Piper Classification - Stage II

The very earliest disease developed within the temporomandibular joint is laxity of the lateral collateral ligament. These patients are typically symptomatic from nighttime bruxism. Hence, they might develop a nighttime headache, daytime fatigue in the elevator muscles and clicking which could occur first thing in the morning. This clicking typically reduces with a few early morning opening movements of the mandible. As the lateral collateral ligaments become slightly loosened, hyperactivity of the lateral pterygoid muscle will intermittently displace the disc from the lateral pole. At the medial pole, the anatomy is still normal. The retrodiscal attachment at the lateral aspect of the articular space is also somewhat lax. There is little or no fibrosis of the lateral pterygoid muscle. Clinically, this Stage Is picked up through palpation via the external auditory ear canal. If there is no clicking upon palpation over the lateral pole of the condyle, and if clicking can be induced through forward compression against the posterior aspect of the condyle, then the disc is knocked out of position at the lateral pole.