New criteria demonstrate successful outcomes following temporomandibular joint (TMJ) arthroscopy

Abstract

Purpose Outcomes of temporomandibular joint (TMJ) surgery, including TMJ arthroscopy, use both subjective and objective criteria based on changes in pain and maximum interincisal opening (MIO). TMJ arthroscopy has reported success rates of 80% to 90%.1,2 Studies have demonstrated an increase in MIO may not be accompanied by reduction in pain, and conversely, reduction in pain may result without an increase in MIO. The purpose of this study was to determine whether the use of a MIO-pain change measurement/index that provides equal weight to objective changes in MIO and subjective changes in pain would more accurately reflect the results of surgery. Methods The study included 102 patients with internal derangement and severe inflammatory/degenerative TMJ disease (Wilkes II–V) that failed nonsurgical management and underwent arthroscopy. All patients underwent advanced operative arthroscopy, including removal of adhesions, debridement and biopsy of pathologic tissues, disk mobilization, and injection of steroid medication into inflamed synovium under direct vision. Surgical outcomes (successful vs unsuccessful) were based on a MIO-pain change measurement/index that provided equal weight to objective changes in MIO and subjective changes in pain (visual analogue scale [VAS]). Preoperative pain and MIO changes were compared to postoperative pain and MIO changes, and comparisons between the more successful and the least successful TMJ arthroscopic results were performed (t test). To determine if there were any significant predictive differences in the successful and unsuccessful groups, the following variables were compared: gender, age, arthroscopic findings, magnetic resonance imaging (MRI) findings, and MIO-pain changes. Results The mean postoperative follow-up period was 7.9 months. Comparison of the groups with respect to the combined MIO-pain change index demonstrated significant differences between the successful group (SG) (1.2338 + 0.5588) and the unsuccessful group (UG) (0.15010 + 0.3418) (P Conclusion This study demonstrated similar successful outcomes following TMJ arthroscopy as previous reports. There were no major predictive differences between the SG and the UG, although the mean age of the SG was older than the UG. This study demonstrated that the outcomes of arthroscopy must consider the importance of establishing an accurate diagnosis (atypical intra-articular pathology and systemic disease), which can alter the course of treatment. Importantly, using an outcome measurement with equal influences of pain and MIO changes, may provide a more accurate depiction of the effects of surgery.