Post-traumatic TMJ internal derangement: impact on facial growth (findings in a pediatric age group)

Many clinical studies have shown how jaw injuries sustained during impact trauma to the face or mandible are the single most important cause of TMJ subsequent internal derangement. Proper function of the masticatory system is certainly the most influential variable in the TMJ remodelling; once a TMJ is internally deranged, adaptative or degenerative osteocartilagineous processes take place in the mandible, temporal bones and muscles. To evaluate relationships between consequences of post-traumatic TMJ internal derangement and disturbed facial skeleton growth in children, 25 patients (16 boys, 9 girls), 14 year of age or younger, were selected out of a group of 74 and analysed. They all had been treated by physiotherapy and had undergone combined clinical and radiographic examination for five years. Symptoms included, either individually or in various combination, pain, mechanical TMJ dysfunction and facial skeletal abnormalities, such as mandibular retrognathia and lower facial asymmetry manifested by chin deviation from the midline. Seventeen patients were found to have at least one abnormal and internally deranged TMJ on imaging studies; in twelve of them a mandibular asymmetry with chin deviation from the midline to the smaller or more degenerated TMJ was evident. Of the eight retrognathic patients, five were found to have bilateral TMJ derangement. In three patients both TMJ(s) were normal with normal facial structure.

These data suggest that TMJ derangement in children may potentially have an impact on facial growth and lead to the development of retrognathia, with or without asymmetry, in many cases.

1. Wilkes CH. Internal derangement of the temporomandibular joint: pathologic variations. Arch Otolaryngol Head Neck Surg 115: 469-77, 1989.

2. McGuirt WF, Salisbury PL III. Mandibular fractures: their effect on growth and dentition. Arch Otolaryngol Head Neck Surg 113: 257- 261, 1987.

3. Norman JE. Post-traumatic disorders of the jaw joint. Ann R Coll Surg Engl 64: 27-36, 1982.

4. Moss KF, L-Attar A. Ten years of mandibular fractures an analysis of 2137 cases Oral Surg 59: 120-129, 1985.

5. Proffitt WR, Vig KWL, Turvey TA. Early fracture of the mandibular condyles: frequently an unsuspected cause of growth disturbances Am J Orthod 78: 1-24, 1980.

6. Leake D, Doykos J, Mautaz et al. Long-term follow-up of fractures of the mandible condyle in children. Plast Reconstr Surg 47: 127-131, 1971.

7. Lindahal L, Hollender L. Condylar fractures of the mandible. A radiographic study of remodelling processes in the temporo-mandibular joint. Int J Oral Surg 6: 153, 1977.

8. Schellhas KP. Temporomandibular joint injuries. Radiology 173: 211- 6, 1989.

9. Schellhas KP. Internal derangement of the temporomandibular joint: radiology staging with clinical, surgical and pathologic correlation. Magn Reson Imaging 7: 495-515, 1970.

10. Katzberg RW, Tallents RH, Hayakawa K, Miller TL, Goske MJ,Wood BP. Internal derangement of the temporomandibular joint: findings in he pediatric age group. Radiology 154: 125, 1985.

11. Schellas KP,Wilkes CH, Fritts HM, Omlie MR, Heithoff KB, Jahn JA.Temporomandibular joint: MR imaging of internal derange-ments and postoperative changes. AJR 150: 381-389, 1988.

12. Schellhas KP, Piper MA, Omlie MR. Facial skeleton remodelling due to temporomandibular joint degeneration: an imaging study of 100 patients. Am J Roentgenol 155: 373-83, 1990.

13. Schellas KP,Wilkes CH.Temporomandibular joint inflammation: comparison of MR fast scanning with T1-and-T2-weight-ed imaging techniques AJR 153: 93-98, 1989.

14. Schellhas KP, Wilkes CH, Fritts HM, Lagrotteria LB, Omlie MR. MR of osteochondritis dissecans and avascular necrosis of the mandibular condyle. Am J Roentgenol 152: 551-60, 1989.

15. Moses JJ, Topper DC. A functional approach to treatment of temporomandibular joint internal derangement. J Craniomand Disord Facial Oral Pain 5: 19-26, 1991.

16. Razook SJ, Gotcher JE, Bays AR. Temporomandibular joint noises in infants: review of the literature and report of cases. Oral Surg Oral Med Oral Pathol 6: 658-663, 1989.

17. Mintz SS. Craniomandibular dysfunction in children and adoles-cents: a review. Cranio 11: 224-311, 1993.

18. Katzberg RW, Keith DA, Guralnick WWC, Manzione JV, Ten Eick WWR. Internal derangement and arthritis of the temporo-mandibular joint. Radiology 146: 107-12, 1983.

19. Raustia AM, Pirttiniemi P, Pyhtinen J. Correlation of occlusal factors and condyle position asymmetry with signs and symptoms of temporomandibular disorders in young adults. J Craniomand Pract 13: 152-156, 1995.

20. Schellhas KP, Keck RJ. Disorders of skeletal occlusion and temporomandibular joint disease. Northwest Dent 68: 35-42, 1989.

21. Schellhas KP. Unstable occlusion and temporomandibular joint disease. J Clin Orthod 23: 332-7, 1989.

22. Rao VM, Barbaria A, Manoharan et al. Altered condylar morphology associated with disc replacement in TMJ dysfunc-tion: observations by MRI. Magn Reson Imaging 8: 231-5, 1990.

23. Nickerson JW, Moystad A. Observations on individuals with radiographic bilateral condylar remodelling. J Craniomand Pract 1: 21, 1982.

24. Schellas KP. MR of muscle of mastication.AJNR 10: 829-837, 1989.

25. Schellas KP, Piper MA, Bessette RW, Wilkes CH. Mandibular retrusion, temporomandibular joint derangement and ortho-gnathic surgery planning” Plast Reconstr Surgery 1992.