Temporomandibular joint (TMJ) arthroscopic lysis and lavage: Outcomes and rate of progression to open surgery

A guide for temporomandibular joint surgery using a simple surgical classification - A narrative-style review

The aim of this narrative style review is to clarify the role of TMJ surgery in the management of specific TMJ disorders by introducing a simple and practical surgical classification. A decade ago, a new surgical classification was published which, like the Wilkes classification, included the five escalating degrees of joint pathology, but with more practical definitions and proposed surgical options for each of the disease categories. The classification begins with Category 1 - painful but otherwise structurally normal joints, which are largely managed nonsurgically. Categories 2 and 3 denote reducing and nonreducing disc displacement of the TMJ, respectively, with the former treated by TMJ arthrocentesis or level 1 arthroscopy and the latter best managed with disc repositioning or discopexy. Category 4 describes degenerative changes to the disc itself, where the disc cannot be salvaged and is thus removed with TMJ discectomy. Lastly, Category 5 refers to end-stage joint disease, where none of the joint components can be salvaged; both the disc and condylar head are sacrificed, and the TMJ is reconstructed with a prosthetic total joint replacement. In the decade since its publication, various studies have served to validate the usefulness of the TMJ surgical classification, and how it can be applied to better understand the role of TMJ surgery in everyday clinical practice.

Progress in the Study of Temporomandibular Joint Lavage in Temporomandibular Joint Disorder

With the continuous development and progress of medicine, there are many methods for the treatment of temporomandibular disorders, among which temporomandibular joint lavage is also constantly developed. In the past century, through the efforts of some scholars and clinical summary, the understanding of this disease has been deepened and broadened. At present, through continuous exploration of the treatment methods, the lavage is relatively mature, and has achieved good clinical results. In this paper, the application of temporomandibular joint lavage in the treatment of temporomandibular joint disorders, its treatment methods, treatment mechanism, the auxiliary of other drugs, indications, complications and so on were discussed.

Clinical and demographic factors associated with the effectiveness of temporomandibular joint arthroscopy

PURPOSE

High success rates and minimal complications have consolidated arthroscopy as the therapeutic alternative of choice for minimally invasive treatment of internal disorders (ID) of the temporomandibular joint (TMJ). However, there is no certainty regarding the demographic and clinical factors associated with the technique's success or failure. This study was performed to analyze the effectiveness of arthroscopy regarding pain and the mandibular dynamics and also to determine whether variables such as age, sex, and preoperative Wilkes stage influence the results.

METHODS

A retrospective study was conducted involving 92 patients with ID of the TMJ between September 2017 and February 2020. In all cases, a first stage of intra-articular lysis and lavage was executed. As needed, a phase of operative arthroscopy or arthroscopic discopexy was implemented.

RESULTS

A total of 152 arthroscopies were performed. Both the variation in pain and mouth opening in patients with ID of the TMJ treated were statistically significant for the follow-up periods studied. Better results were observed for patients with lower Wilkes stages. No association with age was found.

CONCLUSION

Based on the results, we recommend early intervention as soon as an ID in the TMJ is detected.

Bone marrow aspirate concentrate - A novel approach to alter the course of temporomandibular joint osteoarthritis (a clinical study)

INTRODUCTION

TMJ OA is characterized by severe osteocartilaginous degradation of the joint structure resulting in severe deterioration of both joint function as well as joint structure. bone marrow aspirate concentrate (BMAC) gained wide acceptance as an auspicious addition for regenerative medicine as it is confirmed to be a rich source of pluripotent mesenchymal stem cells and growth factors that produce promising relief of clinical symptoms with significant repair of the joint structure. Thus, the study aims at assessing the efficacy of bone marrow aspirate concentrate (BMAC) as a treatment modality for TMJ osteoarthritis and compare its efficacy with that of hyaluronic acid (HA).

METHODS

24 patients were included in the present study and divided into 12 patients in each group. Joint arthrocentesis was performed to all patients followed by intra-articular BMAC injection in Group I. While Group II received HA acid injection RESULTS: A trend towards long term joint repair at 12 and 18 months follow up period was observed in the bone marrow aspirate concentrate (BMAC) group as a therapeutic modality for TMJ OA by providing necessary growth factors and anti-inflammatories that impedes the progression of the osteoarthritic degeneration. On the contrary to the viscosupplementary action of hyaluronic acid (HA) that showed relapse of patients conditions.

CONCLUSION

Bone marrow aspirate concentrate (BMAC) is able to reverse the degenerative effects of TMJ OA however,further studies are mandatory with larger population and longer follow-up time.

Which comorbid conditions and risk factors affect the outcome of and progression to total temporomandibular joint replacement?

Surgery is an effective modality to reduce pain and increase range of motion (ROM) in TMJ disorders. The aim of this study was to determine which comorbidities and risk factors affect outcomes and progression to total joint replacement (TJR). A retrospective cohort study of patients who underwent TJR between 2000- 2018 at MGH was conducted. Primary outcome was successful vs unsuccessful surgery. Success was defined as pain score ≤ 4 and ROM ≥ 30 mm; failure was defined as lack of either or both. Secondary outcome was differences between patients undergoing TJR only (group A) and those undergoing multiple surgeries progressing to TJR (group B). 99 patients (82 females, 17 males) were included. Mean follow-up was 4.1 years; mean age at first surgery was 34.2 (range 14-71) years. Unsuccessful outcomes were associated with high preoperative pain, low preoperative ROM, and higher number of surgeries. Male sex favored successful outcome. 75.0% group A and 47.6% group B had successful outcome. Group B had more females, higher postoperative pain, lower postoperative ROM, and used more opioids compared to group A. High preoperative pain, low preoperative ROM, and more surgeries were associated with poorer outcomes and frequent opioid use.

Bilateral arthroscopy of the temporomandibular joint: clinical outcomes and the role of a second intervention-a prospective study

OBJECTIVE

Evaluate the efficacy of bilateral temporomandibular joint (TMJ) arthroscopy in patients with different categories of severity based on Dimitroulis classification (categories 2-4) and the role of a second TMJ intervention in primary failure.

METHODS

A 3-year prospective study was designed, including patients submitted to bilateral TMJ arthroscopy. The primary outcome was TMJ pain (VAS, 0-10) and the secondary outcomes were the maximum mouth opening (MMO) and masticatory myalgia degree (0-3). In cases of symptomatic relapse, a second TMJ intervention was performed (TMJ arthrocentesis or TMJ open surgery).

RESULTS

Eighty patients (93.4% women) were enrolled, with a mean age of 32.40 ± 11.41 years. With an average follow-up of 523.7 days (34-1606), a statistically significant improvement in TMJ pain, MMO, and myalgia degree was observed (P < 0.0001). The overall successful outcome of one-single bilateral arthroscopy was ~ 69%. Twenty-two patients relapsed: (1) arthralgia (n = 15, 68.18%); (2) arthralgia + myalgia (n = 4, 18.18%); (3) dislocated disc without reduction (DDwoR) (n = 2, 9.09%); (4) DDwoR + osteoarthrosis (OA) (n = 1, 4.55%). Arthralgia was re-managed with TMJ arthrocentesis with local anesthesia (n = 19, 86.36%). New DDwoR with or without OA was re-treated with TMJ open surgery (n = 3, 13.64%). After the second intervention, the success rate increased to 85%.

CONCLUSIONS

Bilateral TMJ arthroscopy presented overall benefit in all parameters evaluated.

CLINICAL RELEVANCE

This study highlights the importance of TMJ arthroscopy as the first line of treatment for moderate-severe temporomandibular disorders cases contributing to the reduction of TMJ open surgeries. In cases of arthroscopy unsuccess, TMJ arthrocentesis under local anesthesia was an effective and safe intervention for patients with recurrent TMJ arthralgia.

Arthroscopic Disk Repositioning After Failed Open Disk Repositioning

PURPOSE

Open disk repositioning has been long achieving excellent functional and stability outcomes. However, still remains some relapses for whom a second open surgery is often challenging. This study aimed to evaluate the effectiveness of arthroscopic disk reposition as an alternative surgery for unsuccessful cases of anterior disk displacement (ADD) after an initial open disk repositioning.

MATERIALS AND METHODS

This retrospective study included all patients who underwent secondary arthroscopy for disk repositioning of the relapsed ADD after an initial open surgery between January 2012 to June 2017. The redo arthroscopic disk repositioning and suturing procedure was the primary predictor input variable in this study. Outcome evaluation was based on both clinical (visual analog scale and maximal interincisal opening) and magnetic resonance imaging data.

RESULTS

Twenty-seven joints fulfilling the inclusion criteria were included. A significant improvement was detected at 24-month postoperatively compared with the baseline visual analog scale. The maximal interincisal opening showed a statistical improvement from 25.07 mm preoperatively to 38.44 mm at 24-month postoperatively. Twenty-six joints maintained a stable disk position with only 1 joint relapsed to ADD without reduction.

CONCLUSION

Arthroscopic disk reposition and suturing technique is a reliable and effective repeat surgery after failed initial open disk repositioning for management of ADD.

Assessment of postoperative pain in patients undergoing temporomandibular joint arthroscopy with infiltration of dexamethasone disodium phosphate in different concentrations. A randomized controlled trial

The main aim of this work was to evaluate the effect of intra-articular, sub-synovial steroid injections (IASSSI) with different doses during temporomandibular joint (TMJ) arthroscopy. Using a single-blind, randomized clinical trial, the investigators enrolled a sample of subjects who underwent TMJ arthroscopy with vs. without IASSSI for treating TMJ disorder (TMD). The predictor variable was the treatment group classified as no treatment (A - without IASSSI) or active treatments (IASSSI (B) with 2 mg or (C) 4-mg dexamethasone). Study medications were randomly assigned. Only subjects were blinded to treatment assignment. The main outcome variables included the following: 1) pain assessed up to postoperative day 30 with the McGill Pain Questionnaire and visual analog scale (VAS); 2) maximum mouth opening (MMO); and 3) analgesic and anti-inflammatory drug consumption. Other variables were demographic (age, sex) or pathologic (disease manifestations and classifications). Descriptive and bivariate statistics were computed. Statistical significance was set at p ≤ 0.5, one-tailed test of hypothesis. The sample comprised 36 patients (n = 12 per study group). In the active group with 4 mg corticosteroids, pain reduction measured by VAS (odds ratio [OR] = 0.18; p = 0.013) and McGill scale scores (OR = 0.15; p = 0.048) was significantly higher than in the control group. The McGill scale scores significantly decreased in both IASSSI groups, compared to the control group, at the final follow-up (all p < 0.012), and IASSSI was significantly associated with reduced analgesic consumption at postoperative days 7 and 14 (p = 0.003). However, there was no significant difference regarding MMO among the three groups. Within the limitations of the study, it seems that intra-articular, sub-synovial steroid injections (IASSSI) with 4 mg dexamethasone should be preferred whenever appropriate when pain relief is the priority of the procedure. Brazilian Registry of Clinical Trials (ReBec)- 28yb2g.

Temporomandibular joint arthroscopy in advanced stages of internal derangement: a retrospective cohort study on the influence of age

The aim of this investigation was to evaluate the outcomes of patients with advanced internal derangement of the temporomandibular joint who underwent operative arthroscopy, according to age stratified into two groups: <45 years and ≥45 years. The study included a series of 194 patients. Outcome variables were pain intensity and mandibular mobility. Additionally, the difference in arthroscopic findings in these age groups was studied. The data analysis included the paired t-test, χ² test, and two-way analysis of variance, with a P-value <0.05 indicating statistical significance. A significant reduction in pain and an improvement in maximum inter-incisal opening (MIO) was observed in both groups starting at 1 month of follow-up (P < 0.01). However, the results for MIO were worse in the ≥45 years group (P=0.036) at 12- and 18-months follow-up. Regarding arthroscopic findings, the study showed a higher prevalence of severe chondromalacia in the ≥45 years group (P = 0.031) and disc displacement without reduction in the <45 years group (P = 0.020). Analysis of variance showed a greater pain reduction if no obliteration of the articular space was observed (P = 0.039). In young and older patients, operative arthroscopy can be useful for short-term treatment in advanced stages of internal derangement of the temporomandibular joint.

Cytokines in temporomandibular joint synovial fluid and tissue in relation to inflammation

BACKGROUND

Synovial tissue is known to be the origin of inflammation in joint disease. Despite this, synovial fluid is the main biological specimen of choice in temporomandibular joint (TMJ) inflammation and pathology biomarker research. No comparison of TMJ protein content between synovial fluid and synovial tissue has been made.

OBJECTIVES

To investigate if cytokine concentrations in synovial fluid can be related to cytokine concentrations in synovial tissue, and to analyse correlation of clinical parameters reflecting local inflammation to cytokine concentrations.

METHODS

Synovial tissue and fluid samples were obtained during the same surgical procedure from a cohort of 101 patients with TMJ disorders. Interleukin (IL) 1β, IL-6, IL-8, IL-10, and tumor necrosis factor α (TNF-α) were analysed in the samples and an intraindividual correlation made. Various patient-specific factors relating to TMJ inflammation were associated to the cytokine concentrations in synovial fluid and tissue.

RESULTS

No correlation between cytokine concentration in synovial fluid and synovial tissue was found, except for IL-8 (ρ=.284, P=.024). Synovial tissue cytokines correlated strongly to inflammation-related factors: diagnosis (IL-1β, P=.001; TNF-α, P=.000; IL-10, P=.000), TMJ palpation pain (IL-1β, P=.024; TNF-α, P=.025), synovitis score (IL-1β, P=.015), and subjective TMJ pain (TNF-α, P=.016). Synovial fluid cytokines showed no significant relations to inflammation.

CONCLUSIONS

The investigated cytokine concentrations showed weak correlations between synovial fluid and synovial tissue, besides IL-8. Synovial tissue appeared to reflect inflammation to a higher extent than synovial fluid. Thus, suggesting that synovial tissue research should complement synovial fluid in future explorations of TMJ pathology and inflammation.

The Efficiency of Different Arthroscopic Discopexy Techniques Based on Clinical and Radiographic Findings: A Systematic Review

ABSTRACT

The aim of this systematic review was to evaluate the effectiveness of different temporomandibular joint arthroscopic discopexy techniques.The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and an electronic search was performed using MEDLINE (PubMed), The Cochrane Library, ScienceDirect databases using a combination of the terms "discopexy," "disc recapture," "disc fixation," and "temporomandibular joint" to identify clinical trials published from 2010.In total, 493 records were screened, of which only 9 fulfilled the inclusion criteria and were included in qualitative data synthesis.The results of clinical findings evaluation showed that arthroscopic discopexy statistically significantly improved levels of pain (VAS) and maximum interincisal opening whereas magnetic resonance imaging evaluation showed disc position improvement of up to 90% to 100%.In conclusion, this review provides the evidence of the potential benefits of arthroscopic disc fixation in the treatment of patients with internal derangements : reduced pain, increased maximum interincisal opening, and improved disc position evaluated by magnetic resonance imaging, whereas disc fixation using suturing techniques seems to be the most appropriate method.

The influence of prior arthroscopy on outcomes of primary total lower extremity arthroplasty: A systematic review and meta-analysis

PURPOSE

The primary purpose of this systematic review and meta-analysis was to investigate the impact of prior arthroscopy on postoperative revisions, complications, and other clinical outcomes after conversion total lower extremity arthroplasty.

METHODS

Two individual researchers conducted the platform searches on the Embase, PubMed, Cochrane Central, and Google Scholar electronic databases from inception to June 02, 2021. We identified cohort trials that compared the outcomes of patients who underwent primary THA or TKA in the prior arthroscopy or control groups. The primary outcome was revision, and secondary outcomes included reoperation, patient-reported outcomes, and postoperative complications. A modified version of the Downs and Black tool was used to assess the methodological quality of the non-randomized cohort studies.

RESULTS

Of the 23 included studies with 319946 cases, 18 were matched retrospectively and five were non-matched retrospectively. Methodological quality was high in ten studies and moderate in thirteen studies. Our analysis demonstrated that TKA or THA patients with prior arthroscopy were associated with an increased risk of revision, reoperation, infection, and aseptic loosening. THA patients with prior arthroscopy were also associated with an increased risk of dislocation. Furthermore, there were no significant intergroup differences in periprosthetic fracture, range of motion, Harris Hip Score, or Knee Society Score.

CONCLUSION

Arthroscopy performed before total lower extremity arthroplasty substantially increased the revision, reoperation, infection, and aseptic loosening rates. THA patients with prior arthroscopy were also associated with an increased risk of dislocation. Patients should be counseled on the potential increased risks associated with conversion total lower extremity arthroplasty after prior arthroscopy. Further research is needed to better characterize these findings.

Outcomes of Treatment with Manipulative Reduction Combine with the Disc-condyle Repositioning Splint in Acute Anterior Disc Displacement without Reduction

ABSTRACT

In this report, the authors describe a case of the acute anterior disc displacement without reduction treated by manipulative reduction combined with the disc-condyle repositioning splint to improve the limited mouth opening and relieve the pain, including diagnostic images and treatment performed.

Risk Factors Associated With Poor Outcomes Following Temporomandibular Joint Discectomy and Fat Graft

PURPOSE

Temporomandibular joint (TMJ) discectomy is performed for patients with degenerative joint disease with an unsalvageable disc, but with a salvageable condylar head and glenoid fossa. The purpose of this study was to estimate the incidence and risk factors associated with poor postoperative outcomes following TMJ discectomy and abdominal fat grafting.

METHODS

A retrospective cohort study was conducted on patients who underwent TMJ discectomy. Included in this study were patients who had complete data sets with a minimum of 1-year follow-up. Potential risk factors included demographics, preoperative findings (mouth opening, pain levels, previous TMJ surgery), operative findings (disc degeneration, state of TMJ components), and postoperative outcomes (pain levels, mouth opening). Failed outcomes were those who had return of pain postoperatively, no improvement in mouth opening following TMJ discectomy, and/or those who progressed to TMJ total joint replacement (TJR). Statistical methods included Kaplan-Meier curves and Cox proportional hazards regression time to event analyses.

RESULTS

This study included 129 patients who had undergone 132 TMJ discectomies. Most patients were female (89.9%), with a mean age of 43.2 years, standard deviation 14.2. The success rate for discectomy was 75.2% and the conversion rate of TMJ discectomy to TJR was 11.7%. A total of 32 patients (24.8%) experienced return of pain. The median time to return of pain or second surgery was 94.4 months (95% CI = 88.3 to 101.8). No risk factors were statistically significant, although mouth opening improvement of less than 10% was associated with higher risk of poor outcome (P = .77).

CONCLUSION

The findings of this study suggest that lower improvement in mouth opening at 1 year following surgery is likely to result in failure of the TMJ discectomy procedure although the result was not statistically significant. This outcome may ultimately necessitate a TJR.

Does arthroscopy cause more complications than arthrocentesis in patients with internal temporomandibular joint disorders? Systematic review and meta-analysis

The objective of this study was to compare, through a systematic review with a meta-analysis, the relative risks of arthroscopy and arthrocentesis in the temporomandibular joint. MEDLINE/PUBMED, EMBASE, Cochrane Library (CENTRAL), Web of Science, SCOPUS were the researched databases, as well as grey literature and manual searches. The search results showed 656 studies, but only five met the eligibility criteria. The evaluation included 194 joints (104 patients): 101 were arthroscopy and 93 arthrocentesis. Complications were observed in four patients undergoing arthroscopy (two with temporary facial paralysis and two with prolonged cervical oedema) and in three patients undergoing arthrocentesis (two with severe bradycardia and one with prolonged cervical oedema). The meta-analysis demonstrated a relative risk of 0.99 for complications after arthroscopy compared with arthrocentesis, but the results showed no statistical differences. In conclusion, this systematic review suggests that there is no increased risk of complications with arthroscopy than arthrocentesis. When complications were present, they were temporary.

Does arthroscopic lysis and lavage in subjects with Wilkes III internal derangement reduce pain?

PURPOSE

The aim of this study was to determine the efficacy of arthroscopic lysis and lavage on pain in patients with unilateral Wilkes stage III derangement of the temporomandibular joint. Authors retrospectively evaluated whether the arthroscopic lysis and lavage has an impact on pain decrease in patients with moderate osteoarthritis.

METHODS

Patients with unilateral Wilkes III of temporomandibular joint were included in this study. All patients underwent arthroscopic lysis and lavage (ASC-L), assessed pain before and after the procedure (primary outcome variable), maximal interincisal opening (MIO) was recorded as secondary outcome variable. The patients also subjectively assessed whether they were satisfied with the outcome of the arthroscopy or whether their condition required further interventions. The disc position was evaluated by magnetic resonance imaging (MRI) 24 months after the arthroscopy and compared with the disc position on the MRI prior to the arthroscopy. The R Project for Statistical Computing 3.4.1 and the Gretl Pro programs were used for statistical analysis. In addition to the descriptive statistics methods, the Shapiro-Wilk normality test was used to verify data normality and the two sample t test used to test the hypotheses themselves.

RESULTS

The sample consisted of 62 patients who underwent arthroscopic lysis and lavage (ASC-L) in 2015 and 2016. It included 6 men and 56 women with an average age of 34.37. Pain and MIO were recorded during regular check-ups 1, 3, 6, 12, and 24 months. A therapeutic effect (MIO over 34 mm, VAS score 0-1) was recorded in 69% of cases 24 months after the ASC-L. Nonetheless, the work demonstrated the importance of subjective assessment, as 87% of patients perceived their condition as satisfactory after 24 months and not requiring further intervention, while 8 patients (13%) perceived it as unsatisfactory. Disc reposition 24 months following the ASC-L was recorded in only 44% of patients who assessed their condition as satisfactory. Patients with persistent disc dislocation 24 months after the arthroscopy were older, had a lower average maximal interincisal opening value before the ASC-L and a longer duration of mandibular movement restriction before the ASC-L (evaluated as a statistically significant difference).

CONCLUSION

In this study, the authors confirmed that ASC-L is an effective therapeutic method in patients with WIII, from both clinical and subjective perspectives. This work demonstrated that improvement in patients with Wilkes stage III is not related to disc reposition. Postoperative physiotherapy is an integral component of ASC-L and is reflected in the final results.

Synovial Tissue Proteins and Patient-Specific Variables as Predictive Factors for Temporomandibular Joint Surgery

Our knowledge of synovial tissues in patients that are scheduled for surgery as a result of temporomandibular joint (TMJ) disorders is limited. Characterising the protein profile, as well as mapping clinical preoperative variables, might increase our understanding of pathogenesis and forecast surgical outcome. A cohort of 100 patients with either disc displacement, osteoarthritis, or chronic inflammatory arthritis (CIA) was prospectively investigated for a set of preoperative clinical variables. During surgery, a synovial tissue biopsy was sampled and analysed via multi-analytic profiling. The surgical outcome was classified according to a predefined set of outcome criteria six months postoperatively. Higher concentrations of interleukin 8 (p = 0.049), matrix metalloproteinase 7 (p = 0.038), lumican (p = 0.037), and tissue inhibitor of metalloproteinase 2 (p = 0.015) were significantly related to an inferior surgical outcome. Several other proteins, which were not described earlier in the TMJ synovia, were detected but not related to surgical outcome. Bilateral masticatory muscle palpation pain had strong association to a poor outcome that was related to the diagnoses disc displacement and osteoarthritis. CIA and the patient-reported variable TMJ disability might be related to an unfavourable outcome according to the multivariate model. These findings of surgical predictors show potential in aiding clinical decision-making and they might enhance the understanding of aetiopathogenesis in TMJ disorders.

Is There a Relationship Between Age, Personal Factors or Surgical Findings, and Outcome After Temporomandibular Joint Arthroscopy?

PURPOSE

The variables involved in prognosis after treatment of internal derangement (ID) of the temporomandibular joint (TMJ) are unclear. The purpose of this study was to estimate the frequency and identify which factors are associated with treatment success (or failure) among patients with ID managed with arthroscopy.

MATERIAL AND METHODS

A retrospective cohort study was carried out of patients undergoing TMJ arthroscopy over a 9-year-period. The predictor variable was composed of a set of demographic, clinical, and operative findings, including, as primary variable, the patient's age. The primary outcome variable was based on the American Association of Oral and Maxillofacial Surgery (AAOMS) criteria of pain (measured by visual analogue scale (VAS)) and maximal interincisal opening (MIO) defined as VAS ≤ 3 and MIO greater 35 mm and grouped as success or failure. The improvement in pain and functional values were compared with the age by using the Pearson correlation coefficient, whereas categorical variables were tested using chi-squared analysis, and mean values were compared with Student t-test or ANOVA. Subsequently, a logistic regression model was used, and the odds ratios (OR) of the evaluated comparisons were calculated.

RESULTS

A total of 212 patients were included in this study. In terms of arthroscopic findings, the presence of severe chondromalacia, adhesions or disc perforation (P < .001), was related with older patients. However, there was no statistically significant correlation between age and the postoperative improvement referred to pain or MIO. According to the AAOMS criteria, the procedure was successful in 54.24% of the cases. Two factors were related with a favorable outcome in the adjusted regression analysis: a higher presurgical MIO (OR 0.91, P < .001) and the presence of adhesions (OR 0.41, P = .003).

CONCLUSION

Age has no influence on the outcome after arthroscopy. A higher presurgical MIO and the presence of adhesions provide, in the long-term, a favorable prognosis.

Predictive factors in temporomandibular joint arthroscopy: a prospective cohort short-term outcome study

Improving the outcomes of surgical treatment of the temporomandibular joint (TMJ) is beneficial from a patient and health-economy perspective. Optimizing conditions for a successful result can be reached using validated, strict diagnostic criteria and by identifying patient-specific factors predicting the outcome. The aim of this study was to investigate possible predictive factors in TMJ arthroscopy. A prospective cohort study including 93 patients undergoing arthroscopy was conducted. The outcome was graded as successful (53%, n=49), good (25%, n=23), intermediate (20%, n=19), or deteriorated (2%, n=2) using a predefined set of objective and subjective outcome measures. The outcome was correlated with preoperative and perioperative variables and the diagnosis. Preoperative bilateral masticatory muscle tenderness on palpation was the only variable significantly correlated with a negative outcome in the adjusted regression analysis (odds ratio (OR) 2.56, P=0.048). Low age (OR 1.03, P=0.05) and bilateral joint surgery/operated side (OR 0.24, P=0.05) were found to correlate with an unsuccessful outcome in the unadjusted analysis. Eighty-nine percent of the patients with osteoarthritis benefited from arthroscopy, while corresponding figures were 80% for disc displacement without reduction and 64% for chronic inflammatory arthritis. Preoperative bilateral masticatory tenderness might be a useful predictive factor suggesting the consideration of revised non-invasive therapy before surgery.

Rearthroscopy of the temporomandibular joint: A retrospective study of 600 arthroscopies

PURPOSE

Arthroscopic surgery is an effective treatment for patients with temporomandibular disorders, releasing symptoms and restoring the mandibular function. In patients with poor arthroscopic outcomes, several options of treatment can be considered such as conservative nonsurgical therapy, open surgery, or a second arthroscopy. The purpose of this study was to evaluate our results after 619 arthroscopies.

MATERIALS AND METHODS

The clinical data of 619 arthroscopies performed between 1996 and 2015 were reviewed retrospectively. Outcome assessments were based on reductions in pain, measured using a visual analog scale (VAS), and improvement in maximal interincisal opening (MIO). The minimum follow-up period was 24 months.

RESULTS

The incidence of TMJ reoperation in the 371 patients who underwent arthroscopic surgery was 5.9%, with a mean time between surgeries of 66.73 months. Significant improvement between presurgical and postsurgical pain and presurgical and postsurgical MIO at months 6 and 12 were evident. The mean of preoperative MIO was 30.84 mm, which increased to 35.92 mm 1-year postsurgery, these results being statistically significant (p < 0.05).

CONCLUSIONS

In most of the cases the result of a new arthroscopy is satisfactory. Rearthroscopy of the TMJ is a valid and effective method for patients with a first unsuccessful arthroscopy.

Immunohistochemical expression of TLR-4 in temporomandibular joint dysfunction

Objective Toll-like receptor 4 (TLR-4) is a transmembrane protein involved in the innate immune system and has been implicated in the pathogenesis of temporomandibular joint dysfunction (TMD). The purpose of this study was to histologically examine the level of expression of TLR-4 relative to severity of TMD. Methods Thirty-one human TMJ disc samples were immunostained for TLR-4 and evaluated for intensity of stain. Among the samples, 8 were control samples, 16 were from patients with anterior disc displacement with reduction (ADDwR), and 7 were from patients with anterior disc displacement without reduction (ADDwoR). Results There was no statistically significant difference in intensity of stain between groupings (p = 0.673). Conclusions The results indicate a negative correlation between TMD and the expression of TLR-4.