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TMJ Disorder -TemporoMandibular Joint Message Board
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Old 11-13-2001, 10:14 PM   #1
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Elaine HB User
Types of Internal Derangement

The most common TMJ arthropathy is the internal derangement, which is characterized by a progressive anterior disc displacement. It is often associated with a capsulitis, making pain a common feature. On physical exam, a popping is felt and heard, with associated pain. The most common derangement is anteromedial, and the degree of derangement generally correlates with symptoms.
. Myofascial pain is associated with pain over the temporomandibular joint without a palpable or audible click. A type IA derangement is found with a popping over the joint without associated pain. It is seen in over 50% of normal subjects. A type IB derangement is popping of the joint associated with pain. The popping is due to the noise the condyle makes as it moves under the anteriorly displaced disc. The pain is due to the stretching and subsequent inflammation of the retrodisc pad. The type II derangement is similar to a type IB derangement, but a history of lock jaw can be elicited. There are two types of lock jaw. The closed lock is due to the inability of the condyle to slide under the anteriorly displaced disc. The open lock is due to the inability of the condyle to slide back over the disc into its normal position. A type III derangement is a persistent lock, usually closed. Hence, there is usually no associated click or pop on physical exam. Of note, these symptoms are usually progressive. The patient often gives a history of having passed through each type of derangement. Early treatment of the internal derangement is imperative, as progression of disease leads to a less favorable prognosis. Therapy for type I and II derangements is similar to that for myofascial disorders. NSAIDs and muscle relaxers (valium) are prescribed as is the instruction of a soft diet and jaw rest. Failure of these methods requires the addition of a splint to attempt the repositioning of the condyle. The purpose is to reposition the condyle into a more favorable position related to the disc. Clicking is usually not eliminated, but it may be reduced to a soft pop with reduced pain.

 
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Old 11-14-2001, 07:52 AM   #2
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Re: Types of Internal Derangement

Thanks for this, Elaine. It really clears a lot of things up.

So, I suppose I'm type II. Not a persistent lock, but not just clicking/popping. I'm clicking/popping with locking that can be recaptured if manipulated. I think it's safe to say that it's only a matter of time before I'm type III. Which is a depressing thought, but seeing as all traditional treatments haven't solved the problem... guess I just keep on trying with splints and whatever until I'm type III, then deal with it then.

What a lovely picture of my future.

Melanie

 
Old 11-14-2001, 07:56 PM   #3
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Bren30 HB User
Re: Types of Internal Derangement

You Elaine.. <IMG SRC="http://www.healthboards.com/ubb/wink.gif"> Are way more informed than a few doctors I first saw in the beginning of this nightmare.Thanks Bunches for the info. I feel, I CAN'T know enough about TMJD. I have been through all the phases over the last few years.I'm now to a locked position.I (on a very good day) can almost get one finger between my teeth in the front.Belive me...Im alot of fun to watch with a fork a supper time.I resorted along time to the tear, smash and eat method.
I really hope ..(after alot of thought & reading your post)I do the right thing.
I have found alot of comfort in knowing there are others just like me.

 
Old 11-15-2001, 11:24 AM   #4
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Re: Types of Internal Derangement

Bren,
I was never informed to much by my oral surgeons. What I learned, I learned the hard way. Had I had access to the internet it would have made my decisions a lot easier. There are a "few" success stories out there but they are few and far between. Closed and open locks are a total different situation than what I had surgery for and for me, it should have never been done.
My opening is 13mm which is a little over one finger width, I am tied up with scar tissue again on top of loose screws so the nightmare goes on. Just got a notice from my insurance company that they won't cover me to have the implant removed. They could care less if I can eat, am dying from pain, etc. I have exhausted my TMJ coverage and I am on my own. I have no idea what I am going to do.
Elaine

 
Old 11-15-2001, 02:49 PM   #5
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MissiM HB User
Re: Types of Internal Derangement

Hi Elaine
Wow That is quite a bit of info. I am in phase III. That's kinda depressing!
Thanks For all you know!<p>[This message has been edited by MissiM (edited 11-15-2001).]

 
Old 02-19-2002, 10:04 PM   #6
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Elaine HB User
Re: Types of Internal Derangement

More information about Internal Derangement....

Wilkes Classifications for Internal Derangement

Class I: Painless clicking. No restricted motion. Slight forward displacement of disk.
Class II: Occasional painful clicking, intermittent locking, headaches. Slight forward displacement of disk, beginning deformity, and slight thickening of posterior edge.
Class III: Frequent pain, joint tenderness, headaches, locking, restricted motion, and painful chewing. Anterior disk displacement with significant deformity/prolapse of disk.
Class IV: Chronic pain, headaches, and restricted motion. Increase in severity from III with early to moderate degenerative changes, flattening of eminence, deformed condylar head, sclerosis. Class V: Variable pain, joint crepitus, and painful function. Disk perforation, filling defects, gross anatomic deformity of disk and hard tissues with degenerative arthritic changes.

 
Old 02-20-2002, 07:02 AM   #7
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blueshore99 HB User
Re: Types of Internal Derangement

Very interesting, though I wonder in the last post where those of us who do not lock open or closed fit into the scheme of things. Thankfully I have never experienced locking but I have had my share of the other associated pains like headache, facial pain, etc. I wonder if it is because my tmj stems from a clenching disorder and not from something internal in the joint. Hmmmm, something to think about.

 
Old 02-20-2002, 09:32 AM   #8
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Re: Types of Internal Derangement

blueshore99, my TMJD most likely stems from a clenching disorder as well (at least that's the only explanation anyone has on the matter). But my clenching did lead to internal derrangement of some sort. I do have the locking but my disc isn't always displaced. When it's displaced, I'm locked, and when I unlock, I re-place the disc. I've never heard of anyone in a situation like me... most people with chronic locking have anterior displacement all the time, and the times they lock are simply times in which the condylar head can't move past the disc for whatever reason. When the condyle can move past, it clicks, when it can't, it locks. But with me, the clicking isn't as frequent. I click/pop occasionally and it's almost always right before, after, or during the closed lock.

That's why specialists think I'm nuts. They put their hands on my face and listen as I open and close - no noise. They take images of my joint and see a disc sitting right where it belongs. So when I tell them I wake up locked every morning, they have no way to confirm my claims. I've actually let my joints stay locked all day (the longer I let it stay locked the harder it is to unlock and I risk not being able to - this has happened and I've been locked for weeks at a time before) just so I could prove to the doctor that yes, I do lock.

Then the typical roll-call of questions. Have you ever been in an accident? Suffered a blow to the head? Whiplash? MVA? They check my bite - it's fine. They listen to my joints - no major clicking. They tell me it's in my head and send me on my way. That's why I think that my internal derrangement was ultimately caused by years of clenching, without even knowing I do it. It's the only explanation, and many specialists and doctors out there don't believe that bruxism can cause TMJ. So they send me packing and tell me to get therapy for my dellusional jaw problems.

Very frustrating indeed. I think that us clenchers and grinders should be more noticed and taken more seriously. It annoys me to no end when people say that it doesn't cause internal derrangement!

Melanie

 
Old 02-20-2002, 09:50 AM   #9
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MissiM HB User
Re: Types of Internal Derangement

Hi Elaine,
You are such a wealth of info and Good for you! Knowledge is POWER! I know that you and I had spoken about stage III. Is there anything out there on treatments or help for people who are permanantly locked shut? And what happens after stage III? Do we need to get a whole new face?? I have stopped seeing my TMJD specialist...he wants to see me ever week and every week I tell him the same thing I don't feel any better,..and every week he tells me the same thing...YOU WON'T. I trust him he is a graduate of the clinic I loved so much. He just tells me to do relaxation techniques that I learned at the clinic and not to think about surgery! He truly believes that this is now a case of retraining my brain to deal with this TMJD pain and not to focus on the pain but focus on removing the pain!

 
Old 02-20-2002, 02:54 PM   #10
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blueshore99 HB User
Re: Types of Internal Derangement

Melanie,
I agree about not being taken seriously. I don't show any outward signs of tmj, no clicking or locking. But thankfully I found a dentist who made it his business to be informed about tmj and clenching because his wife had it and he wanted to find something to help her. So, not to be happy about anyone having tmj but I'm happy his wife did because other wise who knows where I would have ended up!

 
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