ID (Internal Derangement )

Akibat posisi disc yang tidak normal (progressive slipping & displacement of disc). Adanya bunyi klik dari joint selanjutnya diikuti rasa sakit

Etiologi : 1. Robeknya ligament pd discus. 2. Ligament yg meregang. 3. Trauma akut. 4. Trauma kronik atau mikro trauma, seperti bruxism, maloklusi yg parah, Edentulous. 5. Pergerakan rahang yg berulang.

Internal Derengement
1. Jaringan lunak 2. Jaringan keras/tulang

ID pada JARINGAN LUNAK

1. With reduction: Discus dapat meluncur atau keluar dari posisi normal, saat buka atau menutup mulut, tetapi bisa kembali lagi. Sehingga menimbulkan bunyi meletup (popping sound)

2. Without reduction : Discus secara permanent berubah letak/ dislokasi pada posisi yg salah, sehingga ada pembatasan rahang.

Gejala : 1. Pain, pada sendi, terutama bila ada pergerakan. 2. Sakit dull, terasa tertusuk, atau seperti terbakar pada otot sekitar sendi. Ini potensial untuk cephalgia, dan sakit pada otot leher. 3. Sakit telinga, tinnitus dan berkurangnya pendengaran. 4. Suara Klick atau popping sound, patagnomonik.

5. Bukaan terbatas (locked jaw).

PERAWATAN :
I NON SURGERY 1. Kurangi pergerakan rahang. 2. Buattkan plate untuik exercise. 3. Obat-2amn : NSID, Muscle Relaxan. 4. Physio therapy. 5. Diet lunak. II. SURGERY : Disc Replacement.

CLASSIFICATION
INTRACAPSULAR (= Intra Articular) 1. Internal Derangement (ID). II. EXTRACAPSULAR (= Extra Articular) 1. Orofacial problem (pulpitis, otitis etc) 2. Joint dysfuction (infection, trismus, tetanus, myocitis, neoplasma etc.) 3. Myofacial Pain Dysfunction (MPD) = Temporo Mandibular Pain Dysfunction Syndrome (TMPDS)
I.

1. INTERNAL DERANGEMENT. 1.1. Deviation in form. 1.2. Disc Displacements. 1.2.1. Partial anteromedial disc displacement. 1.2.2. Anteromedial disc displacement with reduction (a. Partial, b. Complete). 1.2.3. Anteromedial disc displacement with intermittent locking. 1.2.4. Anteromedial disc displacement without reduction (a. Acute, b. Chronic). 1.2.5. Anteromedial disc displacement with perforation of retrodiscal tissue.
I.

1.3. Adhesive disc hypomobility. 1.4. Displacement of disc-condyle complex. 1.4.1. Subluxation. 1.4.2. Dislocation.

ETIOLOGY OF INTERNAL DERANGEMENT

Acute Macrotrauma. 2. Chronic Microtrauma (Bruxism, clenching , Overfilling, disbalance articulation etc) 3. Role of Occlusion. 4. Developmental and Acquired Defects.
1.

ARTICULAR DISC DISPLACEMENT.

Disc Displacement with reduction (ICD= 718.38)= Reciprocal Clicking. Alteration of the disc-condyle structural relationship during mandibular translation. Diagnoctic criteria : a). Pain. b). Reproducible joint noise : clicking. c). In MRI, displaced disc that reduces. d). No crepitus. e). Range of motion usually normal.
1.

2. Disc Displacement without reduction. (ICD = 718.28). Acute and Chronic. A). Acute. Diagnostic criteria : a). Pain (extreem). b). Limited mandibular opening (locking). c). No Joint noise. d). Stright line deviation. e). Limited laterotrusion. f). In MRI, displaced disc without reduction.

B). Chronic. Dioagnostic Criteria : a). Not painful. b). Joint noise and limitation opening. c). Joint noise : crepitus. d). Limited opening (slight). e). Silght limited laterotrusion. f). In MRI, displaced disc without reduction.