Complications of temporomandibular joint arthroscopy: a retrospective analytic study of 670 arthroscopic procedures.
OBJECTIVE
Temporomandibular joint (TMJ) arthroscopy has been considered a safe surgical procedure in the treatment of TMJ derangement. However, it is not exempt from complications. This study evaluates the complications of arthroscopy in patients with internal derangement of TMJ.


METHODS
Five hundred consecutive patients (670 joints) with TMJ derangement who underwent arthroscopy between 1995 and 2004 were retrospectively analyzed. All the patients were classified as II to V in the Wilkes classification. Lysis and lavage, electrocautery of the posterior ligament, injection of corticoids, injection of ethanolamine, myotomy of lateral pterygoid muscle attachments, myotomy and electrocautery, motor debridement, injection of sodium hyaluronate, and meniscal suture were performed in different patients.


RESULTS
Complications were recognized during or immediately after the surgery. They were observed in 5 of 341 (1.26%) arthroscopies of the right TMJ and 4 of 329 (1.21%) arthroscopies of the left TMJ. A 1.34% complication rate was found in the whole series. No blood clots within the external auditory canal were observed. Bleeding within the superior TMJ space was observed in 57 cases (8.5%), 36 of them in the right TMJ and 21 in the left TMJ, but they were not considered as true complications. Lacerations of the external auditory canal were found in 2 cases (0.3%), with no cases of perforation of the tympanic membrane. Lesion of the auriculotemporal nerve was observed in a case. Paresia of the facial nerve was found in 4 cases (0.6%). Alteration of visual accuracy of the ipsilateral eye was also observed in a patient immediately after the surgery.


CONCLUSIONS
Special care must be taken to reduce complications within the upper joint space by means of an adequate instrumentation and by paying attention to essential points of the arthroscopic technique.
González-García
Raúl
R
Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital La Princesa, Madrid, Spain. raugg@mixmail.com
Rodríguez-Campo
Francisco J
FJ
Escorial-Hernández
Verónica
V
Muñoz-Guerra
Mario F
MF
Sastre-Pérez
Jesús
J
Naval-Gías
Luis
L
Gil-Díez Usandizaga
José L
JL
D001182:Arthroscopy / Q000009:adverse effects*; D020209:Cranial Nerve Injuries / Q000209:etiology; D004424:Ear Canal / Q000293:injuries; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D013704:Temporomandibular Joint / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000601:surgery*; D014786:Vision Disorders / Q000209:etiology