Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mattias Ulmner, Carina Kruger-Weiner, Bodil Lund
PurposeAlthough indications for surgical treatment of internal derangement of the temporomandibular joint (TMJ) and choice of treatment is debated, arthroscopy seems generally accepted as a minimally invasive alternative. The objective with this study was to investigate various factors and their possible correlation to an unsuccessful outcome of arthroscopic lysis and lavage on patients diagnosed with chronic closed lock, arthralgia with or without concomitant osteoarthritis of the TMJ, or systemic rheumatologic disease with involvement of the TMJ.MethodsA retrospective analysis of 224 operations was made to identify pre-, peri-, and postoperative factors correlated to adverse outcome. Criteria for success was maximum interincisal opening (MIO) of ≥ 35 mm and self-graded joint pain on a 10th graded visual analog scale (VAS) as ≤ 3.ResultsThe outcome of surgery was grouped as either successful (n=150, 67%), improved (n=16, 7%), minor or no improvement (n=55, 25%) or deteriorating (n=3, 1%). Preoperative factors correlated to a negative outcome were: presence of psychiatric disorders (p=0.0333); high self-graded global pain (p=0.0320); bilateral muscle palpation tenderness (p=0.0309); low MIO (p=0.0018). In systemic arthritis patients at younger age was correlated to un-successful outcome (p=0.0317).ConclusionThe results indicate that psychiatric co-morbidities, high self-graded global pain, bilateral masticatory muscle tenderness and a low MIO, seems to predict for an unsuccessful outcome after arthroscopic lysis and lavage. A potential explanation could be that these factors may be possible cofounders for chronic pain disorders including chronic myofascial pain, increased pain sensitivity, and decreased coping abilities associated with poor out-come.
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