Temporomandibular Joint Discectomy in Patients With Disc Displacement: Assessment of Osteoarthritis at 10- and 30-Year Follow-Up.

Abstract

Few ≥ 10-year follow-up studies of temporomandibular joint (TMJ) discectomy without replacement in patients with disc displacement (DD) analyse the relationship between the surgery and osteoarthritis (OA) exist. To radiologically evaluate bony joint changes and OA development 10 and 30 years after TMJ discectomy as well as 30-year clinical outcome. Twenty-two discectomy patients at the University of Oslo, Norway, with records confirming initial TMJ diagnosis and attendance of 10-year radiological follow-up were evaluated and eligible for 30-year follow-up. Primary variables: discectomy and CT-/CBCT-diagnosed OA at follow-ups. Secondary variables: perioperative TMJ diagnoses and remodelling at follow-up. Unoperated TMJs (Unop-TMJs) in unilaterally operated patients were controls. Statistical association and correlation analyses were performed for the 10-year follow-up (significance level p < 0.05). Twenty-two patients attended the 10-year follow-up (mean follow-up 11 years) with 27 operated TMJs (Op-TMJs) and 17 Unop-TMJs. OA perioperatively was associated with DD without reduction (p = 0.001) and additional disc abnormalities (p = 0.016). Although statistically non-significant, the number of TMJs with OA had increased at 10-year follow-up (p = 0.114, Op-TMJs: 14 to 20 joints; Unop-TMJs: 2 to 5 joints). Remodelling was correlated with discectomy (p = 0.003) and to OA (p = 0.006). Nine patients attended the 30-year follow-up (mean follow-up 32 years, 11 Op-TMJs). All TMJs with OA at 30-year follow-up had OA at 10-year follow-up. Mean maximal interincisal opening was 39 mm. No DC-TMD-diagnosed arthralgia was found. Osteoarthritis developed similarly between Op- and Unop-TMJs. Only remodelling, not OA, was correlated to the surgery. The clinical results were still favourable at final follow-up.