Characteristics of Medical Malpractice Claims Involving Temporomandibular Joint Surgery in the United States

Abstract

Medical malpractice claims contribute to the practice of defensive medicine which exposes patients to unnecessary tests and limits access to care. The purpose of this study is to characterize medical malpractice claims involving temporomandibular joint (TMJ) operations by oral and maxillofacial surgeons in the United States. Retrospective cross-sectional study of closed medical malpractice claims against oral and maxillofacial surgeons in the Unites States insured by OMS National Insurance Company, RRG (OMSNIC), from January 1, 2016, through December 31, 2020. All claims were obtained from the OMSNIC claims database and classified by procedure type. The primary outcome measure was closed claims involving a TMJ operation. Claims regarding postoperative TMJ complications from non-TMJ operations were excluded. Predictor variables included alleged error and type of TMJ procedure performed. Claim outcome was reported as a secondary outcome measure. Additional outcomes measured included claims involving dentoalveolar or dental implant procedures. Descriptive statistics were performed, and risk ratios were calculated for TMJ claim settlement by alleged error and procedure. Significance was set at P<.05. A total of 1455 closed claims occurred during the study period. There were 14 closed claims involving a TMJ operation (0.96% of all claims). "Improper performance" was the most common alleged error for TMJ claims. Two claims (1 TMJ arthroscopy and 1 TMJ replacement) were settled with payment, and the alleged error for these claims was improper performance. No TMJ claim received a court-adjudicated payout. Dentoalveolar and dental implant-related claims made up 68.73% (n=1,000) and 15.53% (n=226) of all OMSNIC claims, respectively. The risk of a settlement was not significantly influenced by alleged error or TMJ procedure performed. Medical malpractice claims against oral and maxillofacial surgeons for TMJ operations are very uncommon. Medical malpractice risk should not factor into a surgeon's decision to exclude TMJ operations from their practice.