft tissue massage(intra and extra oral), manipulation in combination with muscle relaxants and exercises to improve vertical opening. Neck, thoracic,& pelvis manual therapy as everything is connected! ie:Central nervous system and musculoskeletal system. (I have read a study that found 96% of people with increase in Masseter tone have increased tone in hip flexors and 76% of people have increased tone in adductors of the hip!)

2.  Surgery: This is called “An Arthrocentesis and lavage with manipulation which is the best option if physiotherapy is unsuccessful to improve the vertical mandibular opening more than 25mm and makes eating/swallowing more painful. This is a procedure that is usually done under general anaesthetic so muscles relax, allowing easy manipulation. A needle is placed in the upper joint space to inject saline or water. A steroid is often added to dampen any inflammation. After that patients will often feel bruised and bite may feel spongy due to effusion.

This procedure should put the disc into the anatomical correct position but the disc attachments (eg: fascia and ligaments) need a LONG time to heal.

Main Fact to remember when considering surgery: “Time is the healer so there are no magic short cuts.” Soft tissue takes about a year. Expect set backs as healing tissue can tear…18 months recovery is not unusual.

Management post surgery: Take anti inflammatory medicines, use local heat pads, soft diet and active jaw opening/stretching exercises guided by a physiotherapist.

No wide opening: so yawn with chin on chest.

No kissing and especially not with tongues!

No hard foods, even if cut up: apples, nuts, raw carrots, pizza and steaks etc.

Options of food to eat: Smoothies, Fish, chicken & pasta 

The surgeon will advise you on “Standard risks of surgery”

Personal thoughts: If you can function  without pain, I would recommend physiotherapy.

The success rate of the surgery is high.  However, you have to maintain the jaw opening by doing exercise prescribed by physiotherapist, avoid chewing/eating hard food.etc as mentioned above…  Soft diet is a must for a 1 year -18 months !

 

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