Unsuccessful Temporomandibular Joint Arthroscopy: Is a Second Arthroscopy an Acceptable Alternative?

Mancha de la Plata, Maria; Muñoz-Guerra, Mario; Escorial Hernandez, Veronica; Martos Diaz, Pedro; Gil-Diez Usandizaga, Jose Luis; Rodriguez-Campo, Francisco J.

doi:10.1016/j.joms.2008.06.043

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 66, Issue 10 , Pages 2086-2092, October 2008

Unsuccessful Temporomandibular Joint Arthroscopy: Is a Second Arthroscopy an Acceptable Alternative?

Maria Mancha de la Plata, MD
- Resident, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, Madrid, Spain
- Address correspondence and reprint requests to Dr Mancha de la Plata: C/ Araiz No. 16, 28023 Madrid, Spain
Mario Muñoz-Guerra, MD, PhD
- Staff Surgeon, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, Madrid, Spain
Veronica Escorial Hernandez, MD
- Staff Surgeon, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, Madrid, Spain
Pedro Martos Diaz, MD
- Staff Surgeon, Department of Oral and Maxillofacial Surgery, University Hospital Señora de la Candelaria, Santa Cruz de Tenerife, Spain
Jose Luis Gil-Diez Usandizaga, MD, DMD
- Staff Surgeon, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, Madrid, Spain
Francisco J. Rodriguez-Campo, MD
- Staff Surgeon, Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, Madrid, Spain

Purpose

Arthroscopic surgery has been shown to be an effective treatment for patients with temporomandibular disorders, relieving patients' symptoms and restoring adequate mandibular function. For those patients with poor arthroscopic outcomes, various treatment modalities are possible, such as nonsurgical therapy, open surgery, or repeat arthroscopic surgery. The purpose of this study was to evaluate our results with rearthroscopy in patients with temporomandibular joint dysfunction.

Patients and Methods

The clinical data and operative reports for 50 patients who underwent a second arthroscopic procedure from 1994 to 2004 were reviewed retrospectively. Outcome assessments were based on reductions in pain, measured using a visual analog scale, and improvements in maximal interincisal opening. The minimum follow-up period was 2 years.

Results

Significant differences were evident between presurgical and postsurgical pain at months 1, 6, 12, and 24. The mean score of preoperative pain on the visual analogue scale was 61.65 mm, which was reduced to 36.28 mm at 2-year follow-up. With regard to mandibular function, all patients presented with restricted mouth opening, with a mean preoperative maximal interincisal opening of 26.73 mm. Postoperatively, the maximal interincisal opening showed a statistically significant improvement (P < .05), and at 2-year follow-up, we obtained a total improvement of 7 mm. Only 8 patients (16%), who had an unsuccessful result after a second arthroscopy, underwent further surgical intervention (open surgery).

Conclusion

Arthroscopic surgery is a reliable and effective procedure for temporomandibular joint dysfunction that improves pain and mouth opening, with the advantages of being minimally invasive and repeatable. Repeat arthroscopic surgery, with a proven history of fewer complications, can be attempted before open arthrotomy.