Prognostic Factors Associated with Arthroscopy Success in the Treatment of Temporomandibular Joint Internal Derangement
The authors implemented a retrospective cohort study and enrolled a sample composed of subjects diagnosed with having an abnormality in the relationship between the disc and the other components of the joint (TMJID), and underwent arthroscopy between 2004 and 2011. Presenting factors that were considered and analyzed were age, sex, duration of symptoms, preoperative and postoperative pain, preoperative and postoperative maximum interincisal opening (MIO), radiographic and magnetic resonance imaging findings. Other factors considered were history of systemic disease, trauma or orthognathic surgery, parafunction, appliance therapy, orthodontic treatment, and use of narcotic or psychoactive medication. Successful treatment was defined as a decrease in pain with no change or improved MIO or improvement in MIO with no change in pain. Unsuccessful treatment was defined as any increase in pain or any outcome that resulted in no improvement in either pain or MIO. Student’s t-tests and Fisher’s exact tests were used to analyze the data.
The study sample was composed of 118 joints. Eighty-five joints had a successful outcome (72%). Post-operative MIO was significantly greater for the successful cases (36.9 ± 7.9 mm) than the unsuccessful cases (27.8 ± 10.3 mm) (P <0.05). Pre-operative pain was significantly lower for the unsuccessful group (4.7 ± 2.5) than the successful group (5.8 ± 2.5) (P < 0.05). Post-operative pain was also significantly lower for the successful joints (2.8 ± 2.4) than the unsuccessful cases (5.4 ± 2.2) (P < 0.05). The mean age for subjects in the successful group (40.6 ± 13.1 years) was significantly greater than the unsuccessful group (32.6 ± 9.6 years) (P < 0.05). Radiographic evidence of remodeling of the mandibular condyle was significantly greater in successful cases (P < 0.05). All other factors were statistically similar between the successful and unsuccessful groups.
The severity of pre-operative pain, older age, and remodeling of the mandibular condyle may be prognostic factors associated with a successful outcome of arthroscopy treatment for the TMJID. Immediate post-operative improved MIO was also seen in successful cases. Better understanding of factors associated with success may help in case selection and optimize improved outcome.
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