The outcome of arthroscopic treatment of temporomandibular joint arthropathy

A Modified Technique of Temporomandibular Joint Arthroscopic Operative Surgery of the Superior and Inferior Joint Spaces

PURPOSE

This paper describes in detail the first author's technique of performing arthroscopic surgery in both the superior and inferior joint spaces of the temporomandibular joint.

METHODS

The key is careful measurement of sagittal and coronal tomograms to determine the individual size and shape of the joint. The joint is then distracted to allow 3-port video arthroscopy.

RESULTS

The detailed steps in the procedure are described and illustrated.

CONCLUSION

This modified technique is safe and allows procedures in both joint spaces and surgical access to the fossa, condyle and disc.

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.

Temporomandibular joint disc perforation: long-term results after operative arthroscopy

PURPOSE

Disc perforation (DP) is one of the most important pathologic signs of intracapsular temporomandibular joint (TMJ) disease; however, few clinical studies have focused on the arthroscopic management of this feature. The purpose of the present study was to assess whether operative arthroscopy with abrasion of the perforation borders is effective for the treatment of this alteration of the internal derangement of the TMJ.

PATIENTS AND METHODS

Thirty-six patients (39 joints) who underwent TMJ arthroscopy under general anesthesia and presented with DP (Wilkes stages IV and V) from 1994 through 2006 were included in this study. The age range at the time of surgery was 14 to 59 years. DPs were classified into 3 groups according to size: small (SMA), medium (MED), or large (LAR). Pain (visual analog scale, scores 0 to 100), maximal interincisal opening, and lateral and protrusive excursions were assessed at 1, 3, 6, 12, 24 and 48 months after surgery. Preoperative and postoperative scores were compared and tested for statistically significant differences by the Student t test for paired data. The level of statistical significance was set at .05. Differences in the global, SMA, MED, and LAR groups were evaluated.

RESULTS

In the global group, the mean score of preoperative pain according to the visual analog scale was 53.97 mm, which decreased to 14.33 mm at 4-year follow-up. The maximal interincisal opening improved from a mean of 28.56 mm before surgery to 34.88 mm after the final follow-up. SMA perforations were found in 11 cases (28.20%), MED in 19 cases (48.71%), and LAR in 9 cases (23.07%). A significant decrease in pain (P < .01) was observed from the first postoperative month to the end of the follow-up period in the global and SMA groups. A statistically significant increase in mouth opening was observed in the global group from 6 months postoperatively; however, no significant differences were observed in the MED and LAR groups from before surgery to the different times of follow-up. After the final follow-up, 2 patients underwent open TMJ surgery owing to unfavorable results.

CONCLUSIONS

Operative arthroscopy of the TMJ is a reliable and effective procedure for the articular dysfunction associated with DP because this procedure alleviates pain and improves mouth opening. Patients with SMA perforations are better candidates for this surgical treatment.

The role of surgery in the management of disorders of the temporomandibular joint: a critical review of the literature. Part 2

The literature is unequivocal in its support for surgery in the management of certain disorders of the Temporomandibular joint (TMJ). Unfortunately, the literature on TMJ surgery is based more on observation than science since randomised clinical trials comparing surgical treatment of the TMJ with medical treatment and no treatment (i.e., placebo) do not exist. Because the application of scientific principles in clinical studies which involve surgical intervention are ethically unfeasible, the true benefit of surgical intervention for Temporomandibular Disorders (TMD) may never be conclusively established. Waiting for properly designed, placebo controlled, random clinical trials will only impede the progress of surgical experience and frustrate the decision making for both clinicians and patients. Therefore, the current recommendations for surgery must rely on the best available evidence. The aim of this, the second of two papers, is to scrutinize the role of TMJ surgery in light of the controversies that have appeared in the literature in recent years.

A review of 56 cases of chronic closed lock treated with temporomandibular joint arthroscopy

PURPOSE

The aims of this prospective clinical study were to look at the features that constitute chronic closed lock of the temporomandibular joint (TMJ) and to assess the effectiveness of TMJ arthroscopic lavage and lysis in the management of this condition.

PATIENTS AND MATERIALS

Sixty joints in 56 patients who presented with mandibular hypomobility suggestive of chronic closed lock were prospectively examined and treated with TMJ arthroscopic lavage and lysis during a 3-year period from 1996 to 1999.

RESULTS

Eighty-seven percent (49 of 56) of patients were found to have chronic closed lock of the TMJ. The most common intra-articular findings were fibrillation (76%) and synovitis (54%). TMJ arthroscopic lavage and lysis were found to be effective in the management of chronic closed lock in 84% (47 of 56) of patients, with an average 66% reduction in pain levels and a mean improvement of 9.8 mm in interincisal mouth opening up to 6 weeks after the procedure.

CONCLUSIONS

Chronic mandibular hypomobility is a clinical sign that is often but not always caused by chronic closed lock of the TMJ. The intra-articular findings of this study suggest that cartilage degradation and synovial inflammation are important components of chronic closed lock of the TMJ that respond well to arthroscopic lavage. Patients with mandibular hypomobility not caused by closed lock of the TMJ (ie, myofascial pain and dysfunction, osteoarthrosis, and others) are less likely to derive benefit from arthroscopic lavage and lysis, so other treatment methods should be considered.

The incidence of reoperation after temporomandibular joint arthroscopic surgery: a retrospective study of 450 consecutive joints

PURPOSE

The purpose of this study was to investigate the incidence of reoperation after temporomandibular joint arthroscopic surgery in 315 consecutive patients (488 joints).

STUDY DESIGN

The clinical data and operative reports of all patients who underwent arthroscopic procedures from 1995 to 2000 were reviewed retrospectively. Patients had a preoperative clinical and panoramic radiographic evaluation. Most of the patients had disk displacement without reduction. In the remaining patients, the intra-articular pathologic conditions ranged from disk displacement with reduction to degenerative joint disease. The outcome assessment was based on reduction in pain, improvement in vertical dimension of mouth opening, and mandibular excursions. The same surgical team performed all arthroscopic procedures. Before surgery, all patients received at least 3 to 6 months of nonsurgical therapy consisting of anti-inflammatory medications, muscle relaxants, splint therapy, physiotherapy, exercise, moist heat, cold laser, ultrasound, and soft diet or a combination thereof. Patients were monitored postoperatively for as long as 5 years.

RESULTS

Results showed that approximately 20% of those patients who had temporomandibular joint arthroscopic surgery underwent further temporomandibular joint procedures ranging from repeat arthroscopic surgery to open-joint arthrotomy.

CONCLUSION

Temporomandibular joint surgical arthroscopy is an appropriate therapeutic modality for patients with temporomandibular joint internal derangements, with reoperation required for only 20% of patients.