The ESTMJS (European Society of Temporomandibular Joint Surgeons) Consensus and Evidence-Based Recommendations on Management of Condylar Dislocation.

Andreas Neff ,Ulla Vieth ,Mattias Ulmner ,Andrew J Sidebottom ,Luke Cascarini ,Hadas Lehman ,Florencio Monje ,Orhan Güven ,Frederik Spijkervet ,Nadeem Saeed ,Merle Riechmann ,B Speculand ,Esben Aagaard ,Louis G Mercuri ,Salvatore Sembronio ,Christian Wilms ,J Fernández Sanromán ,Constantinus Politis ,Maurice Y Mommaerts ,Gerhard Undt ,Niall Mcleod ,Bernard Bonte ,Andreas Kolk ,Vladimír Machoň ,Giovanni Gerbino ,Fabrizio Spallaccia ,David Faustino Ângelo ,Dušan Hirjak ,Carrol P Saridin ,Linda Skroch

doi:10.3390/jcm10215068

Abstract

Although condylar dislocation is not uncommon, terminology, diagnostics, and treatment concepts vary considerably worldwide. This study aims to present a consensus recommendation based on systematically reviewed literature and approved by the European Society of TMJ Surgeons (ESTMJS). Based on the template of the evidence-based German guideline (register # 007-063) the ESTMJS members voted on 30 draft recommendations regarding terminology, diagnostics, and treatment initially via a blinded modified Delphi procedure. After unblinding, a discussion and voting followed, using a structured consensus process in 2019. An independent moderator documented and evaluated voting results and alterations from the original draft. Although the results of the preliminary voting were very heterogenous and differed significantly from the German S3 guideline (p < 0.0005), a strong consensus was achieved in the final voting on terminology, diagnostics, and treatment. In this voting, multiple alterations, including adding and discarding recommendations, led to 24 final recommendations on assessment and management of TMJ dislocation. To our knowledge, the ESTMJS condylar dislocation recommendations are the first both evidence and consensus-based international recommendations in the field of TMJ surgery. We recommend they form the basis for clinical practice guidelines for the management of dislocations of the mandibular condyle.

Highlights

Dislocation of the temporomandibular joint (TMJ) is not a rare event, with an estimated incidence of up to 25 of 100,000 population per year [1] and a lifetime prevalence of5–8% [2,3,4]
Updated searches that fed into the evidence presented in the German Guidelines identified a further 34 articles
We evaluated the changes between Strength of Consensus (SoC) and grade of recommendation (GoR) in the preliminary voting and the approved final version of recommendations

Summary

Introduction

Dislocation of the temporomandibular joint (TMJ) is not a rare event, with an estimated incidence of up to 25 of 100,000 population per year [1] and a lifetime prevalence of. 5–8% [2,3,4] Despite these diagnostics, treatment concepts vary considerably worldwide, and there is a general lack of agreement on even the basic terminology regarding dislocation of the TMJ. There is evidence-based German guidelines on dislocation of the TMJ [1,5], there are none that are widely accepted internationally. In May 2019, members of the European Society of TMJ Surgeons (ESTMJS) discussed and agreed on recommendations concerning the management of TMJ dislocation. The aim of our study is to present a state-of-the-art consensus approach to TMJ dislocation based on current literature and practical experiences of the ESTMJS members internationally

Objectives

Methods

Results

Discussion

Conclusion