CLINICAL COMMUNICATION

 

Previously undiagnosed MVA trauma to TMJ

 

 

Z Yakoob^I; A Uys^II

^IBChD, PDD, MSc (Maxillofacial Radiology), School of Dentistry, University of Pretoria, E-mail: zarah.yakoob@up.ac.za
^IIBSc, BChD, Dip, Odont,(Materials), Dip, Odont, (Endo), MSc(Odont,), School of Dentistry, University of Pretoria, E-mail: andre.uys@up.ac.za

 

 

Temporomandibular disorders (TMD) have a multifactorial aetiology, one suggestion being that facial trauma caused by motor vehicle accidents (MVA) may result in TMD. However, the relationship is somewhat controversial as there is no conclusive evidence.¹ Trauma to the temporomandibular joint (TMJ) can be classified as micro-or macro-trauma. The degree of severity varies from malocclusion, whiplash during MVA and facial fractures including mandibular and condylar fractures. Trauma to the TMJ whether direct or indirect may affect the balance of the TMJ, resulting in degeneration of the articular cartilage by altering the mechanical properties of the disc. A number of problems may be experienced including dislocation, effusion, fibrous adhesions, ankylosis, fracture of the condylar head or neck and limited jaw opening.² A long-term effect of MVA to the TMJ is a secondary malocclusion developing long after the primary treatment. The most common reason for this malocclusion is that the anteroposterior or transverse dimensions have been altered. In cases where condylar fractures were undiagnosed an open bite will develop, leading to a retrognathic mandible.³

 

CASE HISTORY

A 24 year old female with a history of a previous MVA presented at our Oral Health hospital. The patient had sustained the injuries three years ago and had not received treatment. The main complaint was pain in the TMJ during function as well as a limited range of movement. A panoramic radiograph was taken at the initial examination.

During trauma the fractured segment is often displaced antero-medially due to the pull of the lateral pterygoid muscle. Degenerative changes may occur with time and these changes are more severe if the condyle is displaced.

In cases with trauma to the anterior mandible the possibility of a condylar fracture must always be considered.

 

 

ACRONYMS

CBCT: Cone beam computed tomography

MVA: motor vehicle accidents

TMD: temporomandibular disorders

TMJ: temporomandibular joint

 

References

1. Kolbinson D, Epstein J, Burgess J, Senthilselvan A. Temporo mandibular disorders, headaches, and neck pain after motor vehicle accidents: a pilot investigation of persistence and liti gation effects. J Prosthet Dent 1997; 77: 47-51.         [ Links ]

2. Yun P, Kim Y. The role of facial trauma as a possible etiologic factor in temporomandibular joint disorder. J Oral Maxillofac Surg 2005; 63:1576-83.         [ Links ]

3. Laine P, Kontio R, Salo A, Mesimäki K, Lindqvist C, Suuronen R. Secondary correction of malocclusion after treatment of maxillofacial trauma. J Oral Maxillofac Surg 2004; 62:1312-20.         [ Links ]