Influence of discoplasty and discectomy of the temporomandibular joint on elimination of pain and restricted mouth opening.
The retrospective study was based on 36 open joint surgeries done in 33 consecutive patients with anterior disc dislocation without reduction with severe signs and symptoms and unsuccessful nonsurgical treatment lasting at least 6 months. The patients underwent either discoplasty or discectomy followed by auricular cartilage graft implantation and were evaluated for amount of interincisal mouth opening, severity of pain on VAS scores preoperatively and as well as 12 months postsurgically. The minimum pain levels were preoperatively 50 on VAS for the discoplasty group and 60 on VAS for the discectomy group. After the surgery, the VAS values lower than 20 were reported on 69.4% of 25 sides (72.7% in the discoplasty group, 68.0% in the discectomy group). Using the cutoff point for maximal interincisal opening of more than 35 mm, only 6 patients (16.6%) fulfilled the criterion at the baseline. Interincisal distance measured vertically 12 months after the operation increased in all but five patients. In three of the five subjects, the opening was at the same level as before the surgery. Almost ninety-one percent of the patients (90.9%) in discoplasty group and 81.8% in discectomy group, respectively reached 35 mm or more of vertical opening after the operation. Applying the 1984 Criteria for classification of postoperative results (AAOMS), 12 months after surgery, 24 patients (72.7%) displayed good results, 6 patients (18.2%) were evaluated with acceptable results, and in 3 cases (9.1%) we observed bad results. Although only short-term evaluation is presented, our findings show that both discoplasty and discectomy are effective methods for surgical treatment of patients suffering from severe temporomandibular pain and limited mouth opening. Discoplasty should be reserved only for patients without severe changes of the disc.
Krug
Jirí
J
Charles University in Prague, Faculty of Medicine in Hradec Králové, Department of Dentistry, Czech Republic. jirikrug@hotmail.com
Jirousek
Zdenek
Z
Suchmová
Helena
H
Cermáková
Eva
E
D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000637:transplantation; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013704:Temporomandibular Joint / Q000503:physiopathology; D019224:Temporomandibular Joint Disc / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology / Q000601:surgery*