Case report of a posterior disc displacement without and with reduction

This article presents the case of a patient with an acute posterior disc displacement without reduction (PDDWR), whose temporomandibular joint (TMJ) showed, after physiotherapeutic manipulation, the characteristics of a posterior disc displacement with reduction (PDDR). Opto-electronic condylar movement recordings in both the PDDR state and the PDDWR state, and magnetic resonance imaging (MRI) scans of the TMJ in the PDDR state were carried out to document the case. The first 2 physiotherapeutic manipulations were initially successful in reducing the disc, but a few days later the joint showed a relapse to the PDDWR state. From the third manipulation on, now 12 months ago, the patient has been free of symptoms of the PDDWR state. Condylar movement traces of the joint in the PDDWR state indicated that the condyle was prevented from entering the fossa completely. The downward condylar movement deflections during the early phase of closing, recorded after the second manipulation, showed the reduction of the posteriorly displaced disc during closing. The movement recordings also showed that the PDDR could be eliminated by submaximal opening and closing movements. The MRI scans, taken after the third, successful manipulation, showed the disc to be in a normal position with respect to the condyle when the mouth was closed, and to be posteriorly displaced when the mouth was maximally opened. The case shows that manipulation techniques may successfully reverse an acute PDDWR into a PDDR. The technique of MRIs and condylar movement recordings show promise in further unraveling the morphological and clinical features of posterior disc displacements.