Soft-Tissue Temporomandibular Joint Trauma

Abstract

Arthroscopy, various imaging modalities, histologic studies, and clinical reviews lend support to TMJ soft-tissue injury during direct and indirect mandibular trauma. MR imaging has shown that disc displacement as well as joint effusion and soft-tissue edema are common in association with mandibular trauma (with or without fracture). In contrast, arthroscopy has shown some of the intraarticular pathologic conditions and joint effusion associated with trauma but has not described disc displacement as a major event. The arthroscopy reports also contrast the reported clinical findings of disc displacement found at the time of open reduction internal fixation of condylar fracture dislocations.8 Unfortunately, the subject of soft-tissue TMJ injury has not been well described in the literature and no well-conducted prospective studies have elucidated the proper treatment and diagnostic algorithms for this disorder. Questions remain regarding early arthroscopy or arthrocentesis to irrigate the joint space, the necessity of early joint mobilization with combined open reduction internal fixation and disc repositioning procedures, or even whether to perform MR imaging of the TMJ in the acute setting or in cervical whiplash patients. These concerns can be addressed only with further research and well-controlled studies. In the meantime, practitioners must be continually aware of the potential for soft-tissue TMJ injuries in the face of direct and indirect mandibular and facial trauma.