The aim of this paper is to describe the clinical and arthroscopic findings in a group of patients with perforation in the temporomandibular joint disc.
A total of 450 arthroscopies in 340 patients were made over a period of 12 years (1998–2010). A group of 38 patients, in whom disc perforations were found, was studied and compared different clinical, arthroscopic and follow-up parameters.
92% of the patients were female. Average age was 43 years old. In four patients was found bilateral disk perforation. In all cases lysis-lavage of the joint was performed. Most patients had preoperative pain, clicking and limitation of mouth opening; 50% of them reported associated bruxism. Arthroscopy showed that, in 60% of them, the articular disc was reduced and in 40% displaced. Chronic disk perforation was more frequent and was mainly located in the central position of the disk. In two thirds of them synovial joint inflammation corresponded to Holmlund grade III–IV, in 80% adhesions were seen. Cartilage degeneration was advanced with the presence of osteophytes and loose bodies. The evolution of all patients was favorable except of two cases.
Disc perforations are not a common arthroscopic finding (8.3%). They are often associated with osteoarthritis and advanced joint anterior disk displacement without reduction and not always associated to clinical advanced stages. Patients evolved favorable with regression of symptoms and restoration of joint function. Despite the good results, it would require further studies to determine the usefulness of open surgery in the treatment of disc perforations.
Conflict of interest: None declared.