Unilateral temporomandibular joint discectomy without interposal material in patients with disc perforation or fragmentation: a prospective study

Ângelo, David Faustino; Sanz, David; Cardoso, Henrique José

http://hdl.handle.net/10400.26/40174

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Authors

Ângelo, David Faustino

Sanz, David

Cardoso, Henrique José

Abstract(s)

Objective: Temporomandibular joint (TMJ) discectomy is one of the most popular surgical techniques for patients with an unsalvageable disc. Previous studies have demonstrated predictable results of dis-cectomy with optimal results in pain reduction and maximum mouth opening (MMO) improvement.However, those studies had most of the times wide-ranging inclusion criteria. This study was thereforeconducted to assess the role of unilateral TMJ discectomy in a well defined diagnosis.Methods: A 6-year prospective study was designed including patients treated with unilateral TMJ dis-cectomy without interposal material, preserving condyle and temporal fibrocartilage, for two specificintra-articular diagnosis: disc perforation and disc fragmentation.Results: A total of 19 patients were enrolled, with a mean age of 51.05 ± 13.71 (mean ± SD) years.Preoperative pain was 7.63 ± 1.89 (mean ± SD), MMO was 25.95 ± 10.27 mm (mean ± SD) and muscletenderness (MT) was 2.53 ± 0.77 (mean ± SD). The most common diagnosis was disc perforation. Afteran average of 37.9 months of follow-up time (range from 10 to 71 months), a statistically significant improvement of pain (P < 0.0001), MMO (P < 0.0001) and MT (P = 0.00011) was observed. Postoperatively,16 of 18 patients (89 %) showed a reduction in pain and improvement in MMO, fulfilling the criteria fora successful outcome of TMJ surgery. No second surgery was necessary. Conclusion: Unilateral TMJ discectomy without interposal material in patients with disc perforation or fragmentation seems to be an adequate technique. However, we encourage rigorous long-term studiesand new preclinical trials to pursuit a disc substitute, as relevant preclinical trials have demonstrated significant degenerative changes after TMJ discectomy.