Characterization of patients with disc displacement without reduction unresponsive to nonsurgical treatment: A preliminary study

dc.contributor.authorHirotate Iwaseen_US
dc.contributor.authorTadaaki Sasakien_US
dc.contributor.authorSetsuko Asakuraen_US
dc.contributor.authorKazuhiro Asanoen_US
dc.contributor.authorSomsak Mitrirattanakulen_US
dc.contributor.authorYoshizo Matsukaen_US
dc.contributor.authorYutaka Imaien_US
dc.contributor.otherThe UCLA School of Dentistryen_US
dc.contributor.otherDokkyo Universityen_US
dc.contributor.otherMahidol Universityen_US
dc.description.abstractPropose: Arthrocentesis and arthroscopic lysis and lavage have been described as effective treatment modalities for temporomandibular joint (TMJ) disc displacement without reduction (DDw/oR). More commonly, nonsurgical intervention is offered as the desired first-line treatment; however, a certain group of DDw/oR patients receiving nonsurgical treatment may remain unresponsive, thereby prolonging suffering and treatment dissatisfaction. The purpose of this study is to characterize these nonresponders by evaluating the characteristic pretreatment findings peculiar to this group. Patients and Methods: This retrospective study was based on the review of pretreatment clinical and magnetic resonance imaging (MRI) findings of 52 DDw/oR patients who were treated with stabilization appliance, jaw-stretching exercise, and nonsteroidal anti-inflammatory medication. On the last treatment visit, each patient was classified as either a responder (R) or nonresponder (NR) based on the satisfaction or dissatisfaction with the treatment received, respectively. Pretreatment data were then examined and analyzed by logistic regression to identify which clinical and MRI findings were specifically related to the NR group. Results: Logistic regressions indicated that NR had significantly higher odds ratio for pretreatment pain-free mouth opening of less than 30 mm (odds ratio [OR] = 7.385), "stuck" disc (OR = 4.521), and unchanged disc shape during mouth opening (OR = 4.050). Multiple logistic regression analyses revealed that these factors combined gave the highest likelihood ratio of 15.90 (P = .001), indicating a strong possibility that these factors are associated with the NR group. Conclusions: Nonresponders can be characterized by their pretreatment pain-free mouth opening (<30 mm) in combination with MRI confirmation of "stuck" disc and unchanged disc shapes during mouth opening. © 2005 American Association of Oral and Maxillofacial Surgeons.en_US
dc.identifier.citationJournal of Oral and Maxillofacial Surgery. Vol.63, No.8 (2005), 1115-1122en_US
dc.rightsMahidol Universityen_US
dc.titleCharacterization of patients with disc displacement without reduction unresponsive to nonsurgical treatment: A preliminary studyen_US