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In reply:
We agree with Dr. Hall that there is no proof that
muscles attached to the temporomandibular joint disk
cause disk displacement. To date no definitive mechanism(s) have been identified that explain this commonly seen phenomenon. We disagree with the
statement "there are no muscles attachments to the
disk that could explain the occasional pure medial or
lateral displacement." On the one hand, as cited in
our article, Myers 1 has described fibers of the deep
masseter muscle that attach to the anterior-lateral
corner of the disk. Pure lateral displacement has been
reported to be extremely rare. Our study 2 failed to
identify deep masseter muscle attachment in any of
the specimens. On the other hand, we observed in all
specimens that the most superior fibers of the superior belly of the lateral pterygoid muscle attach to the
anterior-medial margin of the disk, especially the inferior surface of the anterior margin. At wide openi n g with the condyles translated approximately 12
m m forward the angulation of the lateral pterygoid
fibers would approximate a 75 degree angle to the
midsagittal plane. The pull of these muscle fibers in
a medial direction at wide opening could serve to
medially displace the disk.
The concept that the disk moves back onto the
condyle in the modified condylotomy procedure may
be erroneous. It is plausible that the condyle moves
forward to relocate into the concavity of the normally
shaped disk. We have observed the development of an
anterior open bite after a modified condylotomy as the
condyle/disk assembly moved into a more superior
position in the glenoid fossae after removal of intermaxillary fixation. Furthermore, the idea that the disk
relocates after modified condylotomy in no way explains the mechanism of discal displacement. Dr.
Hall's hypothesis regarding the mechanical mechanisms serving to maintain the displaced position of
the disk is certainly plausible. Alteration in the morphology of the disk, once displaced, has been recognized for many years. However, it does not explain
the initial cause of displacement. It is important to
differentiate between initial displacement of the disk