Effect of Auriculotemporal Nerve Block Anesthesia on Manual Reduction of Disc Displacement without Reduction of the Temporomandibular Joint

악관절의 비정복성관절원판변위의 수조작 정복에 대한 이개측두신경 전달마취의 효과

  • Kim, Sook-Young (School of Dentistry, Chonnam National University) ;
  • Kim, Ji-Yeon (Department of Dentistry, Seoul Veterans Hospital) ;
  • Hong, Su-Min (Department of Dental Hygiene, Baekseok University) ;
  • Kim, Byung-Gook (Department of Oral Medicine, School of Dentistry, Chonnam National University) ;
  • Park, Byung-Ju (Department of Oral Biochemistry, School of Dentistry, Chonnam National University) ;
  • Im, Yeong-Gwan (Department of Oral Medicine, Chonnam National University Hospital)
  • 김숙영 (전남대학교 치의학전문대학원) ;
  • 김지연 (서울보훈병원 치과) ;
  • 홍수민 (백석대학교 치위생학과) ;
  • 김병국 (전남대학교 치의학전문대학원 구강내과학교실) ;
  • 박병주 (전남대학교 치의학전문대학원 구강생화학교실) ;
  • 임영관 (전남대학교치과병원 구강내과)
  • Received : 2011.02.05
  • Accepted : 2011.03.03
  • Published : 2011.03.30


Aim: Disc displacement without reduction of the temporomandibular joint (TMJ) has been managed by mandibular manipulation to reduce the displaced disc but with a low success rate. The purpose of this study was to determine whether auriculotemporal nerve block anesthesia had an effect on the reduction of the displaced disc and to analyze the factors that influenced the result. Methods: 112 patients were diagnosed with disc displacement without reduction and treated by mandibular manipulation. Disc was recaptured in 35 patients. Among the 77 patients with whom disc recapture had failed, the auriculotemporal nerve was blocked with a local anesthetic in the 49 patients (mean $age \;{\pm}\; SD\; =\; 34.4\;{\pm}\; 15.1$; male 24, female 25) and then mandibular manipulation was performed again. Factors including age, elapsed time from the onset, and opening amount were analyzed in association with disc reduction rate with the auriculotemporal nerve block. Results: Among 49 patients who did not respond to manipulation only, manual reduction with auriculotemporal nerve block anesthesia was successful in 19 patients (38.8%). Maximum unassisted opening amount significantly increased in the 19 patients with successful recapture of the disc ($mean \;{\pm}\; SD\; =\; 46.1 \;{\pm}\; 4.5\; mm$), in contrast to the limited opening amount of the 49 patients before local anesthesia of the auriculotemporal nerve ($mean \;{\pm}\; SD\; =\; 25.7 \;{\pm}\; 6.0\; mm$). Age, elapsed time after the onset, and preoperative opening amount were not associated with the reduction rate. Conclusion: The results of this study suggest that auriculotemporal nerve block anesthesia increases the reduction rate of the disc displacement without reduction of the TMJ when combined with mandibular manipulation, and such anesthesia should be applied at the first stage of manual treatment of disc displacement without reduction.


Supported by : 전남대학교병원


  1. Farrar WB. Characteristics of the condylar path in internal derangements of the TMJ. J Prosthet Dent 1978;39:319-23.
  2. Jagger RG. Mandibular manipulation of anterior disc displacement without reduction. J Oral Rehabil 1991;18:497-500.
  3. Minagi S, Nozaki S, Sato T, Tsuru H. A manipulation technique for treatment of anterior disk displacement without reduction. J Prosthetic Dent 1991;65:686-691.
  4. Kurita H, Kurashina K, Ohtsuka A. Efficacy of a mandibular manipulation technique in reducing the permanently displaced temporomandibular joint disc. J Oral Maxillofac Surg 1999;57:784-787.
  5. Foster ME, Gray RJ, Davies SJ, Macfarlane TV. Therapeutic manipulation of the temporomandibular joint. Br J Oral Maxillofac Surg 2000;38:641-644.
  6. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301-355.
  7. Donlon WC, Truta MP, Eversole LR. A modified auriculotemporal nerve block for regional anesthesia of the temporomandibular joint. J Oral Maxillofac Surg 1984;42:544-545.
  8. Solberg WK. Temporomandibular disorders: physical tests in diagnosis. Br Dent J 1986;160:273-277.
  9. Hansson TL, Nilner M. A study of the occurrence of symptoms of diseases of the temporomandibular joint, masticatory musculature and related structures. J Oral Rehabil 1975;2:313-325.
  10. Totsuka Y, Nakamura T, et al. Treatment of closed lock by mandibular manipulation assisted by hydraulic pressure in the upper cavity of the TMJ. Oral and Maxillofacial Surgery Clinics of North America 1989;1:111-122.
  11. 김현철, 최종훈, 박혜숙, 김종열. 악관절잡음 및 동통을 동반한 정복성 관절원판 변위 환자에 대한 관절강 pumping 효과. 대한구강내과학회지 1999;24:9-24.
  12. Hosaka H, Murakami K, Goto K, Iizuka T. Outcome of arthrocentesis for TMJ with closed lock at 3 years follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:501-504.
  13. Murakami KI, Iizuka T, Matsuki M, Ono T. Recapturing the persistent anteriorly displaced disk by the persistent anteriorly displaced disk by mandibular manipulation after pumping and hydraulic pressure to the upper joint cavity of the TMJ. J Craniomandib Prac 1987;5:18-24.
  14. Barkin S, Weinberg S. Internal derangements of the temporomandibular joint: the role of arthroscopic surgery and arthrocentesis. J Can Dent Assoc 2000;66:199-203.
  15. Yoda T, Imai H, Shinjyo Y, et al. Effect of arthrocentesis on TMJ disturbance of mouth closure with loud clicking: a preliminary study. Cranio 2002;20: 18-22.
  16. Davidson JA, Metzinger SE, Tufaro AP, Dellon AL. Clinical implications of the innervation of the temporomandibular joint. J Craniofac Surg 2003;14: 235-239.
  17. Isberg A. Temporomandibular Joint Dysfunction: A Practitioner's Guide. 2001, Isis medical media., p. 17.
  18. Wang K, Arendt-Nielsen L, Jensen T, Svensson P. Reduction of clinical temporomandibular joint pain is associated with a reduction of the jaw-stretch reflex. J Orofac Pain 2004;18:33-40.
  19. Ayesh EE, Ernberg M, Svensson P. Effects of local anesthetics on somatosensory function in the temporomandibular joint area. Exp Brain Res 2007;180:715-25.
  20. Okeson JP. Management of Temporomandibular Disorders and Occlusion. 5th ed., 2003, St. Louis, Mosby Co., p.448
  21. Martini G, Martini M, Carano A. MRI study of a physiotherapeutic protocol in anterior disk displacement without reduction. Cranio 1996;14:216-24.
  22. Rao VM, Liem MD, Farole A, Razek AA. Elusive "stuck" disk in the temporomandibular joint: diagnosis with MR imaging. Radiology 1993;189: 823-827.
  23. Nitzan DW, Marmary Y. The "anchored disc phenomenon: a proposed etiology for sudden-onset, severe, and persistent closed lock of the temporomandibular joint. J Oral Maxillofac Surg 1997;55: 797-802.
  24. Dimitroulis G, Dolwick MF, Martinez A. Temporomandibular joint arthrocentesis and lavage for the treatment of closed lock: a follow-up study. Br J Oral Maxillofac Surg 1995;33:23-26.