La influencia de la superficie articular y la membrana sinovial en la evolución de pacientes afectos por bloqueo crónico de la articulación temporomandibular tratados mediante artroscopia

Abstract

Introduction Arthroscopy of the temporomandibular joint (TMJ) has been considered an effective technique to treat close lock (CL). The purpose of this study is to evaluate if the status of the joint surface and the synovial membrane directly seen via arthroscopy can determine the post operative results of patients with chronic block of the TMJ. Patients and methods Two hundred and fifty-seven out of the 500 patients (344 joints) met the criteria for chronic block of the TMJ. One hundred and seventy-two patients with unilateral affectation were selected for this study. Synovitis and chondromalacia are the parameters chosen to evaluate the synovitis membrane and joint surface, respectively. Two groups of patients were formed: a) patients with light affectation: level I/II synovitis and level I/II chondromalacia, and b) patients with severe affectation: level III/IV synovitis and level III/IV chondromalacia. The dependent variables were pain and interincisal maximum oral opening (MOO). All of the patients had post operative follow-up at 1, 3, 6, 12, and 24 months. The “t” Student test was used before and after surgery to match evidence to compare the average values of visual analogical scale (VAS) and function (MOO). The “t” Student test was used for independent samples to compare the different groups that were established. A value of p ≤ 0.05 was considered statistically significant. Results Level I/II synovitis was seen using arthroscopy in 87 (50.58%) patients, and level III/IV synovitis was seen in 54 (31.39%) of patients, while level I/II chondromalacia was observed in 66 (38.37%) patients and level III/IV chondromalacia was observed in 54 (31.39%). During the follow-up period a significant decrease in pain and a parallel increase in oral opening were observed after arthroscopy in patients affected by level I/II and III/IV synovitis and level I/II and III/IV chondromalacia. There was a significant statistical difference in relation to observed pain in patients with level I/II synovitis and in patients with level III/IV synovitis in the sixth month after surgery. However this difference did not continue in the rest of the follow-up period. Nor were there any statistical differences related to the MOO related to synovitis during follow-up. There were no differences in pain or oral opening between patients with level I/II chondromalacia and patients with level III/IV chondromalacia at any time during follow-up. Even though the average levels of pain were less in the group of patients with level I/II synovitis and level I/II chondromalacia compared to the group of patients with level III/IV synovitis and level III/IV chondromalacia throughout follow-up, the difference was not statistically significant. In the same way, higher values of maximum oral opening were observed in the group with level III/IV synovitis and level III/IV chondromalacia, but this difference was no statistically significant either. Conclusions After arthroscopic surgery on the TMJ there was a significant decrease in pain as well as a significant increase in MOO one month after surgery in those who suffered any type of synovitis and/or chondromalacia. After TMJ arthroscopic we did not observe any statistically significant differences in terms of pain and function between patients with light joint surface and synovial membrane affectation and those who had severe joint surface and synovial membrane affectation.