Evaluating the Effect of Conservative Therapy in Patients with Wilkes Stage III Temporomandibular Joint Derangement.

Vladimír Machoň,René Foltán,J Levorová ,Milan Drahoš,Dušan Hirjak,Michal Beňo

doi:10.14712/23362936.2021.24

Abstract

The authors evaluated effects of physiotherapy in patients experiencing Wilkes III temporomandibular joint (TMJ) derangement with clinically limited joint mobility, but no pain. The group consisted of 31 patients with unilateral temporomandibular joint involvement, 3 men and 28 women (average age was 30.93, ranging from age 12 to 61). None of the patients in the group had experienced any previous TMJ therapy. The patients underwent conservative therapy in the form of home exercise (mobilisation and isometric exercises) as the first step in treatment. The authors evaluated the improvement in jaw movement (maximal interincisal opening - MIO) and the patients' subjective assessments of their condition. Disc position before and after two months of exercise was also evaluated using ultrasound examination. The average MIO value in patients before starting the exercises was 33.5 mm, and after two months of exercises, 42.4 mm. Subjective assessment by patients: 26 patients (83%) described their condition as completely satisfactory, not requiring further therapy. Of these patients, ultrasound examination showed 10 patients with complete disc reduction, 9 patients with a change in disc displacement with reduction, and 7 patients with a continuing (unchanged) state of disc displacement. Results of our study show the effect of conservative therapy in patients with painless TMJ due to disc displacement (WIII). Effect of home exercises which were easy to perform, simple and acceptable to the patient were demonstrated.

Highlights

Wilkes stage III (WIII) is a term for an intra-articular disorder of the temporomandibular joint (TMJ) which clinically manifests as limited jaw mobility, blocked jaw movement, frequent pain, joint tenderness and headache
Physiotherapy is an integral part of conservative therapy for temporomandibular joint disorders (TMD), as is the use of occlusal splints or drug therapy
Evaluation of patients before the commencement of home physiotherapy: The average MIO value was 33.5 mm, with jaw movement deviating to the affected side in all cases, while acoustic phenomena and pain were not recorded in any case

Summary

Introduction

Wilkes stage III (WIII) is a term for an intra-articular disorder of the temporomandibular joint (TMJ) which clinically manifests as limited jaw mobility, blocked jaw movement, frequent pain, joint tenderness and headache. WIII is characterised by disc displacement without reduction and thinning-deformation of the disc. Treatment of WIII is usually conservative (non-surgical). Physiotherapy is an integral part of conservative therapy for temporomandibular joint disorders (TMD), as is the use of occlusal splints or drug therapy. In the case of disc displacement without reduction, the main treatment option is physiotherapy with manual manipulation, especially in acute cases, and muscle massage, relaxation (in the presence of muscle spasm), muscle exercises (passive muscle stretching, assisted muscle stretching, resistance exercises) (Okeson, 2008)

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