Clinical and radiological findings in temporomandibular joints with disc perforation

Sixteen temporomandibular joints from 15 patients, reported to have disc perforation at arthrography, were studied. Pain from the TMJ region was reported by 11 patients. Clicking was found in 6 joints and crepitation in 6 joints. Nine patients displayed a deviation of the mandible at maximum mouth opening towards the affected side. The muscles of the affected side were tender on palpation more frequently than those on the contralateral side. The disc perforation was located in the posterior attachment in most joints. An anterior disc displacement was found in all joints except one, which exhibited a normal disc position. In 4 joints with an anterior disc displacement with reduction, the configuration of the discs varied, whereas in all 11 joints with an anterior disc displacement without reduction the disc was biconvex. In most joints, the condyle was located in a central position in the fossa in the intercuspal position and 13 joints were tomographically diagnosed as being osteoarthrotic. It is concluded that most joints with disc perforations are osteoarthrotic and the most severe clinical and radiological findings are associated with an anterior disc displacement without reduction.