Preliminary Clinical Experience and Outcome of the TMJ Arthroscopic Chemical Contracture Procedure in Dislocation Patients

• Statement of the problem:

Among the various temporomandibular joint dysfunction entities, the dislocation term can be related to one of 2 structures. First is the articular disc as in Wilkes II, III categories. Secondly is the condyle as in the mandibular dislocation/ subluxation cases. The safety and efficiency of minimally invasive arthroscopic posterior capsulorrhaphy and contracture procedure has been established in the literature using laser or electrothermal devices to create a scar tissue along the oblique protuberance of the retrodiskal synovium. This structure has a greater number of collagen fibers than the rest of the superior lamina of the retrodiskal pad. The scar will inhibit forward motion of the disk and mandibular condyle by second-stage healing and scar contracture.

The current study aims to introduce an innovative safe, simple, and effective arthroscopic retrodiskal chemical contracture technique to treat Wilkes II, early III and hypermobility patients.

This procedure includes arthroscopically deposited sclerosing agent namely sodium tetradecyl sulfate, being injected into the retrodiscal tissue to reduce laxity via scar formation, and to destroy potential vascular inflammatory pathways with accompanying nerve supply causing the pain.  This chemical has been employed for different reasons in vascular and orthopedic literatures.

• Materials and methods:

A prospective evaluation of a total of 39 patients suffering from internal derangement (ID) of TMJ with Wilkes classification II, III and /or mandibular dislocation were selected. These patients underwent TMJ arthroscopic chemical contracture surgical procedure, where a sclerosing agent was injected in several spots lateral to and into the oblique protuberance in the retrodiscal tissue after confirmation of and/or manual disc reduction, in order to form a scar that will inhibit forward motion of the mandibular condyle and disk by second stage healing and contracture of the scar.  Those procedures were performed in Baptist Hospital, Miami, Florida, USA; starting from January 2011 to January 2014.

• Methods of data analysis:

This study was assessed through the general outcome of the arthroscopic chemical contracture procedure using clinical assessment in terms of range of mandibular motion (ROM), pain on loading (Joint Loading sign) and functional jaw pain was evaluated by using a visual analog scale (VAS) ranging from 0 to 100, over an average of 179.97 +/- 160.05 days follow up period.

Statistical analysis was performed using SPSS version 20.

Continuous data was represented as mean +/- standard deviation. Categorical data was represented as frequencies and percentages. Paired t-test was used to compare continuous variables, chi square and McNemar tests were used to compare categorical variables.

• Results:

There was a statistical significant improvement in the outcome of arthroscopic chemical contracture procedure in regards of TMJ pain and function as well as ROM. (P=0.002)

Current study also showed statistical significant improvement in joint loading sign, joint and muscle pain as well as the need for medications.

Also, the study showed a decrease in the joint noises after the procedure but was statistically insignificant. (P= 0.61)

No complications were encountered from the procedure.

• Conclusions:

The present study showed preliminary results that advocates the safety and efficiency of the arthroscopic chemical contracture procedure as an innovative minimally invasive surgical treatment of the TMJ dislocation patients. Additional future more objective outcome analysis will be addressed with longer follow up periods.

• 2 References:

• Daniel E. Torres, Joseph P. McCain. Arthroscopic electrothermal capsulorrhaphy for the treatment of recurrent temporomandibular joint dislocation Int. J. Oral Maxillofac. Surg. 2012; 41: 681–689.

• B. McAree, A. Ikponmwosa, K. Brockbank, C. Abbott, S. Homer-Vanniasinkam, M.J. Gough. Comparative Stability of Sodium Tetradecyl Sulphate (STD) and Polidocanol Foam: Impact on Vein Damage in an In-vitro Model. European Journal of Vascular and Endovascular Surgery. 2012; 43: 721-725.