Magnetic Resonance Imaging Of Temporomandibular Joint Research Articles

Clinical and Magnetic Resonance Imaging Findings of the Temporomandibular Joint in Patients With Rheumatoid Arthritis

BackgroundThe aim of this study is to evaluate temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis by magnetic resonance imaging (MRI), jaw clenching force, mouth opening, and Fonseca’s questionnaire, and to establish the relationship between these findings and clinical, radiologic, and laboratory activity parameters that are unique to rheumatoid arthritis.MethodsIncluded in the study were 30 RA patients and 30 healthy volunteers. Jaw clenching force of the entire cases was measured with Istanbul Bite Force Recorder (kg) and the mouth opening was measured with a ruler (cm). Additionally, hand grip forces of patients with rheumatoid arthritis were measured with hand dynamometer (kg). Hand and feet graphs and TMJ MRIs of patients were obtained. MRI findings were classified as normal, mild, medium, and severe. DAS28 and sharp scores of patients were estimated. Sedimentation rate (ESR), C-Reactive protein (CRP) and rheumatoid factor (RF) were checked in the patient group and Fonseca’s questionnaires were filled in.ResultsA significant difference was not observed between age, gender, and level of education of the groups. Jaw clenching force and mouth opening were established as significantly low in RA group compared to the control group (P < 0.001). A significant correlation was found between jaw clenching force, hand grip force, mouth opening, questionnaire, and MRI findings with the disease duration sharp score, DAS28, and hand grip force of the RA group (P < 0.05). However, a significant correlation was not established with ESR, CRP, and RF (P < 0.001).ConclusionsJaw clenching force, mouth opening, and Fonseca’s questionnaire can be used as parameters pointing to TMJ involvement in patients with RA. Yet, further studies in which TMJ involvement is followed up since the onset of the disease are of necessity.

MAGNETIC RESONANCE IMAGING FEATURES OF THE TEMPOROMANDIBULAR JOINT IN NORMAL DOGS

Evaluation of the canine temporomandibular joint (TMJ) is important in the clinical diagnosis of animals presenting with dysphagia, malocclusion and jaw pain. In humans, magnetic resonance imaging (MRI) is the modality of choice for evaluation of the TMJ. The objectives of this study were to establish a technical protocol for performing MRI of the canine TMJ and describe the MRI anatomy and appearance of the normal canine TMJ. Ten dogs (one fresh cadaver and nine healthy live dogs) were imaged. MRIs were compared with cadaveric tissue sections. T1-weighted (T1-W) transverse closed-mouth, T1-W sagittal closed-mouth, T1-W sagittal open-mouth, and T2-W sagittal open-mouth sequences were obtained. The condylar process of the mandible and the mandibular fossa of the temporal bone were hyperintense to muscle and isointense to hypointense to fat on T1-W images, mildly hyperintense to muscle on T2-W images, and were frequently heterogeneous. The articular disc was visible in 14/20 (70%) TMJs on T1-W images and 13/20 (65%) TMJs on T2-W images. The articular disc was isointense to hyperintense to muscle on T1-W images and varied from hypointense to hyperintense to muscle on T2-W images. The lateral collateral ligament was not identified in any joint. MRI allows evaluation of the osseous and certain soft tissue structures of the TMJ in dogs.

Spectrum of magnetic resonance imaging appearances of juvenile temporomandibular joints (tmj) in non-rheumatic children

Temporomandibular joints (TMJ) are frequently involved in children with juvenile idiopathic arthritis (JIA), and gadolinium-enhanced magnetic resonance imaging (MRI) is the only modality for an early diagnosis. However, only very few data exist on the appearance of contrast-enhanced MRI of normal juvenile TMJ. To define the spectrum of normal MRI findings of juvenile TMJ, and to assess a possible overlap with findings typical for active synovitis in JIA. 96 children (192 TMJ), 51 boys and 45 girls with a median age of 7.8 years (range 3-13 years), underwent a head MRI. The presence of autoimmune disease, including JIA, was excluded via chart history, available laboratory findings, and the absence of known typical pathological MRI changes (degree of synovial enhancement, hyperintense signal on T2-weighted images in the synovia or bone marrow, and morphologic changes of the mandibular condyle) of the TMJ affected by JIA. In 90 (94%) children, the TMJ showed no MRI abnormalities compatible with arthritis. In three children (3%), the only abnormal MRI finding was a small bilateral joint effusion. A further three children (3%) had a mild synovial enhancement seen on both axial and coronal MR planes in one child and only in the axial plane in the other two children. Signal hyperintensity on T2-weighted images and other corresponding characteristics of TMJ inflammation were lacking in all these six patients. The vast majority of juvenile TMJ in non-rheumatic children shows no MRI abnormalities. Exceptions, including a discrete enhancement of the synovial membrane (3%) or small joint effusions (3%), can occur in a minority of patients, but none of them are accompanied by other signs of inflammation or morphological changes of the TMJ.

Magnetic resonance imaging of the condylar growth pattern and disk position after chin cup therapy: a preliminary study.

This study was conducted on lateral cephalograms and magnetic resonance images (MRIs) obtained from 20 subjects with Class III malocclusion. Only clinically temporomandibular joint (TMJ) symptom-free subjects were included in this study. In the treatment group, a chin cup with 600 g of force was applied in 13 patients (10 girls and three boys) with a mean age of nine years. The chin cup was applied in a direction from the chin toward the TMJ. The control group consisted of seven patients (six girls and one boy) with a mean age of eight year nine months. Orthodontic treatment was not applied in the control group. Records were taken at the beginning and end of chin cup therapy from all the subjects. Measurements were made on lateral cephalograms and unilateral-left sagittal-oblique TMJ MRIs. Variables obtained at the beginning and end of the study were compared by Student's t-tests and paired t-tests. Relationships between craniofacial and TMJ variables were analyzed by correlation analysis. The mandibular corpus length was increased and condylar head angle was decreased by chin cup therapy. A positive correlation existed between activation of sagittal maxillary and mandibular growth and bending of the condylar head. This study showed that the condylar growth pattern was altered by chin cup. It may be implied that the source of improvement is adaptation of the craniofacial structures to the changes of the condylar growth pattern produced by the chin cup.

Effects of symphyseal distraction osteogenesis on the temporomandibular joint seen with magnetic resonance imaging and computerized tomography

The aim of this case report was to evaluate the effect of symphyseal distraction osteogenesis on the position of the mandibular condyle and the disc of an asymptomatic adolescent patient by using magnetic resonance imaging and computerized tomography. A 15-year-old girl with severe maxillary and mandibular dental crowding was treated with a Haas-type banded maxillary expansion appliance and symphyseal distraction osteogenesis with a Hyrax-type tooth-borne distractor, respectively. Lateral cephalometric and panoramic radiographs, dental casts, and extraoral and intraoral photographs were obtained before and after treatment in addition to temporomandibular joint magnetic resonance imaging and computerized tomography scans. This patient was treated successfully. The distraction osteogenesis produced inconspicuous rotation of the mandibular condyles with an unchanged position of the disc as determined by the imaging and scans of the temporomandibular joint.

MRI of TMJ in Patients with Severe Skeletal Malocclusion Following Surgical/Orthodontic Treatment

The aim of this study was to evaluate temporomandibular joints (TMJ) by magnetic resonance imaging (MRI) in patients who had undergone surgical/orthodontic or orthodontic treatment in a three-year follow-up study. Subjects consisted of 20 patients (40 TMJ), 16 females and four males (mean age 33.7 years, range 19-53 years), with severe temporomandibular disorders (TMD) referred to the Oral and Maxillofacial Department at Oulu University Hospital due to skeletal jaw discrepancy. All patients underwent extensive surgical/orthodontic or orthodontic treatment between 1996 and 2003. Clinical stomatognathic examination and MRI examinations were performed before the surgical/orthodontic or orthodontic treatment and one year after the completion of the treatment. The average treatment time was 23 months (range 12-34 months). MRI revealed a marked decrease, especially in the number of TMJ with joint effusion after the treatment. There were only a few changes in the number of diagnosed disk dislocations before and after the treatment. In five joints with anterior disk dislocation with reduction (r-ADD), a change to anterior disk dislocation without reduction (nr-ADD) was found. In 25 of the 40 condyles, the condylar configuration was normal on MRI before the treatment and in 19 condyles one year after the treatment. TMD signs and symptoms according to the Helkimo dysfunction index showed a statistically significant decrease after the treatment.

Binocular motility system and temporomandibular joint internal derangement: A study in adults

Ocular convergence defects have been confirmed in adults with temporomandibular joint (TMJ) dysfunction, but few studies of the relationship of the oculomotor apparatus to TMJ disc displacement have been reported. The purpose of this study was to examine the impact of disc displacement on the oculomotor capacity of the eyes in adults. Fifty symptomatic patients with bilateral TMJ disc displacement (13 men, 37 women; mean age, 28.84 +/- 8.22 years; range, 18-40 years) were compared with the same number of asymptomatic volunteers with normal disc position (14 men, 36 women; mean age, 29.96 +/- 5.04 years; range, 18-37 years). All subjects underwent standardized clinical examinations, bilateral TMJ magnetic resonance imaging, and sensorial and motor orthoptic tests by an orthoptist. Subjects with TMJ disc displacement had alterations in binocular function, including reductions in convergence (P <0.023) and positive fusional vergence (break point [P <0.046] and recovery point [P <0.045]) compared with those with normal disc positions. Significant alternations in binocular function were seen in patients with TMJ disc displacement compared with healthy control subjects.

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OBJETIVO: esta revisão de literatura visa avaliar, através de literatura específica, a sensibilidade e especificidade do exame de ressonância magnética (RM) para o diagnóstico dos desarranjos internos da articulação temporomandibular (ATM). METODOLOGIA: tanto artigos que utilizaram ATM de cadáveres para comparar achados anatômicos aos achados de ressonância magnética (RM), como artigos que compararam achados clínicos com achados de RM foram utilizados. Através dos achados desses artigos, as propriedades de sensibilidade e especificidade da RM para o diagnóstico de desarranjos internos da ATM foram calculadas. Com isso, a confiabilidade e a aplicabilidade do exame de RM no diagnóstico dos desarranjos internos da ATM foram discutidas. RESULTADOS: encontrou-se sensibilidade de 90% e especificidade de 88% da RM para desarranjos internos da ATM. CONCLUSÃO: o exame de RM de ATM possui ótima sensibilidade e especificidade para o diagnóstico dos desarranjos internos da ATM. Porém, tal exame deve ser solicitado com cautela, apenas nos casos onde a imagem seja indispensável para o plano de tratamento.

Evaluation of TMJ articular eminence morphology and disc patterns in patients with disc displacement in MRI

The aim of this study was to assess the shape of the temporomandibular joint (TMJ) articular eminence and the articular disc configuration and position in patients with disc displacement. TMJ magnetic resonance images (MRI) of 14 patients with bilateral disc displacement without unilateral reduction were analyzed. Articular eminence morphology was characterized as box, sigmoid, flattened, or deformed. Articular disc configuration was divided into biconcave, biplanar, biconvex, hemiconvex or folded, and its position, as "a" (superior), "b" (anterosuperior), "c" (anterior) or "d" (anteroinferior). The images were divided and the sides with disc displacement with reduction (DDWR) and without reduction (DDWOR) were compared. Regarding articular eminence shape, the sigmoid form presented the greatest incidence, followed by the box form, in the DDWR side, although this was not statistically significant. In the DDWOR side, the flattened shape was the most frequent (p = 0.041). As to disc configuration, the biconcave shape was found in 79% of the DDWR cases (p = 0.001) and the folded type predominated in 43% of the DDWOR cases (p = 0.008). As to disc position, in the DDWR side, "b" (anterosuperior position) was the most frequent (p = 0.001), whereas in the DDWOR side, "d" (anteroinferior position) was the most often observed (p = 0.001). The side of the patient with altered disc configuration and smaller shape of TMJ articular eminence seems to be more likely to develop non-reducing disc displacement as compared to the contralateral side.

Orthodontic Effects on Dentofacial Morphology in Women with Bilateral TMJ Disk Displacement

To determine the difference in skeletal response to orthodontic treatment between patients with bilateral disk derangement and normal disk position of the temporomandibular joint (TMJ). Subjects consisted of 46 women whose malocclusions were treated only by orthodontics. All patients had TMJ magnetic resonance imaging (TMJ MRI) taken prior to orthodontic treatment. They were classified into three groups according to results of the TMJ MRI: bilateral normal disk position (BN), bilateral disk displacement with reduction (BDDR), and bilateral disk displacement without reduction (BDDNR). Twenty cephalometric variables were evaluated by the Kruskal-Wallis test to identify any differences in morphological changes between the three groups during orthodontic treatment. This study showed that patients with BDDNR had more severe sagittal and vertical skeletal discrepancies than those with BN and BDDR at the pretreatment stage with discrepancies maintained after treatment. Compared to patients with BN, BDDR patients exhibited significant changes in SNB, N perpendicular to pogonion, SN to mandibular plane angle, total anterior facial height, ramus inclination, and effective mandibular length during treatment. This means that patients with BDDR showed more backward movement and rotation of the mandible than those with BN. In contrast, patients with BDDNR who had the most severe skeletal discrepancies did not show any significant skeletal changes during orthodontic treatment compared to those with BN or BDDR. In patients with bilateral TMJ disk displacement, orthodontic treatment should be undertaken carefully to prevent backward rotation and movement of the mandible.

Image-Guided Minimally Invasive Surgical Access to the Temporomandibular Joint: A Preliminary Report

To establish a protocol for image-guided minimally invasive surgical access to the temporomandibular joint (TMJ). This study involved 2 patients with TMJ pain and mandibular motion dysfunction. Axial magnetic resonance imaging (MRI) of the TMJ was obtained and loaded into an intra-operative navigation system to guide joint space injection. With a navigated syringe, 1 mL synvisc Hylan G-F 20 was directly injected into the superior and inferior joint spaces under navigation guidance. With the assistance of an intraoperative navigational system, the TMJ MRI images were visualized in 3 dimensions and enabled guiding a needle into the superior and inferior joint spaces for therapeutic injection. The treatment outcome for both patients was satisfactory with improvement in pain score and mandibular motion. A protocol for image-guided minimally invasive surgical access to the TMJ was established. This could provide the technical basis for evaluation of accurate joint space intervention as a form of treatment of appropriate TMJ disorders.

The value of three-dimensional computed tomography in diagnosis and management of Jacob's disease

This study reports a case of Jacob's disease characterized with limited mouth opening due to bilateral coronoid hyperplasia forming pseudojoints with zygomatic arches. Magnetic resonance (MR) examination of temporomandibular joint (TMJ) is usually the imaging method chosen in patients with such symptoms. However, the coronoid processes can not be displayed because they are not included in field of view in MR imaging of TMJ. For that reason, these patients may be treated for a misdiagnosis of TMJ disorders. In this study, the aetiology and diagnostic methods of Jacob's disease, the pre-operative/post-operative role of three-dimensional computed tomography and some measurements used in diagnosis were evaluated.

MR of 2270 TMJs: prevalence of radiographic presence of otomastoiditis in temporomandibular joint disorders

Objective : The purpose of this study is to determine the prevalence of radiographic presence of otomastoiditis while examining temporomandibular joint (TMJ) disorders in magnetic resonance images (MRI) in a series of 2270 temporomandibular joint magnetic resonance images and to examine the relationship between otomastoiditis and TMJ disorders. Materials and methods : 2270 temporomandibular joint magnetic resonance images and patients’ data were retrospectively investigated. Magnetic resonance images were obtained from the patients who referred to Osaka University Dental Hospital Outpatient Clinic with TMJ complaints for the last four years (from January 1998 to January 2003). The patients, who were diagnosed as otomastoiditis based on their temporomandibular joint magnetic resonance images, were sent to Osaka University Hospital Department of Otolaryngology for a medical consultation in order to have their pathologies certified following their MR process. Age and sex were recorded for all patients and for otomastoiditis cases; location of the disease, symptoms of patients and TMJ findings were noted as well. Results : Seven patients were diagnosed as acute otomastoiditis and one patient diagnosed as chronic active otitis media with cholesteatoma in the series of 2270 MR, which were representing a prevalence of 0.39%. Neurilemoma diagnosed in left mastoid process in one patient. The final diagnoses of all patients were made after medical consultation. Conclusion : While examining temporomandibular joint magnetic resonance images; it is not only important to examine just the TMJ structures, but also to look at the nearby anatomical features to check evidence for inflammatory disease.

A comparative assessment of mandibular condylar position in patients with anterior disc displacement of the temporomandibular joint

Purpose: The purpose of this study was to determine whether the position of the mandibular condyle in patients with anterior disc displacement (ADD) is different from that of a control group with normal joints using a novel method to quantify the irregular shape of the temporomandibular joint (TMJ). Materials and Methods: Twenty-six magnetic resonance images of TMJs with ADD were evaluated and compared with 14 normal joints. The position of the condyle was determined by using 2 different methods: 1) measuring the horizontal and vertical normalized distances in millimeters between the geometric centers of the glenoid fossa and the condyle and 2) calculating the anteroposterior joint space ratio. Results: Using the first method, the horizontal distance between the centers of the condyle and the glenoid fossa was 14.0 ± 11.1 in the ADD group and 5.3 ± 10.9 in the control group ( P < .001). The vertical distance was 64.7 ± 22.7 in the ADD group and 68.3 ± 32.9 in the control group ( P = .015). The ratio of the horizontal and the vertical condylar displacement in the ADD group was 2.4. Using the second method, the anteroposterior joint space ratios in the ADD group and in the control group were 1.7 ± 0.5 and 1.2 ± 0.4, respectively ( P = .001). Conclusion: This study found that condyles of patients with ADD were situated more posterior and superior in the fossa than those in the control group. Moreover, in the ADD group, the posterior condylar displacement was noted to be 2.4 times greater than the superior condylar displacement.

Correlation between eminence steepness and condyle disc movements in temporomandibular joints with internal derangements on magnetic resonance imaging.

A steep articular eminence is reported to be a predisposing factor for the development of disc displacement. The purpose of this study was to evaluate the biomechanics of the temporomandibular joint (TMJ) in internal derangements and, additionally, to investigate whether a relationship exists between the steepness of the articular eminence and disc displacement, with (DDR) and without reduction (DDWR). The material consisted of the sagittal TMJ magnetic resonance images (MRIs) of 39 joints (26 DDR and 13 DDWR). Sagittal and coronal TMJ MRIs were obtained at maximum inter-cuspation and in the maximum mouth-opening position. The steepness of the articular eminence, disc, and condyle rotation, and condyle translation were investigated. A Student's t-test was performed and correlation coefficients calculated. The results revealed an increase in disc rotation in the DDR group and in condyle translation in the DDWR group (P < 0.01). Condyle rotation and the steepness of the articular eminence were similar in both groups. Disc rotation was positively correlated with condyle rotation and negatively correlated with condyle translation in the DDR group (P < 0.05, r = 0.44). Condyle translation was positively correlated with steepness of the articular eminence in the DDWR group (P < 0.01, r = 0.74). There was no correlation between movements of the disc-condyle assembly and the steepness of the articular eminence in the DDR group. Nevertheless, a relationship between condyle translation and the steepness of the articular eminence was found in the DDWR subjects.

Craniofacial asymmetry and temporomandibular joint internal derangement in female adolescents: a posteroanterior cephalometric study.

Unilateral or bilateral pathology of the osseous components of the temporomandibular joint (TMJ) can result in pronounced facial asymmetry because of dissimilar size and shape of the right and left sides of the mandible. To date, it is unknown whether abnormalities of the soft tissues of the TMJ are associated with greater than normal craniofacial asymmetry. In this study, we investigated the amount of craniofacial asymmetry in female orthodontic patients with unilateral or bilateral TMJ internal derangement (TMJ ID) relative to the amount in female patients without TMJ ID. The total sample consisted of 80 female adolescents. Bilateral TMJ magnetic resonance images were used as a database for objectively scoring the severity of TMJ ID. Craniofacial asymmetry was measured from posteroanterior cephalograms. Females with bilateral TMJ ID had significantly greater asymmetry in the vertical position of the antegonion. If the TMJ ID was more advanced on the right side, the ipsilateral ramus was shorter, resulting in significant asymmetry in this region. In all other craniofacial regions, the amount of asymmetry was not significant between females with normal TMJs and those with TMJ ID. The results indicate that a female orthodontic patient with bilateral TMJ ID or unilateral right TMJ ID may present with or develop a vertical mandibular discrepancy.

Whiplash injuries of the temporomandibular joint in motor vehicle accidents: speculations and facts.

Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.

The influence of observer calibration in temporomandibular joint magnetic resonance imaging diagnosis

Objective. This study was undertaken to investigate the potential of reducing observer variation through a calibration program. Study design. The study was based on three sets of randomly selected temporomandibular joint magnetic resonance images. Each set consisted of bilateral images from 20 consecutive patients with temporomandibular disorders. As a baseline, three well-experienced noncalibrated investigators interpreted the images individually for disk position and disk configuration. After the initial interpretation, interobserver agreement was calculated as a kappa index and presented to the examiners. On the same occasion, the investigators analyzed agreement between them on the criteria to be used. Results. Overall data in this study showed an increase in the frequency of interobserver agreement with regard to disk position after the calibration trials were instituted. With regard to disk configuration, substantial interindividual variations were observed even after the observers reached consensus as to the criteria to be used. Conclusions. These data suggest that after calibration trials, it is possible for three examiners to obtain reliable and reproducible results in reporting temporomandibular joint disk position on magnetic resonance images.

CPSC launches publication on product-related injuries

This retrospective study was designed to analyze the relationships between temporomandibular joint (TMJ) disk displacement and skeletal deformities in orthodontic patients. Subjects consisted of 460 adult patients. Before treatment, lateral cephalograms and TMJ magnetic resonance imaging (MRI) were recorded. Subjects were divided into six groups based on TMJ MRI according to increasing severity of TMJ disk displacement, in the following order: bilateral normal TMJs, unilateral disk displacement with reduction (DDR) and contralateral normal, bilateral DDR, unilateral disk displacement without reduction (DDNR) and contralateral normal, unilateral DDR and contralateral DDNR, and bilateral DDNR. Subjects were subdivided sagittally into skeletal Class I, II, and III deformities based on the ANB (point A, nasion, point B) angle and subdivided vertically into hypodivergent, normodivergent, and hyperdivergent deformities based on the facial height ratio. Linear trends between severity of TMJ disk displacement and sagittal or vertical deformities were analyzed by Cochran–Mantel–Haenszel test. The severity of TMJ disk displacement increased as the sagittal skeletal classification changed from skeletal Class III to skeletal Class II and the vertical skeletal classification changed from hypodivergent to hyperdivergent. There were no significant differences in the linear trend of TMJ disk displacement severity between the sexes according to the skeletal deformities. This study suggests that subjects with skeletal Class II and/or hyperdivergent deformities have a high possibility of severe TMJ disk displacement, regardless of sex.

Long-term follow-up of modified condylotomy for internal derangement of the temporomandibular joint

Objectives: The purpose of this study was to evaluate disk position and patient response 10 years after modified condylotomy for symptomatic reducing disk displacement. Study designs Questionnaires and invitations to return for examination and temporomandibular joint magnetic resonance imaging were mailed to 39 consecutive patients 10 years after modified condylotomy. Results On a 10-point scale the mean pain experienced by the 17 respondents (27 joints) to the questionnaire was 2.0. Ninety percent of 20 joints (12 patients) examined were free of tenderness to palpation. Magnetic resonance imaging in 10 patients (17 joints) showed disk reduction in 59%, displacement with reduction in 29%, and displacement without reduction in 12%. Eighty-five percent of the joints met American Association of Oral and Maxillofacial surgeons criteria for a successful therapeutic outcome. Conclusions The study suggests a role for modified condylotomy in the long-term management of symptoms associated with reducing disk displacement. Further, modified condylotomy can frequently reverse an internal derangement and seems to protect against the natural progression of osteoarthrosis.