The use of dermis grafts after discectomy for internal derangement of the temporomandibular joint.
OBJECTIVE
The aim of this retrospective clinical study was to review the outcomes of temporomandibular joint (TMJ) discectomy with autogenous dermis used as an immediate interpositional graft in patients with advanced internal derangement of the TMJ.


METHODS
Thirty-five joints in 29 patients who presented with advanced internal derangement of the TMJ with degenerate and irreparable discs were identified and included in the study. All patients underwent a TMJ arthrotomy (including 6 bilateral TMJ procedures) that involved removal of the disc (discectomy) and immediate replacement with autogenous dermis graft. Patients were followed up for an average of 2 years.


RESULTS
There was a mean +6.7-mm improvement in maximum interincisal opening, a 66% mean improvement in pain ( P < .001), and a 42% mean improvement in function ( P < .05) after TMJ discectomy with immediate dermis graft replacement. After an average follow-up period of 24.6 months, patients reported good to excellent improvement in their TMJ symptoms in 30 of the 35 joints (85.7%). All patients showed radiologic evidence of varying degrees of condylar remodeling at 6 months or later after surgery. Of the 7 patients who had magnetic resonance imaging (MRI) performed at 6 months or later after surgery, none showed any radiologic evidence of the dermis graft. No clinical evidence of joint sounds such as crepitus was found in 33 of the 35 operated joints.


CONCLUSIONS
This study found that TMJ discectomy can have a significant positive effect on the management of patients with advanced internal derangement of the TMJ who fail to respond to less invasive measures such as splint therapy and TMJ arthroscopy. However, the only advantage of dermis grafts over no grafts seems to be that it can minimize or eliminate joint sounds such as crepitus in the discectomized TMJ. In this study, the dermis grafts did not prevent regressive remodeling of the mandibular condyles.
Dimitroulis
George
G
Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Australia. geodim@netspace.net.au
D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000379:methods; D020405:Dermis / Q000637:transplantation*; D005157:Facial Pain / Q000601:surgery; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008335:Mandibular Condyle / Q000473:pathology; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016038:Skin Transplantation; D019224:Temporomandibular Joint Disc / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000601:surgery*; D016896:Treatment Outcome