Comparison of Results of Temporomandibular Joint Arthroscopic Surgery in Younger Vs Older Patient Groups

Epidemiologic studies have reported temporomandibular disorders (TMDs) to have a peak prevalence between ages 20-40, with a lower prevalence in older individuals.¹  Patients with significant symptoms due to disc displacement tend to be younger (mean age 32.7) compared to those with degenerative joint disease (mean age 54.2).²   According to the American Society of Temporomandibular Joint Surgeons, patients seeking surgical care are on average, age 30.  There is a paucity of information concerning the effect of the age of the patient as it relates to outcomes of surgical intervention, arthroscopic diagnoses, and presence of systemic joint disorders (eg. rheumatoid arthritis, psoriatic arthritis, chondrocalcinosis, etc.).  The goal of this investigation was to compare younger and older age groups undergoing TMJ arthroscopy with respect to the following variables:  presence/absence of systemic joint disorders, arthroscopic diagnoses, and the outcomes of TMJ arthroscopic surgical intervention. 

The study population consisted of 103 patients diagnosed with internal derangement and severe inflammatory/degenerative temporomandibular joint disease (Wilkes II-V) and failed non-surgical management who underwent temporomandibular joint operative arthroscopy, including removal of adhesions, pathologic tissue with motorized shaving, disc mobilization, and direct injection of steroid.  The mean follow-up period was 7.8 months.  Patients were divided into 2 groups based on age:  YOUNG (Group Y); age less than 40, n=51) and OLDER (Group O); age greater than 40, n= 52).  Group Y and Group O were compared for the presence/absence of systemic joint disease, and arthroscopic findings of synovitis and osteoarthritis  (chi square).  Patient outcomes were based on changes in preoperative and postoperative pain (VAS=visual analog scale) and maximum interincisal opening (MIO) distance (student t-test).    

Group Y had systemic joint disease in 18% and Group O in 25 % of patients, demonstrating no significant difference (p=0.23).  Arthroscopic synovitis was similar in both groups being present in Group Y(86.2%), and Group O(86.9%).  Arthroscopic osteoarthritis was significantly more prevalent (p<0.01) in Group O (58%) compared to Group Y (17.6%).   There was significant improvement in pain in Group Y (preoperative 6.8+1.7, postoperative 3.3+2.9, p<0.01) as well as in Group O (preoperative 6.2+2.5, postoperative 1.9+2.4, p<0.01).  There was significant improvement in MIO in Group Y (preoperative 31.2mm+7.8, postoperative 40.8mm+7.1mm, p<0.01) as well as in Group O (preoperative 29.7mm+7.7, postoperative 39.4mm+6.3, p<0.01).  The postoperative pain level for Group Y was 3.33+2.79 compared to Group O 1.91+2.40 and this difference was significant (p<.05).   However, when comparing whether there were significant differences in the degree of pain improvement between Group Y (3.45+3.05) and Group O (4.42+2.93) this difference was not significant (p=0.10).  When comparing the degree of improvement in MIO (Group Y 10.27mm+9.35, Group O 9.45mm+6.01) there were no significant differences.

This study demonstrates that arthroscopic surgery is effective in both young and older patient populations providing significant improvement in pain and MIO. A significant difference between the young and old groups is that, as expected, the older group had a significantly higher prevalence of arthroscopically diagnosed osteoarthritis.  A surprising finding was that postoperatively the older group had significantly lower pain levels than the younger group.  An important finding is that approximately half of our patients undergoing arthroscopic surgery were in the older age group demonstrating that significant temporomandibular joint disorders do not necessarily occur in only younger patient populations.     

References

1. LeResche L, Drangsholt M.  Epidemiology of orofacial pain:  prevalence, incidence and risk factors. Editors: Sessle BJ, Lavigne GL, Lund JP, Dubner R. editors.  Orofacial pain.  From basic science to clinical management. 2^nd ed.  Chicago:  Quintessence Publishing:  2008, p. 13-8.
2. Manfredini D, Piccotti F, Ferronato G, Guarda-Nardini Luca. Age peaks of different RDC/TMD diagnosis in a patient population. Journal of Dentistry 38 (2010:) 392-399.