Clinical controversies in oral and maxillofacial surgery: surgical arthroscopy (part 1) or arthroscopic lysis and lavage (part 2) as the preferred treatment for internal derangement of the temporomandibular joint

Arthroscopic lysis and lavage for internal derangement of the temporomandibular joint

INTRODUCTION

Arthroscopy of the temporomandibular joint (TMJ) is a valuable diagnostic and therapeutic tool for various intra-articular disorders, especially internal derangement (ID) of the TMJ.

OBJECTIVES

To evaluate the efficacy and safety of a standardized arthroscopic procedure for the treatment of two stages of ID; early/intermediate stage and intermediate/late stage.

MATERIALS AND METHODS

Retrospective analysis of medical records of 78 patients (99 joints) treated by arthroscopic lysis and lavage in the authors' department during a 5-year period. Patients were diagnosed preoperatively as suffering from ID of the TMJ. The results were stratified according to the stage of ID. Three outcome variables were used to assess efficacy of treatment: Maximal interincisal opening (MIO), level of pain on a visual analog scale (VAS), and frequency of intermittent locking episodes. In addition, complications were reported.

RESULTS

Mean MIO of the group of patients with intermediate/late stage ID increased from 27 ± 4.7 mm preoperatively to 38 ± 5.4 mm postoperatively (P < 0.0001). For the group of patients with early/intermediate stage ID, mean MIO did not change significantly after arthroscopy (39.1 ± 6.2 mm compared to 41.4 ± 5 mm, P = 0.06), however, subjective evaluation of pain on a VAS decreased from 7.2 ± 1.2 preoperatively to 3.4 ± 2.2 postoperatively (P < 0.0001), and 80% of the patients (25 of 31) denied experiencing intermittent locking episodes after treatment (P < 0.0001).

CONCLUSION

Arthroscopic lysis and lavage is a safe and effective therapeutic modality for the treatment of both mild and advanced stages of ID.

Arthrocentesis for the treatment of temporomandibular joint closed lock: a review article

Although arthrocentesis is not a panacea, it has been widely used for a variety of temporomandibular joint (TMJ) disorders. Uncritical acceptance of the procedure has been cautioned against, as further analysis and clarification of published studies was required. The aim of this article was to review the efficacy of arthrocentesis in the treatment of patients with TMJ closed lock. The rationale behind this approach was based on the notion that TMJ surgical results should be reported by the specific category of TMJ disorder. After a Medline search of the international literature, 14 articles were found fulfilling the criteria set forth by this article. Another five articles were added after an additional hand search based on the available references of the papers found. The majority of the reviewed publications were prospective case series with flawed methodology and, despite the impression that arthrocentesis may be beneficial for patients with TMJ closed lock, there have been no good prospective randomized clinical trials that confirm the efficacy of this procedure.