title: Radiographic and clinical features of temporomandibular dysfunction in patients following indirect trauma: a retrospective study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, William Osler Health Center, Toronto, ON, Canada. mgrushka@yahoo.com
authors.forename: Miriam
authors.initials: M
authors.lastname: Grushka
authors.forename: Victor W
authors.initials: VW
authors.lastname: Ching
authors.forename: Joel B
authors.initials: JB
authors.lastname: Epstein
authors.forename: Meir
authors.initials: M
authors.lastname: Gorsky
mesh_terms: D000063:Accidents, Traffic / Q000331:legislation & jurisprudence*; D000328:Adult; D016009:Chi-Square Distribution; D005157:Facial Pain / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013704:Temporomandibular Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors