SA1 - Clinical Outcomes of Arthroscopic Management in the Treatment of Advanced End-stage Internal Derangement Wilkes V Cases of the Temporomandibular Joint

On-demand

Figure 1 - A. Pre-operative region of articular disc perforation, fibrillations, chondromalacia. B. Post-operative photograph after advanced arthroscopic debridement, demonstrating smoothened articular surface, increased joint space, and removal of inflammatory tissues.

Figure 2 - Intraoperative Photographs of Operative Arthroscopic Debridement of an Internal Derangement Wilkes V Case.

Oral Abstract Presenter(s)

Christopher A. Fanelli, DDS, FRCDC

Surgical Fellow, Attending Staff Surgeon OMFS. Endoscopic Maxillofacial & Minimally Invasive Surgery
Massachusetts General Hospital - Harvard Medical School, Harvard School of Dental Medicine
Boston, Massachusetts

Disclosure: Nothing to disclose.

Co-Author(s)

Joseph P. McCain, DMD, FACS

Associate Professor. Director of TMJ Surgery. Fellowship Director
Massachusetts General Hospital - Harvard Medical School, Harvard School of Dental Medicine
Boston, Massachusetts

Disclosure: Nothing to disclose.

Abstract:

Purpose: Internal derangement of the temporomandibular joint (TMJ) is 1 of the most common forms of temporomandibular joint disorders. The clinical efficacy and patient outcomes associated with TMJ arthroscopy have been well-documented for articular disorders (I-IV) of internal derangement.1,2 No studies to date, however, have focused specifically on patient outcomes of arthroscopic management of end-stage articular disorder Wilkes V cases. The purpose of the present study was to evaluate the clinical outcomes of operative arthroscopic management of end-stage cases of internal derangement of the TMJ.

Patients and methods: This is a retrospective case series. Inclusion criteria were patients with internal derangement articular disorder Wilkes V, denoted by articular disc perforation, crepitation, pain, and associated degenerative bone changes such as erosion and flattening of the mandibular condylar head. Exclusion criteria were patients with pre-existing primary arthritis, patients with internal derangement articular disorders I-IV, and patients with psychiatric disorders. Outcome variables were maximum voluntary mouth incisal opening (MIO), visual analog scale assessment for patient self-reported pain, and jaw functional-limitation index scores (0-10). Other variables, including patient age and gender, were evaluated in relation to the outcomes.

Results: Thirty-seven patients with internal derangement articular disorder Wilkes V were identified in the study (total of 58 sides). Mean age was 40 years old (range 23 to 65 years old); 28 of the patients were female and 9 males. The mean preoperative MIO was 26mm, and the mean preoperative visual analog scale for pain and functional limitation scores were both 8 out of 10. Operative arthroscopic surgery was conducted (Figures 1 and 2). The mean duration of postoperative follow-up was 8 months (1.5-17 months). Postoperatively, mean MIO was 37mm (32-51mm range). Mean postoperative visual analog scale for pain and functional limitation scores improved to 3 and 2, respectively, out of 10.

Conclusion:
The results from the present study demonstrated that operative arthroscopic intervention effectively increases ROM, reduces pain, and improves functional limitation and jaw use in end-stage advanced internal derangement articular disorder Wilkes V of the TMJ. This work demonstrates the efficacy of this procedure in advanced degenerative end-stage internal derangement cases and is a viable treatment to preserve articular anatomy and improve joint function. Further continued multi-center rigorous study and evaluation is required to demonstrate the reproducibility of this technique and associated outcomes in the Wilkes V internal derangement patient population.

References:
1. McCain JP, Hossameldin RH, Srouji S, Maher A: Arthroscopic discopexy is effective in managing temporomandibular joint internal derangement in patients with Wilkes stage II and III. J Oral Maxillofac Surg 73(3):391-401, 2015

2. González-García R, Rodríguez-Campo FJ: Arthroscopic lysis and lavage versus operative arthroscopy in the outcome of temporomandibular joint internal derangement: a comparative study based on Wilkes stages. J Oral Maxillofac Surg 69(10):2513-24, 2011