Influencia de la edad en los hallazgos y el resultado del tratamiento artroscópico de la disfunción temporomandibular. Un estudio basado en 162 casos

Abstract

IntroductionThe aim of this study was to analyse whether the findings and clinical improvement after arthroscopic surgical treatment were different according to the age of the patients affected by temporomandibular dysfunction. Material and methodsA retrospective review was performed on the data corresponding to patients treated arthroscopically over a 7-year period in two hospitals using the same protocol. Only patients with a diagnosis of chronic closed lock (stage IV and V, according to Wilkes-Bronstein classification) were considered. The study involved the analysis of two different patient groups: a) Group A under 45 years of age at diagnosis, b) Group B over 45 years of age at diagnosis.During the diagnostic phase of the temporomandibular dysfunction arthroscopy protocol, the parameters “synovitis” and “chondromalacia” were collected for the evaluation of the synovial membrane and joint surface, respectively. The presence or absence of adhesions and/or disc perforation was also analysed. Regarding the clinical outcome of the treatment of patients, pain during mandibular function, maximum inter-incisal opening, protrusive movement, and laterality in contralateral direction to the joint involved, were considered as study variables. These data were collected at 3, 6, 9, 12, and 24 months after the surgery.Data analysis was based on a one-way variance analysis for quantitative variables and the χ2 test for the study of qualitative variables. The values were considered significant for a p<.05. ResultsThe study population included 162 patients (Group A 90 patients, group B 72 patients). Pathological findings of advanced-stage synovitis and chondromalacia were more frequent for group B, with statistically significant differences, while findings of disc adhesions and perforation did not differ between both groups. After TMJ arthroscopy, a significant decrease in pain (from the first postoperative month) was observed, together with a significant increase in maximum inter-incisal opening (from 3 months post-surgery follow-up) in both study groups. The rate of patients undergoing re-arthroscopy or open joint surgery in post-surgery follow-up was higher in Group A patients. ConclusionsArthroscopic treatment of temporomandibular dysfunction in advanced stages of the disease shows a clinical improvement in patients over and under 45 years of age. Patients over 45 years of age showed intra-articular pathological changes corresponding to both synovitis and chondromalacia in more advanced phases. In contrast, these older patients did not show a higher incidence of other signs of joint degeneration, such as adhesions or disc perforation. Patients over 45 years of age did not have any differences in the percentage of failure and/or re-operation after arthroscopic treatment of temporomandibular dysfunction, compared to younger patients.