OBJECTIVES: Patients developing temporomandibular dysfunction (TMD) following a motor vehicle accident (MVA) have been reported to respond poorly to standard TMD treatment compared with TMD patients who have not sustained an MVA. The purpose of this study was to determine clinical and radiographic differences between post-MVA and nontrauma TMD patients and to determine whether radiographic findings in post-MVA patients undergoing litigation show more severe anatomical changes than post-MVA patients not undergoing litigation. STUDY DESIGN: One hundred thirty-six files with magnetic resonance imaging (MRI) and/or bone scan studies of TMD patients were randomly drawn (54 post-MVA and 82 nontrauma TMD). RESULTS: Patients with post-MVA TMD demonstrated significantly more orofacial pain complaints but significantly less disk displacements on MRI (47.5% post-MVA vs. 69.2% control; P = .03). Litigating post-MVA patients had significantly more nonreducing disks than the nonlitigating group (37.7% litigating vs. 7.7% nonlitigating; P = .05). CONCLUSION: Based on these findings, it is suggested that treatment limited to the temporomandibular joints (TMJs) in post-traumatic TMD patients may fail without consideration that pain may originate in structures other than the TMJs. Within the post-MVA group, the more severe anatomical changes were found in the litigating patients, suggesting that some of their symptoms are associated with anatomical changes.
OBJECTIVES:Patients developing temporomandibular dysfunction (TMD) following a motor vehicle accident (MVA) have been reported to respond poorly to standard TMD treatment compared with TMDpatients who have not sustained an MVA. The purpose of this study was to determine clinical and radiographic differences between post-MVA and nontrauma TMDpatients and to determine whether radiographic findings in post-MVA patients undergoing litigation show more severe anatomical changes than post-MVA patients not undergoing litigation. STUDY DESIGN: One hundred thirty-six files with magnetic resonance imaging (MRI) and/or bone scan studies of TMDpatients were randomly drawn (54 post-MVA and 82 nontrauma TMD). RESULTS:Patients with post-MVA TMD demonstrated significantly more orofacial pain complaints but significantly less disk displacements on MRI (47.5% post-MVA vs. 69.2% control; P = .03). Litigating post-MVA patients had significantly more nonreducing disks than the nonlitigating group (37.7% litigating vs. 7.7% nonlitigating; P = .05). CONCLUSION: Based on these findings, it is suggested that treatment limited to the temporomandibular joints (TMJs) in post-traumatic TMDpatients may fail without consideration that pain may originate in structures other than the TMJs. Within the post-MVA group, the more severe anatomical changes were found in the litigating patients, suggesting that some of their symptoms are associated with anatomical changes.