How to Manage "Closed Lock" Disc Displacement Without Reduction With Limited Opening

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"Closed lock:" disc displacement without reduction with limited opening

Presentation

Population

Signs

Symptoms

Investigation

  1. Obtain thorough medical and dental history, including details related to pain and dysfunction.
  2. Perform head and neck examinations (cranial nerve, muscle and joint tenderness, joint sound, range of motion of jaw) and intraoral (teeth, gingiva, oral soft tissue) to rule out local pathology or other sources of pain and to assess joint function.
  3. Downward force applied to the mandibular incisors produces minimal, if any, increase in range of opening (hard end feel).
    1. Restricted mouth opening (maximum interincisal opening) as a result of muscle disorders is usually variable in terms of range of opening. However, mild passive force applied to the mandibular incisors will usually result in an increase in range of opening (soft end feel).
  4. Loading of the involved joint is often painful.
  5. Confirm the diagnosis on a magnetic resonance imaging (MRI) scan of the TMJ.
    1. In the maximal intercuspal position, the posterior band of the disc is located anterior to the 11:30 position and intermediate zone of the disc is anterior to the condylar head.
    2. On full opening, the intermediate zone of the disc is located anterior to the condylar head.
  6. Determine whether the disc displacement without reduction with limited opening (closed lock) is acute or chronic.
    1. The clinical picture becomes less clear if disc displacement is chronic, as the ligaments become further elongated and the morphology of the disc becomes altered, thus allowing a greater range of movement. This may mistakenly be considered as a disc displacement without reduction without limited opening.

Diagnosis

A diagnosis of disc displacement without reduction with limited opening is based upon patient history, clinical examination and related tests.

Differential Diagnosis

Treatment

Approaches to acute cases may be different from chronic cases.

Common Initial Treatments

Acute cases