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Clinic & Revision

Temporomandibular Joint

WILKES CLASSIFICATION

 

The most widely used classification of TMJ dysfunction. It's main advantage is that it can be used to guide management. It is based upon clinical presentation, appearance on imaging and what is found at arthroscopy or surgery.

 

Stage 1
Clinical: Painless clicking with no restrictions in motion
Imaging: Slightly forward disc that can reduce. Normal bone contour
Surgical appearance: Normal disc.
Management: Conservative and discharge. For patients who grind or clench then refer back to dentist for lower soft mouth guard worn at night

 

Stage 2
Clinical: occasionally painful clicking, intermittent locking, headaches
Imaging: slightly forward disc that can reduce. Early disc deformity. Normal bone contour
Surgical appearance: thickened disc. Anterior disc displacement
Management: most difficult group to decide on management. If mildly symptomatic, treat conservatively. If any muscle pain consider physio. If parafunction then refer to dentist for soft mouthguard. If still symptomatic they perform arthrocentesis. If still symptomatic after arthrocentesis some would consider arthroscopy if available or tertiary referral. Surgery is always contraindicated in this group

 

Stage 3
Clinical: frequent pain, joint tenderness, headaches, closed lock, painful chewing. These patients usually progress to a stage 4 given time
Imaging: anterior disc displacement (early stages reduce, late stages don't), disc thickening, normal bone contour
Surgical appearance: disc deformed and anteriorly displaced. Sometimes adhesions, no bone changes
Management: MRI to confirm diagnosis. which will show anterior disc displacement. Most start with arthrocentesis. Arthroscopy will show a damaged disc and enable interventions such as adhesiolysis.

 

Stage 4
Clinical: chronic pain, headache and restricted motion
Imaging: non reducing anterior disc displacement. Disc thickening. Abnormal bone contours
Surgical appearance: gross arthritic degenerative changes 
Management: open surgery eg arthroplasty, meniscopexy

 

Stage 5
Clinical: variable pain, joint crepitus, painful function. Pre-ankylosis
Imaging: non reducing anterior disc displacement. Disc thickening. Abnormal bone contours
Surgical appearance: gross arthritic degenerative changes 
Management: open surgery eg arthroplasty, meniscopexy

 

 

Author: Johno Breeze
Last updated 07.02.15