Purpose: Although indications for the surgical treatment of internal derangement of the temporomandibular joint (TMJ) and the choice of treatment are debated, arthroscopy seems generally accepted as a minimally invasive alternative. The objective of this study was to investigate various factors and their possible correlation with an unsuccessful outcome of arthroscopic lysis and lavage in patients diagnosed with chronic closed lock, arthralgia with or without concomitant osteoarthritis of the TMJ, or systemic rheumatologic disease with involvement of the TMJ.
Materials and methods: A retrospective analysis of 224 operations was conducted to identify pre-, peri-, and postoperative factors correlated with an adverse outcome. Criteria for success were maximum interincisal opening (MIO) of at least 35 mm and self-graded joint pain on a 10-point visual analog scale no higher than 3.
Results: Surgical outcome was graded as successful (n = 150; 67%), improved (n = 16; 7%), minor or no improvement (n = 55; 25%), or worse (n = 3; 1%). Preoperative factors that correlated with a negative outcome were the presence of psychiatric disorders (P = .0333), high self-graded global pain (P = .0320), bilateral muscle tenderness at palpation (P = .0309), and small MIO (P = .0018). For patients with systemic arthritis, younger age was correlated with an unsuccessful outcome (P = .0317).
Conclusion: The results indicate that psychiatric comorbidities, high self-graded global pain, bilateral masticatory muscle tenderness, and small MIO predict an unsuccessful outcome after arthroscopic lysis and lavage. These factors could be indicators for chronic pain disorders, including chronic myofascial pain, increased pain sensitivity, and decreased coping abilities, associated with a poor outcome.
Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.