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Acute Malocclusion Caused by Articular Disc Perforation: A Case Report

  • Nam, Hyun (Department of Orofacial Pain and Oral Medicine, Wonkwang University Daejeon Dental Hospital) ;
  • Shim, Young-Joo (Department of Orofacial Pain and Oral Medicine, Wonkwang University Daejeon Dental Hospital) ;
  • Kang, Jin-Kyu (Department of Orofacial Pain and Oral Medicine, Wonkwang University Daejeon Dental Hospital)
  • Received : 2018.11.09
  • Accepted : 2018.12.12
  • Published : 2018.12.30

Abstract

Patients with temporomandibular disorder often present with acute occlusal change and properly managed with conservative treatment. If such change is caused by unusual etiology, differential diagnosis may be challenged. This article describes the diagnosis of a patient exhibiting pain and acute posterior open bite on the ipsilateral side after chewing hard food. After initial conservative treatment failed to resolve the complaint, magnetic resonance imaging was ordered and confirmed partial perforation of articular disc. Disc perforation itself is usually chronic in nature, but sudden macrotrauma may also cause the disorder. However, occlusal discrepancy caused by disc perforation is rare and seldom reported. We present a case of acute malocclusion caused by disc perforation with a review of related literature.

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Fig. 1. (A) Panoramic radiograph and (B) temporomandibular joint panoramic radiograph taken on initial clinical visit does not indicate any gross bone pathology including degenerative changes of condyle.

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Fig. 3. Magnetic resonance (MR) images taken on two-week-followup check. (A-C) Images on first row show T2-weighted MR images of left temporomandibular joint (TMJ) in closemouth position. (A) Inferior condylar position due to posteriorly displaced disc can be observed. (B) Disc is separated as two segments, and anterior segment is visualised by joint effusion (arrow) suggests partial disc perforation. (C) Medial aspect of the disc is seemingly intact. (D) T2-weighted MR image of left TMJ in maximum opening shows no limitation of translation and normal disc-condyle relationship. (F) On T1- weighted coronal MR images, widened joint space of left TMJ is visibile, (E) compared to no specific widening of right TMJ, suggestive of swelling and medial disc displacement.

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Fig. 2. Cone-beam computer tomography image taken on two-week-follow-up check. (A) Right condyle does not show any gross abnormalities. Sagittal oblique images (B, C) of left temporomandibular joint (TMJ) shows degenerative changes including irregular cortical margin with erosion and osteophytic growth. (C) Inferior condylar position is also suspected on sagittal oblique image. (D) Coronal oblique image of left TMJ shows joint space widening on medial aspect and irregular cortical margin with erosion of left condyle.

Table 1. Common temporomandibular disorders and characteristic patterns of occlusal change

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Acknowledgement

Supported by : Wonkwang University

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