PMC10118889_01
(a) Clinical examination of patient on initial visit revealed limited and painful mouth opening to 9.5 mm. (b) Examination at 10-week follow-up after the treatment revealed increased mouth opening to 30 mm.
CRID2023-5947168.001.jpg
PMC10118889_01_CRID2023-5947168.001.jpg
fig1
Physical examination revealed a limited and painful mouth opening to 9.5 mm (Figure 1) with a shift of the mandibular midline to the left at opening. Clinical examination revealed additional mouth opening mobility to 30 mm (Figure 1), and the joint was painless on palpation.
Initial MRI of the left TMJ with the patient's mouth closed (a) and open (b).
CRID2023-5947168.002.jpg
PMC10118889_01_CRID2023-5947168.002.jpg
fig2
The MRI revealed anterior disk displacement of the left articular disk with significant anatomical deformity (thickening of posterior edge) and effusion in the left TMJ. The right TMJ was symptomless. To illustrate the limitation with mouth opening, the MRI images of the left TMJ were obtained with the patient's mouth closed (Figure 2) and open (Figures 2 and 3), and in the intermediate positions stabilized with a specially designed bite block. The dynamic sequences revealed limited condyle movement, disk deformity, and displacement without reduction on opening.
Initial MRI of the left TMJ with the patient's mouth open revealed anterior disk displacement of the left articular disk with significant anatomical deformity (thickening of the posterior edge) and effusion in the left TMJ. The dynamic sequences revealed limited condyle movement, disk deformity, and displacement without reduction on opening. Joint effusion was present.
CRID2023-5947168.003.jpg
PMC10118889_01_CRID2023-5947168.003.jpg
fig3
The MRI revealed anterior disk displacement of the left articular disk with significant anatomical deformity (thickening of posterior edge) and effusion in the left TMJ. The right TMJ was symptomless. To illustrate the limitation with mouth opening, the MRI images of the left TMJ were obtained with the patient's mouth closed (Figure 2) and open (Figures 2 and 3), and in the intermediate positions stabilized with a specially designed bite block. The dynamic sequences revealed limited condyle movement, disk deformity, and displacement without reduction on opening.
Photobiomodulation using LightWalker laser (Fotona d.o.o.) was performed with a flat-top Nd:YAG handpiece. The laser was applied in three places: posteriorly (a), above (b), and anteriorly (c) to the condyle. Four treatment sessions were performed.
CRID2023-5947168.004.jpg
PMC10118889_01_CRID2023-5947168.004.jpg
fig4
The laser was applied in three places: anteriorly, above, and posteriorly to the condyle (Figure 4).
Dynamic MRI of the TMJ at 10-week follow-up with patient's mouth closed (a) and open (b).
CRID2023-5947168.005.jpg
PMC10118889_01_CRID2023-5947168.005.jpg
fig5
PD sagittal sequences with the patient's mouth closed (Figure 5) and in intermediate and open positions (Figures 5 and 6) were performed.
Dynamic MRI of the TMJ at 10-week follow-up with patient's mouth in the open position revealed persistent left disk displacement, however, without signs of inflammation or effusion. The condyle moved further forward than in the first MRI examination and reached the top of the articular eminence.
CRID2023-5947168.006.jpg
PMC10118889_01_CRID2023-5947168.006.jpg
fig6
PD sagittal sequences with the patient's mouth closed (Figure 5) and in intermediate and open positions (Figures 5 and 6) were performed.