Arthrographic evaluation of disk position following mandibular manipulation technique for internal derangement with closed lock of the temporomandibular joint.

The mandibular manipulation technique is widely used and is considered acceptable conservative therapy for an acute closed lock of the temporomandibular joint. However, there are no studies that prove objective morphologic assessment of this method in patients with unlocked disks. In this study, preoperative and postoperative arthrograms were evaluated to clarify the disk position in patients for whom successful mandibular manipulation was carried out. Postoperative arthrograms in 30 closed lock joints revealed that three joints were normal (complete reduction), eight had anterior disk displacement with reduction (click), 15 had partial reduction at the maximum mouth opening position, and four had anterior disk displacement without reduction. Disk mobility increased with improved condylar translation in all joints. These results indicate that complete anatomic reduction of the disk by mandibular manipulation is difficult, but also that clinical symptoms do not always correspond to how well the disk has been reduced by this treatment. Increasing disk mobilization might be effective treatment for patients with closed lock of the temporomandibular joint.