PATHOLOGIC QUIZ CASE 1
Robert E. Fechner, MD, Charlottesville, Va, G. Gary Card, MD, Houston
A 38-year-old man was electively hospitalized with a 13-year history of left temporomandibular joint pain during mastication, which had its onset after a football injury resulting in a mandibular fracture, loosened teeth, and a concussion. The patient underwent multiple conservative measures during the subsequent 13 years, including orthodontic procedures, tooth extractions, exercises, and intra-articular injections of steroids and anesthetics. Despite the varied, multiple forms of therapy, his symptoms persisted. Physical examination showed a tender left temporomandibular joint and pain that was elicited during movement of the mandible. There was audible and palpable crepitation in the joint during opening and closure of the mouth. Roentgenographic examination disclosed the changes as shown in Fig 1 through 4. Figures 1 and 2 are from the right side and show the joint with the mouth open and closed, respectively.
FECHNER RE. Resident's Page. Arch Otolaryngol. 1978;104(12):742–744. doi:10.1001/archotol.1978.00790120068014
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