title: Efficacy of arthroscopic surgery and midlaser treatments for chronic temporomandibular joint articular disc derangement following motor vehicle accident.
abstract: As a result of motor vehicle accident soft-tissue injury, temporomandibular joint articular disc derangement may develop and persist despite symptomatic treatment and medication. This study reports the effectiveness of management directed at controlling the TMJ and masticatory neuromuscular pain dysfunction with a TMJ/interocclusal stabilization appliance, specific biofeedback and ultrasound therapy. Following these conservative measures residual articular disc derangement was present in some subjects who were offered arthroscopic surgery and infrared midlaser with TMJ/occlusal stabilization. Twenty subjects with residual disc derangement were randomly selected into two groups with and without arthroscopic surgery, and analyses of variance made before treatment, 12 months after conservative procedures, 3 months following arthroscopic surgery and midlaser therapy and 3 years since commencement of management. Dependent variables compared were pain-discomfort, Clinical Dysfunction Index, articular disc derangement and maximal voluntary jaw opening. Conservative management alone provided significant reduction of pain-discomfort and clinical dysfunction, while arthroscopic surgery resulted in significant reduction in articular disc derangement. The midlaser with TMJ/occlusal stabilization maintained significant improvement in the variables (p < 0.01) for both groups. The common articular deviations in form found at arthroscopy were soft tissue alteration with hyperaemia, synovitis, synovial membrane and posterior attachment folding with connective tissue hyperplasia, and disc displacement with fibrous adhesions. The Global Status Score of pain behaviour compared with residual function, confirmed the presence of greater pain before treatment commenced.
authors.affiliation: Plastic Surgery and Maxillofacial Unit, Royal Perth Hospital.
authors.forename: D C
authors.initials: DC
authors.lastname: McNamara
authors.forename: I
authors.initials: I
authors.lastname: Rosenberg
authors.forename: P A
authors.initials: PA
authors.lastname: Jackson
authors.forename: J
authors.initials: J
authors.lastname: Hogben
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000704:Analysis of Variance; D001182:Arthroscopy; D001676:Biofeedback, Psychology; D003131:Combined Modality Therapy; D003238:Connective Tissue / Q000473:pathology; D004724:Endoscopy; D005157:Facial Pain / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006940:Hyperemia / Q000601:surgery; D006965:Hyperplasia; D007259:Infrared Rays; D004204:Joint Dislocations / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery / Q000628:therapy*; D053685:Laser Therapy; D008297:Male; D008334:Mandible / Q000503:physiopathology; D017090:Occlusal Splints; D016059:Range of Motion, Articular; D017695:Soft Tissue Injuries / Q000150:complications; D013583:Synovial Membrane / Q000473:pathology; D013585:Synovitis / Q000601:surgery; D019224:Temporomandibular Joint Disc / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D000267:Tissue Adhesions / Q000601:surgery; D014464:Ultrasonic Therapy