A two-year follow-up of temporomandibular joint disk displacement without reduction in 22 subjects

Twenty-two subjects with clinically diagnosed unilateral anterior disk displacement were followed up for two years. Seventeen of the patients were women and five were men, with ages ranging from 17 to 68 years (median 27 years). In 20 cases the duration of locking at the time of the examination was less than 6 months; the other two cases had experienced locking for more than 6 months but less than one year. Case histories were recorded and clinical examinations performed according to accepted principles, followed by calculation of Helkimo's anamnestic dysfunction index Ai and clinical dysfunction index Di. The patients were treated using full coverage splints combined with occlusal adjustment. Follow-up examinations were made after 6 months, one year and two years. At the time of the first visit, 17 patients had severe subjective symptoms such as difficulty in opening the mouth wide and pain on movement of the mandible, while five experienced locking without subjective symptoms. All patients apart from one belonged to Di III and had a maximal mouth opening capacity ranging from 24 to 38 mm. During follow-up, one patient was treated surgically because of continuous severe symptoms; in one case, spontaneous disk reduction was confirmed by MR imaging. At the last examination the rest of the patients (n = 20) had a mouth opening capacity ranging from 31 to 60 mm and belonged to Di II. However, eight patients were completely symptom free and 12 had only mild symptoms. All patients regarded their condition and good as were able to manage well.(ABSTRACT TRUNCATED AT 250 WORDS)