We retrospectively reviewed the outcomes of one surgeon’s experience over 7 years of open surgical management of TMD following failure to respond to arthroscopy to identify which patients benefit from the intervention. Surgical intervention was for pain, restriction and locking and included discectomy, disc plication, eminectomy, eminoplasty and adhesiolysis according to clinical findings. 71% of the patients reported improvement in pain score with 61% reporting an improvement in mouth opening 12 months post-operatively. 38.7% of the patients ultimately needed TMJ replacement. This group included 83.3% of the patients in Wilkes’ stage IV or above, 71.4% of the patients with a pre-operative pain score 90–100 and 50% of the patients with pre-operative mouth opening 20–29 mm. Open surgical management of the TMJ can benefit patients despite prior failure of arthroscopy in the management of TMJ pain, restriction and locking. Arthroscopy seems to significantly decrease the percentage of patients that need treatment with open TMJ surgery, but also the success of subsequent surgery. TMJ replacement is increasingly used to successfully treat end stage disease. These results may be used during consent for open TMJ surgery, especially if there is considered to be a high risk of subsequently requiring TMJ replacement.
Outcomes of open TMJ surgery following failure to improve after arthroscopy: is there an algorithm for success?
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