Long-term evaluation of arthroscopic discectomy of the temporomandibular joint using the Holmium YAG laser.
OBJECTIVE
The goal of this study was to evaluate the clinical results with arthroscopic discectomy using a Holmium YAG laser for treatment of patients with pain and dysfunction and large disc perforations resulting by advanced internal derangement.


METHODS
The subjects comprised 30 patients (38 joints) who underwent arthroscopic discectomy with Holmium YAG laser. All patients had chronic pain, restricted range of motion, and a diagnosis of disc perforation (Wilkes stage IV to V of internal derangement). All patients had not responded to conventional nonsurgical treatment (eg, appliance therapy, nonsteroidal anti-inflammatory drugs, physical therapy) or previous temporomandibular joint (TMJ) arthroscopy. All patients filled out a questionnaire preoperatively and postoperatively for assessment of their signs and symptoms. The questionnaire consisted of a visual analog scale (VAS) with items on pain and diet.


RESULTS
The overall success rate for arthroscopy discectomy using a Holmium YAG laser was 93.33% (28 of 30 patients) in a mean follow-up of 31.7 months. No complications were observed in this study. Maximal interincisal opening improved from a mean of 25.40 to 39.96 mm after 18 months or more from surgery. The subjective data elicited from VAS scores showed a significant improvement in pain score, in interference of pain with normal diet, and effect of pain on life in general. All preoperative scores were significantly different from postoperative scores (P <.05).


CONCLUSIONS
On the basis of this follow-up study, arthroscopic discectomy for treatment of large disc perforations seems to provide an effective treatment for TMJ pain and dysfunction, decreasing the pain and improving the range of motion.
Mazzonetto
R
R
Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, University of Campinas, Unicamp, Brazil.
Spagnoli
D B
DB
D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006695:Holmium; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D053685:Laser Therapy / Q000295:instrumentation; D008297:Male; D008409:Mastication; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000295:instrumentation*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D019224:Temporomandibular Joint Disc / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000601:surgery*
D006695:Holmium