Ten-year outcome of nonsurgical treatment for the internal derangement of the temporomandibular joint with closed lock.
OBJECTIVE
The objective of this study was to assess long-term 10-year results in comparison with the short-term outcomes of nonsurgical treatment for the internal derangement of the temporomandibular joint (TMJ) with closed lock.


METHODS
The survey was conducted on 56 patients, 50 of whom responded. The age at first examination ranged from 13 to 75 years (mean, 33.2 years), and the pretreatment jaw opening was 30.3 mm on average. The short-term clinical outcome of nonsurgical treatment for 56 patients consisted of 42 successful and 14 unsuccessful cases. The mean follow-up period was 9 years and 10 months. All patients rated their pain level on a visual analog scale (VAS) and filled out a pain, jaw-dysfunction, and activities-of-daily-limiting (ADL) questionnaire before and at time of the survey. Jaw opening was also self-assessed. Pretreatment and post-treatment scores were compared and statistically tested, and the treatment outcome was judged according to our success criteria. The patients were also asked for a global rating of the subjective outcome at the survey. Last, long-term outcomes were compared with short-term clinical outcomes.


RESULTS
VAS was significantly reduced from 4.91 to 0.17 (P <.01). Pain, dysfunction, and ADL scores also decreased from 5.89 to 1.07, from 5.34 to 2.0, and from 5.55 to 1.36, respectively (P <.01). Jaw opening also improved. Consequently, 40 patients were assessed as excellent, 10 patients as good, and none as poor. The overall success rate was 89.3% when the 6 nonrespondents were included. The patients' self-rated outcome showed that 31 patients rated good, 10 patients rated neither, and 9 patients did not rate, but none replied not good. Finally, the short-term clinical outcomes did not relate to the long-term outcomes.


CONCLUSIONS
The long-term (10-year) outcomes of nonsurgical treatment for TMJ internal derangement with closed lock were considered to be acceptable and stable when compared with those of other treatment modalities. Short-term results had little effect on the long-term outcomes.
Murakami
KenIchiro
K
Department of Oral and Maxillofacial Surgery, Graduate School and Faculty of Medicine, Kyoto University, Kyoto, Japan. muraken@kuhp.kyoto-u.ac.jp
Kaneshita
Shinji
S
Kanoh
Chikako
C
Yamamura
Isao
I
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000209:etiology / Q000628:therapy; D004358:Drug Therapy; D005157:Facial Pain / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D017090:Occlusal Splints; D010147:Pain Measurement; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome