Pathology · patient case question
What is happening to the articular disc?
Patient case: Painful mandibular deviation on opening
Patient: Adult with temporomandibular symptoms
Chief complaint: Pain and restricted mouth opening.
Background: No relevant medical history reported.
Current findings: On opening, the mandible deviates to the RIGHT and remains deviated. Opening is limited and painful.
Show answer and explanation
Correct answer: D. The right articular disc is displaced anteriorly WITHOUT reduction
- A. With reduction, the disc recaptures with an audible click and opening then returns to normal, producing DEFLECTION that corrects — an S-shaped path rather than persistent deviation, and opening is not limited.
- B. The side is wrong. Deviation is toward the restricted side, which is the right.
- C. Both the side and the mechanism are wrong.
- D. CORRECT. The mandible DEVIATES TOWARD THE AFFECTED SIDE, because the restricted condyle cannot translate forward while the healthy side does. Persistent deviation to the right with limited, painful opening indicates a RIGHT disc displaced anteriorly WITHOUT reduction — closed lock. The disc obstructs translation and never recaptures, so there is no click.
Note: Distinguish the terms: DEVIATION is a persistent shift toward the affected side that does not correct (without reduction). DEFLECTION is a transient shift that corrects as the disc recaptures (with reduction). Limited opening around 25–30 mm suggests closed lock.