Internal derangement (ID) is the clinical and pathological condition of disc displacement of the temporomandibular joint (TMJ). Treatment of symptomatic cases traditionally involved disc repositioning procedures or discectomy. However, the introduction of minimally invasive TMJ arthroscopy lead to successfull results. This was followed by the introduction of arthrocentesis that is particularly effective in cases of symptomatic closed lock. This manuscript aims to retrospectively analyse the value of our stepped surgical treatment approach (arthrocentesis as the first line of treatment, followed by arthroscopic lysis and lavage in unresolving cases) in unilateral symptomatic ID cases.
Methods: Case notes of patients referring to the Department of Oral Surgery for TMJ pain and dysfunction that were managed by the authors of this manuscript with a standard protocol over a period of three years (2007–2009) were retrospectively reviewed. An objective parametre (pain-free inter-incisal opening) and subjective parametres (spontaneous pain, pain on function, difficulty on chewing, perceived disability on jaw movements) were recorded pre-operatively and on post-operative reviews. Subjective parametres were rated on a scale of 4. Standard techniques were used for arthrocentesis and arthroscopic lysis and lavage. The results were statistically evaluated.
Results: Of the 1414 patients reviewed, 43 patients were surgically treated, and 33 were eligible for inclusion. Symptoms of 24 patients were completely or partially resolved after arthrocentesis, hence did not require further treatment, however 9 patients required arthroscopic lysis and lavage. The mean follow-up period was 15.5 months ( s = 5.8). Post-operatively, pain free maximum inter incisal opening values improved (paired t test; p < 0.001), and subjective parameter scores were recorded to be lower (Chi-square analysis; p = 0.000).
Conclusion: Utilizing conservative treatment modalities initially, followed by surgical treatment options in a stepped approach in refractory cases, improves patient compliance and reduces treatment costs.
Key words: temporomandibular joint disorders; arthrocentesis; TMJ arthroscopy