Internal derangement of the temporomandibular joint: review of 214 patients following meniscectomy.

The chief causes of internal derangement of the temporomandibular joint are nervous tension and excessive use of the jaw, manifested by habitual chewing, jaw clenching or nocturnal tooth-grinding. The symptoms of pain, trismus, mild or severe clicking and jaw locking may be accompanied by signs of joint tenderness, palpable "klunking" or poor forward movement of the mandibular heads. A follow-up study of 214 patients after meniscectomy revealed that, on physical examination, 182 (85%) had normal jaw function. Of the remaining 32 (15%), 11 required unilateral condylectomy and 3 required bilateral condylectomy. When occlusive adjustment, sedation, muscle relaxants and dietary revision fail, meniscectomy is considered to be the treatment of choice if carried out before the onset of degenerative arthritic change in the temporomandibular joint.