A modified extraoral technique of mandibular manipulation in disk displacement without reduction.

A main reason for failure when manipulating a mandible in disk displacement without reduction is a lack of coordination, because of a sudden resistance on the patient's part when fingers are placed in his mouth. This work describes a new extraoral manipulation technique that avoids this problem. Basically, this technique involves three stages. In stage one, the patient performs rhythmic left and right sideways movements unassisted; in stage two, gentle finger pressure is applied by the clinician on the external aspect of the mandible in the same direction as the patient's movements; and in stage three, the mandible is forcefully pulled towards the non-lesion side in strict concomitance with the mandibular movement of the patient towards the same side (Figure 1). Usually a splint is then placed intra-orally for three-to-five months, and physical therapy and exercises are prescribed as needed. The technique described improves the rate of success in the management of permanently displaced disks, so that indication for surgery may drop to close to zero. The chronicity of the lesion does not seem to be an exclusion criteria, provided the lesion still has the characteristics of a disk displacement with reduction and no pseudodisk or degeneration has arisen. Treatment success is confirmed by the improvement of free mandibular and masticatory movements and by the absence of pain.