One-year clinical course following visually guided irrigation for chronic closed lock of the temporomandibular joint.
OBJECTIVE
This study aimed to explore the clinical course following visually guided irrigation (VGIR) for chronic closed lock (CCL) of the temporomandibular joint (TMJ) as well as the factors of importance for clinical outcome. Evaluation emphasis was placed on the period needed for the patients to reach the success criteria.


METHODS
Sixty-one patients with unilateral CCL comprised the study group. The cumulative success rate of VGIR and the additional surgical treatments following VGIR were studied. The 61 patients were divided into either the good outcome (g) group or poor outcome (p) group on the basis of whether they reached the success criteria within 3 months postoperatively, and clinical and arthroscopic factors were correlated with the clinical outcome of VGIR.


RESULTS
The cumulative success rate of VGIR increased up to the 6-month follow-up (success rate of 72.1%) but did not change after that point in time. A repeated VGIR (success rate of 87.5%) was performed in 8 patients. Open TMJ surgery (success rate of 87.5%) was performed in 8 patients, 7 of whom had an interfering condylar osteophyte. A pronounced reduction of preoperative painless range of mandibular motion (P-ROM) and advanced osteoarthritis (OA) were more frequently found in the p-group than in the g-group. The multivariate adjusted odds ratio showed that a decreased preoperative P-ROM was significantly predictive for a poor outcome of VGIR.


CONCLUSIONS
The efficacy of VGIR is clinically acceptable as an initial surgical treatment for TMJ CCL. A 6-month follow-up period ought to be sufficient for outcome assessment of VGIR. A pronounced reduction of preoperative P-ROM should be considered as a risk factor for delay of the postoperative improvement, and OA changes may sometimes affect the clinical outcome of VGIR.
Hamada
Yoshiki
Y
First Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, Yokohama, Japan. hamada-y@tsurumi-u.ac.jp
Kondoh
Toshirou
T
Holmlund
Anders B
AB
Nakajima
Toshifumi
T
Horie
Akihisa
A
Saito
Tomoyuki
T
Nomura
Yoshiaki
Y
Seto
Kanichi
K
D000328:Adult; D000368:Aged; D001182:Arthroscopy; D002908:Chronic Disease; D005157:Facial Pain; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D019152:Paracentesis / Q000379:methods; D011379:Prognosis; D016059:Range of Motion, Articular; D013583:Synovial Membrane / Q000473:pathology; D019224:Temporomandibular Joint Disc / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000473:pathology / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000379:methods; D000267:Tissue Adhesions / Q000473:pathology