OBJECTIVE: To evaluate the effectiveness of immediate simple mandibular manipulation therapy at initial presentation of patients with chronic temporomandibular joint closed lock. PATIENTS AND METHODS: 305 consecutive patients (76 men and 229 women; age range 18 to 74 years) were selected based on a clinical diagnosis of temporomandibular joint disc displacement without reduction, otherwise known as closed lock. Patients were randomly divided into 2 groups of 204 study patients who received immediate jaw manipulation and non-steroidal anti-inflammatory drug therapy and 101 controls who received drug therapy only. Treatment success was determined by set criteria for closed lock that included achievement of 36 mm mouth opening and 6 mm lateral excursion. RESULTS: For patients undergoing manipulation in the 18 to 19 years age range, the success rate for treatment given on the day of diagnosis was 100.0%. In the 20 to 49 years age range, the success rate for manipulation was 87.5%, and in the 50 to 59 years age range, the success rate was 78.2%. Treatment given within 1 to 2 days of the onset of closed lock symptoms resulted in 100.0% success and was more than 90.0% if treatment was initiated within 3 weeks of the onset of symptoms. Treatment by manipulation was unsuccessful if given 2 months or more after the onset of symptoms. CONCLUSIONS: Simple jaw manipulation for the treatment of closed lock can be useful if applied early after the onset of symptoms, especially for younger patients. Lower success rates correlated with increasing age, and the likelihood of treatment success tended to decrease when the interval between the onset of symptoms and initial treatment increased.

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