Surgical classification for temporomandibular joint disorders

The American Society of Temporomandibular Joint Surgeons (ASTMJS) would like to express an opinion regarding a recently published paper by Dimitroulis, entitled ‘A new surgical classification for temporomandibular joint disorders’. Although it is published as a research paper we were dismayed to find it presented not new knowledge, but rather the author’s opinion on classifying temporomandibular joint (TMJ) disease. Worse, instead of drawing meaningful distinctions between disease states, the proposed classification scheme lumps widely disparate conditions together without regard to their underlying pathogenesis. Sadly, this both illustrates and perpetuates the fallacious thinking that has confounded the diagnosis and treatment of temporomandibular disorders for over a century.

Orthopaedic surgery uses multiple classifications for the distinct disease families associated with muscles, joints, tendons, etc. That specialty recognizes the importance of combining basic science knowledge of joint disease with measurement scores for pain, alteration of function, and imaging grading. Under Dr. Dimitroulis’s scheme, patients with post-traumatic ankylosis, Wilkes Stage V internal derangement, and severe oromandibular dystonia might all be lumped into a single category. Classification of disease should serve to illuminate distinct conditions, their causes and their best management, not to confound them!

Furthermore, we would expect Dr. Dimitroulis to be aware of the wide variety of research papers delineating recent progress in our knowledge of TMJ dysfunction and disease. For example, the role of chemical mediators seems to be as relevant to some joint diseases as disc position, shape, or integrity. Unfortunately, his classification serves only to perpetuate mechanistic approaches to diagnosis and management of temporomandibular disorders. The experience of the past 150 years in the diagnosis and management of chronic orofacial pain and TMJ disorders has shown that ignoring basic joint biology and taking a narrow, mechanically minded approach focused on occlusion or disc position has produced iatrogenic harm in the form of unnecessary equilibrations, extractions, restorations, and operations. Espousing this proposed classification would only perpetuate such thinking and will not move us forward to more scientific, orthopedically based management of temporomandibular disorders.

The ASTMJS, in conjunction with its sister European and British societies, is embarking on a concerted effort to develop a modern, scientific, evidence-based orthopaedic classification of TMJ disorders for the benefit of their members, the specialty, and most importantly, patients. We would be delighted to actively participate at a consensus conference including all communities of interest in this subject to discuss the future basic and clinical science research required to enhance such a classification system. In the meanwhile, we are disappointed that a major journal published a scheme that so badly misses the mark.



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Jan 24, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Surgical classification for temporomandibular joint disorders
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