Joint intracapsular disorders: diagnostic and nonsurgical management considerations

Arthrocentesis versus occlusal coverage splints in the management of disc displacement without reduction: a systematic review and meta-analysis

Disc displacement without reduction (DDwoR) can cause pain and limitations in mouth opening, with a significant impact on function. The optimal management strategy for DDwoR is unclear. Treatments include conservative management such as mandibular manipulation, occlusal splints, and patient education/self-management, as well as arthrocentesis, which is a minimally invasive procedure. The aim of this systematic review and meta-analysis was to ascertain whether there is a role for arthrocentesis in the management of DDwoR. Studies analysing the outcomes pain and maximum mouth opening (MMO) in patients with DDwoR treated by arthrocentesis or occlusal coverage devices were eligible for inclusion. Following a database search, six studies with a total of 343 participants were found to be eligible for analysis (three prospective observational studies, one retrospective observational study, one non-randomized single-blind clinical trial, and one unblinded randomized clinical trial). When compared to occlusal coverage splints, arthrocentesis demonstrated a slight improvement in pain, although this was statistically non-significant (standardized mean difference (SMD) -0.50, 95% confidence interval (CI) -1.04 to 0.05, P = 0.07; I2 = 81%), and a significant improvement in MMO (SMD 0.79 mm, 95% CI 0.24-1.35 mm, P = 0.005; I2 = 79%). However, due to the significant heterogeneity between studies and the high risk of bias, along with the paucity of double-blind randomized controlled clinical trials, definitive conclusions cannot be drawn for this clinical question.

Efficacy of Arthrocentesis and Anterior Repositioning Splints in Treatment of Internal Derangement of TMJ: A Prospective Clinical Study

The aim of this study is to assess the efficacy of double puncture arthrocentesis and anterior repositioning splints in the treatment of internal derangement of temporomandibular joint. 35 patients with mean age of 36.6 years ± 10.2 years diagnosed with unilateral TMD who fell into Wilkes stage 2 and disc displacement with reduction with intermittent locking described by RDC/TMD were treated with Nitzan's double puncture arthrocentesis and were given a anterior repositioning hard splint. The parameters following parameters were assessed at intervals of 1 week, 2 weeks, 1 month, 3 months and 6 months: pain, maximum inter-incisal mouth opening, Joint noise/click. Statistically significant (p < 0.001) improvements were seen at all recorded intervals in all observed parameters. Simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.

The Effect of Arthrocentesis Treatment for Maximum Mouth Opening and Pain in Temporomandibular Joint Diseases and the Effect of Splint, Drug, and Physical Therapy on This Treatment

Background and Purpose: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular diseases involving the temporomandibular joint complex and the surrounding muscle and osseous structure. TMD can be classified as intra-articular or extra-articular. The aim of this study was to evaluate the effect of arthrocentesis in terms of maximum mouth opening (MMO) and pain in patients with TMD of intra-articular origin. In addition to this treatment, the effects of factors such as splints, medication, and physical therapy on arthrocentesis were examined. Material and methods: This retrospectively designed study was conducted with 79 patients who had previously undergone arthrocentesis. These patients were divided into three groups according to the Research Diagnostic Criteria for temporomandibular disorder: disc displacement (DD) with locking (Group 1), DD without locking (Group 2), and degenerative joint diseases (Group 3) groups. The maximum mouth opening (MMO) and visual analog score (VAS) values of the groups were recorded before arthrocentesis (Baseline: T0), on the third day after arthrocentesis (T1), and at the sixth month (T2) after arthrocentesis. Information about whether the patients received concurrent medical treatment, splint treatment, and physical therapy was also recorded. These data were compared between groups. Results: It was observed that the VAS scores in all three groups decreased from T1 compared to T0 (p < 0.05). Likewise, the MMO value increased in all groups at T1 compared to T0. (p < 0.05). It was observed that splint treatment, pain killer and muscle relaxant treatment, and physical therapy made no additional contribution to arthrocentesis in terms of reducing pain or increasing MMO value (p > 0.05). Conclusions: Arthrocentesis was observed to be effective in terms of pain and function in TMJ patients in this study. It was observed that splint therapy, physical therapy, and medical therapy made no additional contribution to arthrocentesis in terms of MMO or pain.

Evaluation and management of temporomandibular disorders. Part 2: an orthopaedic physical therapy update on examination and clinical reasoning

Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.

Diagnostic accuracy of ultrasonography compared with magnetic resonance imaging in diagnosing disc displacement of the temporomandibular joint: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Diagnosing temporomandibular disorders without an adjunctive chairside diagnostic tool has made the management of temporomandibular disorders challenging and subjective. The use of magnetic resonance imaging, considered the standard imaging modality, is hindered because of high cost, a long learning curve, availability, and a longer examination time.

PURPOSE

The purpose of this systematic review and meta-analysis was to determine whether ultrasonography could be a chairside tool to help clinicians diagnose disc displacement in temporomandibular disorders.

MATERIAL AND METHODS

An electronic search was conducted of the PubMed (including MEDLINE) and Cochrane Central database and the Google Scholar search engine for articles published from January 2000 to July 2020. Studies were chosen based on the inclusion criteria, which included the diagnostic technique's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with respect to imaging the displacement of the articular disc. The quality assessment of diagnostic accuracy studies (QUADAS- 2) tool was applied to assess the risk of bias for the included studies. The Meta-Disc 1.4 and RevMan 5.3 software program were used to conduct the meta-analysis.

RESULTS

Seventeen articles were included in this systematic review, and a meta-analysis of 14 articles was done after applying the inclusion and exclusion criteria. None of the included articles were considered to have applicability concerns; however, 2 articles had a high risk of bias. The sensitivities and specificities for the different selected studies vary substantially from 21% to 95% with a good pooled sensitivity estimate of 71% while the specificities varied from 15% to 96% with a good pooled specificity estimate of 76%.

CONCLUSIONS

This systematic review and meta-analysis suggested that ultrasonography may have clinically acceptable diagnostic accuracy in diagnosing disc displacement of the temporomandibular joint, allowing the treatment of patients with temporomandibular disorders with greater assurance and success. Additional training in the operation and interpretation of ultrasonography is required to reduce the learning curve and make the use of ultrasonography relevant, straightforward, and routine in dentistry to supplement clinical examination and diagnosis in patients with suspected disc displacement of the temporomandibular joint. The evidence acquired needs to be standardized, and further research is required to provide stronger evidence.

Biomechanics and Derangements of the Temporomandibular Joint

The human temporomandibular joint, is a ginglymo-arthrodial joint. The articular disk serves as a fibrous, viscoelastic structure that allows force distribution and smooth movement of the joint in its normal arrangement during mandibular movements. Most studies suggest that in the normal disk position the posterior band is located at the 12'o clock position within the glenoid fossa in the closed mouth posture. When the biomechanics of the joint is altered, the disk may be displaced creating an abnormal relationship between the disk, condyle, and the eminence that is often referred to as an internal derangement. This article reviews the various presentations of internal derangements.

Nonlinear Relationship between Temporomandibular Joint Disc Displacement Distance and Disc Length: A Magnetic Resonance Imaging Analysis

Objective: to explore the association between the distance of disc displacement and disc morphology in patients with temporomandibular disorders (TMDs). Methods: a total of 717 joints in 473 subjects were enrolled in this cross-sectional study. The magnetic resonance imaging (MRI) of each patient was evaluated for temporomandibular joint (TMJ) disc morphology classification and position. The distance of the disc displacement and disc length were measured for smoothing spline prediction. A stratified analysis was performed based on the types of disc positions. The disc width and length-width ratio (L/W) were also measured. Descriptive statistics, one-way analysis of variance, smoothing spline analysis, threshold analysis, and two piecewise linear regression were performed to investigate the association between the displacement distance and length of discs. Results: the differences in displacement distance among morphological categories and among different disc positions were statistically significant. Nonlinear relationships were found between distance and length in all subjects. Two turning points of distance (−1.8 mm and 1.7 mm) were found, dividing the curve into three segments. Disc width and L/W were significantly different among discs in the three segments of the curve. The correlation coefficient (β) for the three segments were as follows: −0.6 [95% confidence interval (CI) = −0.9 to −0.3, p < 0.001], 0.0 (95% CI = −0.1 to 0.0, p = 0.027), and −0.7 (95% CI = −0.8 to −0.7, p < 0.001). Nonlinear relationships were also found between the distance and length in cases with anterior disc displacement (ADD), anterior disc displacement with reduction (ADDWR), and without reduction (ADDWoR). Conclusion: the turning points of the disc displacement distance may be considered as a potential reference value for high-risk disc deformation and ADD. Disc length decreases sharply with anterior disc displacement when the disc displacement distance is over 1.7 mm. Prospective and long-term studies are required to clarify the natural course of the disc at different stages of the regression curve.

Quantitative volume and area assessment of masticatory muscles through magnetic resonance imaging in patients with temporomandibular joint disorders

OBJECTIVE

To compare volume and surface area measurements of the lateral pterygoid (LPM), medial pterygoid (MPM), and masseter muscles (MM) as calculated on magnetic resonance imaging (MRI) based on the position of the temporomandibular joint disk, mouth position, and patient sex, and to calculate the correlations of the measurements among the muscles.

STUDY DESIGN

Measurements of muscle volume and area were performed on the MRIs of 51 patients. Wilcoxon, Kruskal-Wallis, and Mann-Whitney U tests were used to calculate the significance of differences in measurements. The Spearman correlation coefficient calculated the correlation of measurements among the muscles. The significance of difference was established at P < .05.

RESULTS

Volume and area of the left MPM in patients with disk displacement without reduction (DDWOR) were larger than in patients with normal disk position (P ≤ .040). MM volumes were smaller with DDWOR than with DD with reduction bilaterally (P ≤ .031). The volume and area of LPM and MM were significantly different between closed and open mouth positions (P < .001). Differences in volume and area between females and males were significant for all muscles in volume (P ≤ .021) and for MPM and MM in area (P ≤ .021). Significant positive correlations were found among all muscles for volume and area.

CONCLUSION

Volume and area measurements of the masticatory muscles varied according to disk and mouth position and patient sex and exhibited significant positive correlations.

The effects of botulinum toxin A injection on the lateral pterygoid muscle in patients with a painful temporomandibular joint click: a randomized clinical trial study

Background

Temporomandibular disorder (TMD) is the main cause of non-dental pain in orofacial area. The most common symptoms of TMD are joint pain, joint sound and limitation of jaw function. Botulinum toxin (BTX) injection is considered a potential treatment for TMD due to its pain-relieving properties and its ability to reduce muscle activity. Most of the studies are case series and further investigations are required to prove the efficacy of this treatment modality. Thus, in this study, we aimed to investigate the effect of BTX-A injection on the lateral pterygoid (LP) muscle and to evaluate its efficacy regarding TMD.

Materials and methods

Thirty-eight patients (19 women and 19 men; mean age of 26.53 years) with painful unilateral temporomandibular joint click and LP muscle tenderness were enrolled in this study. They were divided into two groups; one received an extraoral BTX-A injection in the LP muscle, and the other received a placebo injection. Pain severity, jaw movements, click severity, and Helkimo index were recorded at the first visit, as well as one week, one month, and three months after the intervention. Data were analyzed using repeated-measures analysis of variance and t-tests.

Results

The results showed that click severity was not significantly different between the BTX-A and placebo groups (P = 0.07). Pain and Helkimo index decreased significantly in the BTX group (P = 0.00 and P = 0.006, respectively); however, there was no significant difference between the two groups (P = 0.22 and P = 1, respectively). There was a significant difference in lateral movements between the groups (P = 0.00) but not in protrusive movement (P = 0.095).

Conclusions

It can be concluded that although some studies have stated that BTX injection can make the click sound disappear, in this study, we did not find a significant difference between the two groups. Furthermore, our results showed that click and pain severity decreased, but the difference was not statistically significant. Therefore, further studies with a higher dosage of BTX and more participants are recommended.

Trial registration The local Ethics Committee of Shiraz University of Medical Sciences approved this research (IR.SUMS.REC. 01/10/2018 and IRCT20130521013406N3).

The effect of functional mandibular advancement for adolescent patients with skeletal class II malocclusion on the TMJ: a systematic review and meta-analysis

OBJECTIVES

This study aimed to assess whether functional mandibular advancement (FMA) will cause temporomandibular joint disorders (TMD) or have side effects on temporomandibular joint (TMJ) in adolescent patients.

METHODS

All searched databases, including PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trails and Scopus were searched. Gray literature and unpublished literature was also searched. Randomized controlled trails (RCT) and non-randomized studies of the effects of interventions (NRSI) directly observe the condition of adolescent patients' TMJ after finishing treatment will be considered to include in our study. According to Cochrane Handbook, Cochrane Collaboration risk of bias tool was used to assess the quality of included RCTs, and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool was used to assess the quality of included NRSIs.

RESULT

Finally 18 researches were evaluated as eligible to include in this study. 5 of the studies were RCTs, 8 were NRSIs and 5 were systematic reviews. The data of RCTs and NRSIs were statistically pooled in meta-analysis. The number of samples under investigated among primary studies was 579 individuals,there were 80 patients who developed temporomandibular symptoms during or after treatment. But all the subjective symptoms disappeared during follow-up time. The statistical outcomes proved that patients received FMA didn't show more tendency to develop temporomandibular symptoms [I2 = 27%, OR = 0.54, 95%CI (0.33,0.87), p = 0.01].

CONCLUSION

(1) TMJ symptoms may occur during the functional oral appliance wearing, but the symptoms will release or disappear after treatment or during the follow-up period. (2) Less convincing evidence indicates that slightly previous TMD and condyle-glenoid fossa relationship will be improved after treatment. (3) There is TMJ disc anterior displacement observed during treatment, but most of them will return to the normal position later. (4) Moderate evidence support that FMA will not have side effects on TMJ of adolescent patients.

Diagnostic use of computerized axiography in TMJ disc displacements

Application of paraclinical methods for investigating the temporomandibular joint (TMJ) has been a subject of constant controversy due to the absence of universally-accepted criteria and lack of consensus regarding their usage. Compared with medical imaging, which provides a structural analysis of the TMJ, axiography involves the functional recording of condylar movements. The aim of the present study was to explore the diagnostic value of computerized axiography for TMJ disc displacements using MRI as the reference standard. The present study included 33 (66 TMJs) patients clinically diagnosed with TMJ disc displacements. On the same day, all patients underwent clinical examination and computerized axiography measurements using Cadiax Compact^® II before undergoing MRI (1.5 T) 1-7 days later. The characteristics of the diagnostic parameters, namely sensitivity, specificity, positive and negative predictive values, accuracy, Youden index and the 95% confidence intervals (CI), were all computed. Compared with MRI, computerized axiography yielded a sensitivity of 85.11%, specificity of 94.74%, positive predictive value of 97.56%, negative predictive value of 72% and a diagnostic accuracy of 87.88% for any disc displacements. This suggests that computerized axiography can confer high sensitivity, specificity and accuracy for the diagnosis of TMJ disc displacements. However, axiographic analysis has no diagnostic significance in TMJ function if not associated with clinical examination.

Orthodontic management of anterior disc displacement without reduction

This article presents a novel idea for managing patients with anterior disc displacement without reduction that often develops in susceptible patients during routine orthodontic treatment. The patient was a 24-year-old male who presented with class I right molar and canine relationship and class III left molar and canine relationship on a class I skeletal base, complaining of bimaxillary crowding. The case was treated with fixed orthodontic appliance with maxillary expansion and unilateral mandibular extraction to eliminate the mandibular crowding. Due to a life crisis, the patient developed anterior disc displacement on the right joint. A maxillary occlusal splint was fabricated to reduce the symptoms and attempt to recapture the disc; however, this attempt failed. An attempt was then made to recapture the disc using occlusal pivots and elastics. The disc was eventually recaptured, and the patient resumed normal jaw function and mouth opening. This case report aims to demonstrate a new way to achieve stable occlusion in a patient who sustained disc displacement.

Magnetic Resonance Imaging Evaluation of Closed-Mouth TMJ Disc-Condyle Relationship in a Population of Patients Seeking for Temporomandibular Disorders Advice

Objective

To characterize the closed-mouth temporomandibular joint (TMJ) disc-condyle relationship in a population of individuals who sought hospital services for temporomandibular disorders (TMD).

Methods

Two hundred and twenty-four TMJ magnetic resonance images (MRIs) of 112 patients were assessed in all spatial planes to classify disc position with respect to the condyle in a closed-mouth position.

Results

Disc displacement (DD) was present in 62.1% and superior disc position in 29.9% of the patients. Position could not be determined in 8% of the cases. Among DD, pure anteriorized position was the most common condition (34.4%), with different combined translational and rotational displacements in all the other joints (27.7%).

Conclusion

There is a wide biological variability in disc position in closed mouth among patients seeking for TMD advice. Getting deeper into the correlation with clinical symptoms is recommended to refine the potential relevance of any diagnostic and management strategies based on the imaging evaluation of TMJ disc position.

Outcomes of Treatment with Manipulative Reduction Combine with the Disc-condyle Repositioning Splint in Acute Anterior Disc Displacement without Reduction

ABSTRACT

In this report, the authors describe a case of the acute anterior disc displacement without reduction treated by manipulative reduction combined with the disc-condyle repositioning splint to improve the limited mouth opening and relieve the pain, including diagnostic images and treatment performed.

Evaluation of the efficiency of different treatment modalities in individuals with painful temporomandibular joint disc displacement with reduction: a randomised controlled clinical trial

The aim of the study was to investigate and compare short and long-term effects of occlusal splints (OS), ultrasound (US), and high-intensity laser therapy (HILT) in patients with painful temporomandibular joint (TMJ) disc displacement with reduction (DDWR). This prospective, randomised, single-blinded, controlled clinical study was conducted on patients with DDWR at a university oral and maxillofacial surgery clinic. A total of 140 patients were allocated randomly to four groups (OS, US, HILT, and control), with 35 patients in each. Patients were evaluated for pain, range of motion of the jaw, disability, and quality of life. A total of 132 patients completed the study. In all treatment groups (OS, US, and HILT), a significant improvement was observed in terms of pain, function, disability, and quality of life, at both weeks four and 12 compared with the control group (p < 0.001). Improvements in VAS pain and maximum mouth opening were not significantly different between the treatment groups. However, compared with the OS group, there was a significant improvement in the HILT and US groups in terms of total Oral Health Impact Profile (OHIP-14) and Jaw Functional Limitation Scale-20 (JFLS-20) scores at week four, but no difference between the groups at week 12. The results of this study show that OS, US, and HILT are effective treatments for pain and functional jaw movements in patients with DDWR. HILT, a new method, can be an alternative treatment in cases of TMD.

COL12A1 Single Nucleotide Polymorphisms rs240736 and rs970547 Are Not Associated with Temporomandibular Joint Disc Displacement without Reduction

Temporomandibular disorders (TMDs) may affect up to 25% of the population, with almost 70% of these TMD cases developing malpositioning of the disc over time in what is known as internal derangement (ID). Despite significant efforts, the molecular mechanism underlying disease progression is not yet very well known. In this study, the role of COL12A1 rs970547 and rs240736 polymorphisms as potential genetic factors regulating ID was investigated. The study included 124 Caucasian patients of both sexes after disc displacement without reduction (DDwoR) in either one or two temporomandibular joints (TMJs), either of which meet the criteria for this condition. All patients underwent clinical examination and 3D digital imaging. The COL12A1 rs970547 and rs240736 polymorphisms were evaluated. There were no statistically significant differences in the chi-square test between the study group and healthy controls. The examined COL12A1 rs240736 and rs970547 polymorphisms do not contribute to DDwoR in Polish Caucasians.

MRI-Based Assessment of Masticatory Muscle Changes in TMD Patients after Whiplash Injury

Objective: to investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury, based on magnetic resonance imaging (MRI), and to correlate them with other clinical parameters. Methods: ninety patients (64 women, 26 men; mean age: 39.36 ± 15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results: TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p < 0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r = 0.346, p = 0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p < 0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion: abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying pathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.

High-resolution ultrasound imaging compared to magnetic resonance imaging for temporomandibular joint disorders: An in vivo study

PURPOSE

The study aims to determine the diagnostic value of high-resolution ultrasonography (US) compared with magnetic resonance imaging (MRI) for the evaluation of temporomandibular disorders (TMD).

METHODS

Fifty consecutive patients (42 female and 8 male) with signs and symptoms of TMD according to the Research Diagnostic Criteria for TMD were enrolled in the study. Each patient underwent US (13 and 20 MHz) and MRI examination of both TMJs, 1-7 days following clinical examination. All MRI examinations were performed by another radiologist using an 1.5 T MRI device. Sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV, NPV) and diagnostic accuracy were computed along with 95% confidence intervals.

RESULTS

For overall disc displacements, 13 MHz US showed a Se of 72.58%, Sp of 86.84%, PPV of 90%, NPV of 66% and diagnostic accuracy of 78%, while 20 MHz US showed a Se of 75.81%, Sp of 86.84%, PPV of 90.38%, NPV of 68.75% and a diagnostic accuracy of 80%. For degenerative changes, 13 MHz US revealed a Se of 58.33%, Sp of 92.11%, PPV of 70%, NPV of 87.5% and a diagnostic accuracy of 84%, whereas 20 MHz US indicated the same Se of 58.33%, Sp of 93.42%, PPV of 73.68%, NPV of 87.65% and a diagnostic accuracy of 85%. The Cohen's Kappa coefficient for the intra- and inter-observer agreement was 0.822 and 0.836 for disc displacement, respectively 0.813 and 0.788 for degenerative disorders (p < 0.001).

CONCLUSIONS

High-resolution US could be a useful imaging technique in diagnosing TMJ disc displacements.

Effect of simultaneous application of arthrocentesis and occlusal splint versus splint in management of non-reducing TMJ disc displacement

Background/Purpose

This study aimed to compare the effect of four approaches in the treatment of TMJ disc displacement without reduction (DDwoR).

Materials and methods

Thirty-two patients (40 joints) with mean age 28.025 ± 7.18 (23 female patients and nine male patients) were assigned randomly into four groups (10 joints in each group). Group I, patients were treated by centric splint. Group II, patients were treated by distraction splint. Group III, patients were treated by arthrocentesis and centric splint, while group IV patients were treated by arthrocentesis and distraction splint. The groups were compared in terms of joint function (mouth opening), joint pain through joint palpation, and use of visual analog scale (VAS). These records were taken preoperatively, two weeks, one month, three, and six months postoperatively. Also, the presence of disc recapture was evaluated in all patients on MRI at the end of the treatment period.

Results

Significant improvements in all parameters were recorded in all groups. At two weeks postoperatively, there was a significant improvement in all parameters in group III and group IV than group I and group II, while there was no statistical difference between group III and group IV. Regarding mouth opening and joint palpation, there was a significant improvement in group III than group I and group II. Also, there was a significant improvement in group IV than group II at the subsequent follow-up periods. Regarding VAS, at one and three months postoperatively, there was a significant improvement in group III than other groups.

Conclusion

However, both types of splints provide better results without a statistical difference; the simultaneous application of arthrocentesis and occlusal splint decreases pain and improving the function effectively and more rapidly.

Surgical treatment of a rare bilateral synovial chondromatosis

Synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is an uncommon entity, mostly when the involvement is bilateral. The authors report a rare case of bilateral SC, with a follow-up of 13 months, and a literature review. A 60-year-old Caucasian woman, with the chief complaint of pain for 6 years in the bilateral pre-auricular region, had a progressive clacking and discomfort on the left side during mouth opening. The panoramic image was suggestive of SC. The bilateral lesion was surgically removed by direct access. Histopathological examination confirmed the clinical diagnosis of bilateral SC. This article shows the importance of a multidisciplinary approach for the early diagnosis and appropriate treatment. Also, it encourages the referral of such cases to professionals with a greater familiarity with this entity.

Association of Temporomandibular Disorder Symptoms with Anxiety and Depression in Saudi Dental Students

BACKGROUND

Temporomandibular dysfunction (TMD) is a term that encompasses a set of chronic painful conditions, and dysfunction in the orofacial region involving the muscles of mastication, the temporomandibular joints (TMJ) and related structures. It can affect individuals of any age.

AIM

We investigated the prevalence of temporomandibular disorder (TMD) and its association with anxiety and depression.

METHODS

Cross sectional study that conducted among 105 dental students (age 20-35 years). The assessment instruments were the Fonseca Anamnestic Questionnaire and the Hospital Anxiety and Depression Scale.

RESULTS

TMD was present in 52 (49.5%) students, and anxiety or depression was present in 53 (50.5%) students. The results of the HAD scale showed that 92 (83.4%) students had some level of anxiety or depression, 38 (36.2%) were border line for anxiety or depression, and 80 (76.2%) were diagnosed with anxiety or depression while regarding to the association of TMD with gender, 9 of 48 (17.3%) were males and 39 (82.7%) were females (P-value = 0.001).

CONCLUSION

Our study revealed a high prevalence of TMD. The women had a higher prevalence of TMD. Also, we reported the higher prevalence of anxiety and depression among TMD students.

Evaluation of the efficacy of different treatment modalities for painful temporomandibular disorders

The purpose of this study was to clinically evaluate the efficacies of three treatment methods and to compare their outcomes in patients with painful disc displacement. The study group comprised 45 patients with unilateral temporomandibular disorders who fell into Axis I group II (with limited mouth opening) of the Research Diagnostic Criteria for Temporomandibular Disorders. Magnetic resonance imaging was used for definitive diagnosis. The patients were divided randomly into three groups according to the treatment method: splint therapy, splint therapy with ultrasound-guided arthrocentesis, and splint therapy with low-level laser therapy. Patients were followed up after treatment for 6 months. The groups were compared in terms of pain and functional jaw movements (unassisted mouth opening without pain, maximum unassisted mouth opening, and contralateral movements). At the end of treatment, functional jaw movements were significantly increased while pain values were significantly decreased in all groups (P<0.05). Group 2 had a quicker improvement in terms of mouth opening scores at the end of the first month, and unassisted mouth opening without pain was found to be more than 35 millimetres in all groups at the end of 6 months. All treatment modalities showed effective results on pain and functional jaw movements in the treatment of temporomandibular disorders.

Correction of skeletal class II severe open bite with temporomandibular joint disorder treated by miniscrew anchorage and molar extraction: a case report

BACKGROUND

Little information is available on the treatment of open bite with temporomandibular joint disorder by intrusion of molars using miniscrews.

CASE PRESENTATION

This case report describes a 42-year-old Japanese woman with a skeletal class II severe anterior open bite and temporomandibular joint disorder. The pretreatment magnetic resonance imaging of both temporomandibular joints revealed osteoarthritis and anterior disc displacement without reduction in both temporomandibular joints. A stabilization splint was used before orthodontic treatment and bilateral upper and lower premolars were extracted. Miniscrews were inserted into the palatal region to intrude the maxillary molars and avoid loss of anchorage. The maxillary left first molar was also extracted to improve the molar relationship and the dental midline. Normal overjet and overbite with Angle class I molar relationship were achieved, and the upper and lower midlines coincided. Our patient's teeth continued to be stable and her temporomandibular joint was asymptomatic after a retention period of 2 years.

CONCLUSIONS

Intrusion of molars by miniscrews is available for skeletal class II severe open bite.

Temporomandibular Disorders Clinical and Anatomical Outcomes After Fat-Derived Stem Cells Injection

Temporomandibular disorders (TMD) are common disorders that usually involve temporomandibular joint (TMJ), masticatory muscles, and other relevant structures. The symptoms may vary limiting the patients' quality of life. Many treatment options were proposed during the last years with the aim to treat the pathology. In this article, we analyze the effect of the injection of the fat-derived stem cell in the joint as a new treatment option.

Temporomandibular joint disc displacement with reduction: a review of mechanisms and clinical presentation

Disc displacement with reduction (DDWR) is one of the most common intra-articular disorders of the temporomandibular joint (TMJ). Factors related to the etiology, progression and treatment of such condition is still a subject of discussion. This literature review aimed to address etiology, development, related factors, diagnosis, natural course, and treatment of DDWR. A non-systematic search was conducted within PubMed, Scopus, SciELO, Medline, LILACS and Science Direct using the Medical Subjective Headings (MeSH) terms “temporomandibular disorders”, “temporomandibular joint”, “disc displacement” and “disc displacement with reduction”. No time restriction was applied. Literature reviews, systematic reviews, meta-analysis and clinical trials were included. DDWR is usually asymptomatic and requires no treatment, since the TMJ structures adapt very well and painlessly to different disc positions. Yet, long-term studies have shown the favorable progression of this condition, with no pain and/or jaw locking occurring in most of the patients.

The efficacy and limitations of USI for diagnosing TMJ internal derangements

INTRODUCTION

This study was conducted to determine the effectiveness of ultrasonographic imaging for diagnosing temporomandibular joint internal derangements.

MATERIALS AND METHODS

Ultrasonographic and magnetic resonance imaging scans of temporomandibular joints were obtained bilaterally in 55 patients who had temporomandibular joint disorders and who were diagnosed with temporomandibular joint internal derangements following a clinical examination. Diagnostic accuracy of ultrasonographic imaging was assessed considering magnetic resonance imaging as the gold standard method.

RESULTS

When the results of ultrasonographic imaging and magnetic resonance imaging were compared, the diagnostic accuracy of ultrasonographic imaging was 0.81 for detecting TMJ disc displacement. The diagnostic accuracy of ultrasonographic imaging in detecting TMJ disc position was 0.81 in the closed-mouth position and 0.93 in the open-mouth position.

CONCLUSION

As a noninvasive and reproducible imaging method acquiring dynamic images, ultrasonographic imaging is a successful method in the evaluation of temporomandibular joint disc displacement.

Prevalence and correlations of temporomandibular disorders in Northern Jordan using diagnostic criteria axis I

AIM

The aim of the present study was to document the prevalence and possible correlations of temporomandibular disorders (TMD) in a sample of participants from Northern Jordan.

METHODS

A total of 368 adult participants were consecutively selected from visitors to a major health facility in Northern Jordan and examined according to the diagnostic criteria (DC) for TMD (DC/TMD) protocol. Patients with conditions that could interfere with TMD diagnosis were excluded. Pearson correlation and analysis of variance statistical tests were applied. Statistical significance was set at P ≤ 0.05, with a 95% confidence interval.

RESULTS

A total of 98 patients (26.7%) had 1 TMD diagnoses; 60 participants (16.3%) had a pain-related TMD diagnosis, 48 (13%) had intra-articular joint disorders (IAD), and 16 had both pain-related TMD and IAD. In addition, six (1.6%) participants were found to have degenerative joint disease. Females were found to have a higher prevalence of pain-related TMD diagnoses (r = 0.111, P = 0.034) and headache (r = 0.129, P = 0.013) than males. Clicking was positively related to both pain-related TMD (r = 0.154, P = 0.003) and IAD (r = 0.576, P = 0.000).

CONCLUSION

The frequency of TMD and related features was reported in a Northern Jordanian population using DC/TMD for the first time, and the results are comparable to other populations in similar study settings.

Evaluation of effusion and articular disc positioning after two different arthrocentesis techniques in patients with temporomandibular joint disc displacement without reduction

OBJECTIVE

To evaluate joint effusion and positioning of the articular disc through magnetic resonance imaging (MRI) before and after two different arthrocentesis techniques.

METHODS

Twenty-six patients with dislocation of the articular disc without reduction (ADDwoR) were included and randomly divided into two groups: single needle arthrocentesis with distention of the upper compartment of the TMJ (A1) and conventional arthrocentesis with 2 needles (A2).

RESULTS

A statistically significant difference was observed between the different effusion categories (p = 0.009). No differences were found comparing both treatment modalities concerning the position of the mandibular condyle and the articular disc.

CONCLUSION

Conventional arthrocentesis was able to change the effusion variable, whereas the single needle arthrocentesis was not. Both techniques were responsible for altering the position of the mandibular head or the disc-head complex, projecting them to a more anterior position related to the increase in the final maximum interincisal distance.

Is the Anchored Disc Phenomenon a Truly Distinct Entity? A Systematic Review

PURPOSE

This review aimed to examine whether the anchored disc phenomenon (ADP) is truly a distinct entity, independent of the closed-lock condition attributed to nonreducible disc displacement.

MATERIALS AND METHODS

Clinical and/or diagnostic imaging studies addressing the anchored disc or ADP were considered. Articles eligible for inclusion were written in English; were conducted in humans; showed, in their titles or abstracts, any of the keywords used in the search method; included some type of disc imaging system; and related disc mobility to disc position. Of 18 potentially relevant articles, 10 were included.

RESULTS

Of the studies, 9 used magnetic resonance imaging and 1 used double-contrast cone-beam computed tomography. In 1,691 joints, 270 discs (16%) were shown to be anchored in a normal (41%) or displaced (59%) position. Of 149 displaced anchored discs, 52 were reducible and 97 were nonreducible. Intra-articular adherences, synovitis, and adhesions were common arthroscopic findings in patients with the ADP.

CONCLUSIONS

The temporomandibular joint anchored disc shown by disc imaging systems is worthy of inclusion in the existing categories of temporomandibular joint internal derangement. Classification of the ADP as a distinct entity still awaits a consensual definition of the problem, validation of the underlying hypothesis, and clarification of the natural history of the phenomenon.

The Efficiency of Anterior Repositioning Splints in the Management of Pain Related to Temporomandibular Joint Disc Displacement with Reduction

Background and Objective

Intra-articular temporomandibular disorders are often related to pain in the area of the temporomandibular joint, ear, and temple. The aim of the study was to investigate the efficiency of anterior repositioning splints in decreasing pain related to temporomandibular joint disc displacement with reduction.

Methods

The research material consisted of 112 patients, aged 24 to 45 years, of both genders, who reported for treatment at the Consulting Room of Temporomandibular Joint Dysfunctions at the Jagiellonian University in Cracow between 2014 and 2016 due to pain in the area of the temporomandibular joint(s) and noise(s) of temporomandibular joint(s) present during jaw movements with comorbid contracture of masticatory muscles. Subjects were examined according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol and, after diagnosis of painful disc displacement with reduction and masticatory muscle contracture, they were assigned randomly to either the study or control groups (56 patients in each). In the study group, we used an anterior repositioning splint on the full lower arch for about 20 hours usage over a 4-month period. In the control group, a noninvasive therapy was applied using a biostimulation laser over 12 sessions performed every second day on the area of both temporomandibular joints with mouth open and while performing muscle self-exercises with a dominant protrusive position of the mandible. Pain intensity was evaluated using the Verbal Numerical Rating Scale (VNRS) immediately before the treatment and then after 4 and 16 weeks. The obtained data were analyzed using the Mann–Whitney U test (p ≤ 0.005).

Results

The VNRS values reported during the final examination for the study group were significantly lower than for the control group (p=0.0004).

Conclusions

The anterior repositioning splint is an efficient tool in decreasing pain related to disc displacement with reduction. This trial is registered with Clinicaltrials.gov NCT03057262.

Expression of chemerin in the synovial fluid of patients with temporomandibular joint disorders

The synovial membrane and fluid are significantly involved in the pathogenesis of temporomandibular joint (TMJ) disorders. This study aimed to investigate the relation between levels of chemerin in the synovial fluid (SF) of patients with TMJ disorder and their relationship. Sixty samples of SF were obtained from patients with an internal derangement (ID) or osteoarthritis (OA). Chemerin in the SF was examined by enzyme-linked immunosorbent assay (ELISA). The results showed greater levels of chemerin in the SF of patients with OA than ID. While chemerin levels were positively correlated with pain scores, they were inversely correlated with MMO. Chemerin levels increased progressively as the disorder stage became more severe. The findings of this study suggest that chemerin in SF may play role as a predisposing factor and may represent a novel potential prognostic biochemical marker in the pathogenesis of TMJ disorders.

Changes in temporomandibular joint spaces after arthroscopic disc repositioning: a self-control study

Disc repositioning is a common procedure for patients with anterior disc displacement (ADD). The purpose of this retrospective record-based study was to evaluate changes in the widths of joint spaces and condylar position changes in patients with unilateral ADD following arthroscopic disc repositioning, with the healthy sides as self-control, using magnetic resonance images (MRI).Widths of anterior, superior, and posterior joint spaces (AS, SS, and PS) were measured. The condylar position was described as anterior, centric or posterior, expressed as . Paired-t test and Chi-square test were used to analyze the data. Fifty-four records conformed to the inclusion criteria (mean age of 21.02 years). Widths of SS and PS increased significantly after surgery (P < 0.001) on the operative sides, while joint spaces of healthy sides and AS of operative sides had no significant changes. Dominant location of condyles of operative sides changed from a posterior position to an anterior position, while healthy sides were mostly centric condylar position no matter preoperatively or postoperatively. Therefore, the results of this study indicate that unilateral arthroscopic disc repositioning significantly increases the posterior and superior spaces of the affected joints, without affecting spaces of the healthy sides.

Correlation between temporomandibular joint morphology and disc displacement by MRI

OBJECTIVES

The aim was to evaluate the morphology of the temporomandibular joint's (TMJs) disc and condyle as well as its correlation with disc displacement, using MRI.

METHODS

190 TMJs were retrospectively analysed. The condyle morphology of each TMJ was evaluated by two observers using both axial and coronal views, as were their disc morphology and displacement, using sagittal view. Condyle morphology was classified as flat, convex, angled or rounded in the coronal sections and as anterior side flat/posterior side convex, biconvex, anterior side concave/posterior side convex, flat or biconcave in the axial view. Disc morphology was determined as biconcave, biplanar, biconvex, hemiconvex or folded. χ2, Fisher exact and Bonferroni correction tests were used to evaluate the data. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between age and disc displacement.

RESULTS

Anterior disc displacement with reduction; convex condyle morphology in the coronal view; anterior side concave/posterior side convex morphology in the axial view; and biconcave discs were found to be the most prevalent findings. An association was observed between disc morphology and disc displacement (p<0.001). No correlation between condyle morphology and TMJ disc displacement was found (p=0.291 for axial and p=0.14 for coronal views).

CONCLUSIONS

The results of this study suggest that TMJ disc morphology is associated with disc displacement.

TMJ Disc Displacement without Reduction Management: A Systematic Review

Various interventions have been used for the management of patients with temporomandibular joint (TMJ) disc displacement without reduction (DDwoR), but their clinical effectiveness remains unclear. This systematic review investigated the effects of these interventions and is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic and manual searches up to November 1, 2013, were conducted for English-language, peer-reviewed, publications of randomized clinical trials comparing any form of conservative or surgical interventions for patients with clinical and/or radiologic diagnosis of acute or chronic DDwoR. Two primary outcomes (TMJ pain intensity and maximum mouth opening) and a number of secondary outcomes were examined. Two reviewers performed data extraction and risk of bias assessment. Data collection and analysis were performed according to Cochrane recommendations. Twenty studies involving 1,305 patients were included. Data analysis involved 21 comparisons between a variety of interventions, either between interventions, or between intervention and placebo or no intervention. Meta-analysis on homogenous groups was conducted in 4 comparisons. In most comparisons made, there were no statistically significant differences between interventions relative to primary outcomes at short- or long-term follow-up (p > .05). In a separate analysis, however, the majority of reviewed interventions reported significantly improved primary outcome measures from their baseline levels over time (p < .05). Evidence levels, however, are currently insufficient for definitive conclusions, because the included studies were too heterogeneous and at an unclear to high risk of bias. In view of the comparable therapeutic effects, paucity of high-quality evidence, and the greater risks and costs associated with more complex interventions, patients with symptomatic DDwoR should be initially treated by the simplest and least invasive intervention.

Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of 'locking duration'

Temporomandibular joint (TMJ) 'closed lock' (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be 'acute' or 'chronic' depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid-August 2013 were conducted for English-language studies of any design investigating the effects of non-surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor-quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high-quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by 'unlock' mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.

Posteroanterior cephalometric changes in subjects with temporomandibular joint disorders

OBJECTIVES

The aim of the study was to establish the changes in posteroanterior cephalometric variables in subjects with temporomandibular joint disorders (TMDs).

METHODS

Posteroanterior cephalograms of 61 subjects (age range 16-36.6 years, standard deviation 4.88 years) were used to determine cephalometric differences. Subjects were classified according to the Research Diagnostic Criteria for Temporomandibular Joint Disorders into three groups: unilateral TMD, bilateral TMD and no TMD. 14 linear and angular measurements were assessed on the posteroanterior cephalogram. For assessing facial asymmetry, the asymmetry index for bilateral measurements was calculated between the right and the left side. In cases with unilateral TMD, the asymmetry index was calculated using the difference between the unaffected and affected side. The differences among multiple groups were analysed using the one-way analysis of variance test and Scheffé post hoc test.

RESULTS

47 subjects were females (77%) and 14 were males (23%). 19 subjects had unilateral TMDs and 16 subjects had bilateral TMDs. The asymmetry index of the distance from the horizontal plane to the antegonion was higher in subjects with unilateral TMD than in patients with bilateral or no TMD (p < 0.05). Also, the asymmetry index of the distances from the vertical plane to the condyle (p = 0.05), gonion (Go) (p = 0.0004), antegonion (p = 0.002) and chin (Ch) (p = 0.02) was higher in subjects with unilateral TMDs. The asymmetry index of the O point-Go-Go' and O point-Ch-Ch' angles differed significantly in subjects with unilateral TMDs (p < 0.05).

CONCLUSIONS

Unilateral TMDs are associated with changes in posteroanterior cephalometric measurements. The assessment of posteroanterior cephalometric variables could be used as a key factor for evaluating the presence of TMDs.

The comparison of outcomes of surgically treated bilateral temporomandibular joint disorder in different groups: a retrospective study

Objectives: The main purpose of this study was to determine the prognosis and outcomes of the patients with bilateral temporomandibular disorder which underwent bilateral temporomandibular joint surgery in a consecutive number of patients in a retrospective study. Study Design: Sixty five patients with 130 bilateral TMJ were included the study with the selection from consecutive 256 TMJ patients who were treated with open surgery who do not respond to conservative treatment. 65 patients were divided in to 3 main groups according to the clinical diagnosis of bilateral TMJ site. In the first group comprised 29 patients with 48 TMJ, the clinical diagnosis was bilaterally presence of anterior disc displacement with reduction (ADDR). In the second group comprised 19 patients with 26 TMJ, bilateral presence of TMD consisted of anterior disc displacement without reduction (ADDNR) on both site. In the third group comprised 27 patients with 46 TMJ, bilaterally presence of TMD consist of ADDR on one site and ADDNR on another site. The patients in three different groups were operated either high condylectomy alone or high condylectomy with additional surgical procedures. Results: In the evaluation of pain relief, clicking, crepitation, headache, marked improvement was determined in all groups, but it was statistically insignificant in the comparison of 3 groups. Slight increase in maximal mouth opening was determined in the mean values of the 3 groups and also in the comparison of 3 groups it was not statistically significant. Conclusions: These similar succesfull outcomes of bilateral TMD with the respect of TMJ surgical procedures were obtained in 3 main groups although different diagnosis on the patients’ groups waspresent.

Key words:Temporomandibular joint, prognosis, retrospective studies.

Application of cone beam computed tomography for assessment of the temporomandibular joints

Radiographic examination is essential for the diagnosis and management of temporomandibular joint (TMJ) disorders. The goals of TMJ radiography are to evaluate cortical and trabecular architecture of the bony structures and confirm their integrity, to assess the extent and monitor progression of osseous changes, and to evaluate the response to treatment. Accurate evaluation of the TMJ by conventional radiography is limited by structure superimposition. Cone beam computed tomography (CBCT) provides high-resolution multiplanar images and delivers substantially lower radiation dose, compared with multislice CT. CBCT allows examination of TMJ anatomy without superimposition and distortion to facilitate analysis of bone morphology, joint space and dynamic function in all three dimensions. This article will describe the role of CBCT imaging for the assessment of the TMJ osseous structures and present typical appearances of common pathological conditions of the TMJ.

Disfonia e disfunção temporomandibular: há relação?

OBJETIVO: verificar se existe relação entre disfonia e disfunção temporomandibular (DTM). MÉTODOS: este estudo foi realizado com 21 indivíduos, do gênero feminino, com faixa etária variando entre 18 - 27 anos, que não referiram sintomas de DTM, antes de serem apresentados ao questionário de triagem e, após o mesmo terem apresentado pelo menos um sintoma. Foram excluídos os indivíduos que não concordaram com o termo da pesquisa, não concluíram o protocolo de coleta de dados e os que apresentaram história de traumas e/ou cirurgia de face. A seleção dos sujeitos ocorreu de forma não probabilística por conveniência, utilizando-se pacientes que foram submetidos à triagem da Clínica Prof. Jurandir Bóia Rocha da Faculdade de Fonoaudiologia de Alagoas apresentando como queixa alterações vocais, levando em consideração os critérios de inclusão. Foram realizadas as seguintes avaliações: Fonoaudiológica (perceptivo-auditiva da Voz e específica para DTM) e Odontológica. Após os dados obtidos serem caracterizados com a utilização de técnicas de estatística descritiva, foi aplicado o Teste de correlação bivariada. Os cálculos foram obtidos através do software SPSS, na versão 16.0. RESULTADOS: dos indivíduos com DTM: 46,15% (N=6) apresentaram qualidade de voz soprosa; 30,76% (N=4) articulação travada; 23,07% (N=3) loudness reduzida e 23,07% (N=3) com ressonância alterada. CONCLUSÃO: não houve correlação entre alterações vocais e disfunção temporomandibular, provavelmente devido ao número reduzido de sujeitos avaliados.