(68) Retrospective Analysis of the Effects of Open Temporomandibular Joint Arthroplasty With Disc Repositioning

Abstract:

Purpose: Temporomandibular joint (TMJ) arthroplasty with disc repositioning is a procedure utilizing bone-borne suture to reconstruct the lateral and posterior discal ligaments. Recent meta-analysis showed open TMJ procedures, including disc repositioning, to be more effective than conservative therapy.1 Still, a lack of quantifiable data is available for evaluation of this technique and for the development of treatment guidelines.2 This retrospective study evaluates pain and mandibular range of motion in 25 patients with MRI-proven internal TMJ derangement treated with disc repositioning treated at our center.Materials and methods: A total of 25 patients were included in this study. Patient demographics can be seen in Table 1. All patients suffered from painful internal TMJ derangement prior to surgery. Range of motion data were collected preoperatively and at an average postoperative time of 31.7 months. Four parameters were assessed: maximum incisal opening (MIO), maximum protrusion, and right and left laterotrusion. Pain was assessed at the postoperative visit using the Graded Chronic Pain Scale, a validated instrument included in the diagnostic criteria for temporomandibular disorders[3].

Results: Postoperative range of motion testing showed the following average values:MIO = 39.92 mm (range 30-51 mm); protrusion = 7.36 mm (range 4-11 mm); right laterotrusion = 6.39 mm (range 4-9 mm); left laterotrusion = 5.83 mm (range 3-8 mm).Average change in MIO from pre- to postsurgery was: +5.28 mm (range -10 - +22). Sixteen patients reported a chronic pain grade of zero, while 6 patients scored Grade I. Three patients reported a Grade II pain score following surgery. Two patients required re-operation due to persistently painful and radiographically evident worsening TMJ disease. Both patients were treated with total joint replacement.

Discussion: Management of painful internal TMJ derangement remains controversial in both surgical and dental literature. Our center advocates for an orthopedic approach to correcting improper TMJ form and function. Data in these 25 patients show disc repositioning to be an effective surgery in properly selected patients. Questions remain concerning limitations of the surgery, specifically when is repair no longer viable and joint replacement clearly indicated. In the 2 patients requiring re-operation, one showed signs of moderate osteoarthritic changes on preoperative imaging. In the second patient, the right mandibular condyle was notably smaller than the left prior to undergoing bilateral disc repositioning. The right joint would later undergo replacement along with definitive orthognathic surgery. Of note, the third patient reporting a pain score of Grade II had been lost to follow-up prior to query associated with this study. His symptoms have improved since initiation of orthodontics.

Conclusions: Preliminary findings in this study show open TMJ arthroplasty with disc repositioning to be an effective therapy for painful internal TMJ derangement. Additional patients will need to be included for further evaluation of this technique and to establish indications and limitations for its use. References1. Al-Moraissi EA, Wolford LM, Ellis E, Neff A. The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials. Journal of Cranio-Maxillofacial Surgery. 2020;48(1):9-23. doi:10.1016/j.jcms.2019.10.0042. Bielajew BJ, Donahue RP, Espinosa MG, et al. Knee orthopedics as a template for the temporomandibular joint. Cell Rep Med. 2021;2(5). doi:10.1016/j.xcrm.2021.1002413. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014;28(1):6-27. doi:10.11607/jop.1151

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