Bilateral arthroscopy of the temporomandibular joint: clinical outcomes and the role of a second intervention-a prospective study

David Faustino Ângelo; David Sanz; Henrique José Cardoso

doi:10.1007/s00784-023-05233-6

Bilateral arthroscopy of the temporomandibular joint: clinical outcomes and the role of a second intervention-a prospective study

Clin Oral Investig. 2023 Oct;27(10):6167-6176. doi: 10.1007/s00784-023-05233-6. Epub 2023 Aug 26.

Authors

David Faustino Ângelo^{1

2

3}, David Sanz⁴, Henrique José Cardoso⁴

Affiliations

¹ Instituto Português da Face, Rua Tomás Ribeiro, nº71, 5º andar, 1150-227, Lisboa, Portugal. david.angelo@ipface.pt.
² Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028, Marinha Grande, Portugal. david.angelo@ipface.pt.
³ Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal. david.angelo@ipface.pt.
⁴ Instituto Português da Face, Rua Tomás Ribeiro, nº71, 5º andar, 1150-227, Lisboa, Portugal.

PMID: 37632580
DOI: 10.1007/s00784-023-05233-6

Abstract

Objective: Evaluate the efficacy of bilateral temporomandibular joint (TMJ) arthroscopy in patients with different categories of severity based on Dimitroulis classification (categories 2-4) and the role of a second TMJ intervention in primary failure.

Methods: A 3-year prospective study was designed, including patients submitted to bilateral TMJ arthroscopy. The primary outcome was TMJ pain (VAS, 0-10) and the secondary outcomes were the maximum mouth opening (MMO) and masticatory myalgia degree (0-3). In cases of symptomatic relapse, a second TMJ intervention was performed (TMJ arthrocentesis or TMJ open surgery).

Results: Eighty patients (93.4% women) were enrolled, with a mean age of 32.40 ± 11.41 years. With an average follow-up of 523.7 days (34-1606), a statistically significant improvement in TMJ pain, MMO, and myalgia degree was observed (P < 0.0001). The overall successful outcome of one-single bilateral arthroscopy was ~ 69%. Twenty-two patients relapsed: (1) arthralgia (n = 15, 68.18%); (2) arthralgia + myalgia (n = 4, 18.18%); (3) dislocated disc without reduction (DDwoR) (n = 2, 9.09%); (4) DDwoR + osteoarthrosis (OA) (n = 1, 4.55%). Arthralgia was re-managed with TMJ arthrocentesis with local anesthesia (n = 19, 86.36%). New DDwoR with or without OA was re-treated with TMJ open surgery (n = 3, 13.64%). After the second intervention, the success rate increased to 85%.

Conclusions: Bilateral TMJ arthroscopy presented overall benefit in all parameters evaluated.

Clinical relevance: This study highlights the importance of TMJ arthroscopy as the first line of treatment for moderate-severe temporomandibular disorders cases contributing to the reduction of TMJ open surgeries. In cases of arthroscopy unsuccess, TMJ arthrocentesis under local anesthesia was an effective and safe intervention for patients with recurrent TMJ arthralgia.

Keywords: Arthralgia; Arthroscopy; Minimally invasive surgical procedures; Myalgia; Pain; Temporomandibular joint disorders.