title: TMJ arthroscopy in patients with Ehlers Danlos syndrome: case series.
abstract: OBJECTIVE
  The purpose of this report was to assess the outcome of temporomandibular joint (TMJ) arthroscopy in patients with temporomandibular disorders (TMDs) associated with Ehlers Danlos syndrome (EDS).
  
  
  METHODS
  This retrospective case series describes 18 patients with EDS who underwent arthroscopy for temporomandibular disorders. The patients' demographics were recorded, along with preoperative TMJ symptoms, Wilkes classification, mouth opening, and the presence of systemic involvement. The incidence of early and late postoperative complications and the final outcome were noted.
  
  
  RESULTS
  All of the patients were females, with EDS Type III, and had a mean age of 34 years. A high proportion of the patients had joints other than the TMJ affected. Five patients were classified as stage II according to the Wilkes classification, 9 patients were stage III, 3 patients were stage IV, and only 1 patient was diagnosed with stage V Wilkes before intervention. Arthroscopy, followed by arthrocentesis and balloon dilatation of the affected TMJs was performed and intra-articular morphine injections were given to all patients. The main pre- and early postoperative complaint was pain, but this resolved in most cases. Improvement of mouth opening was noted from 23.4 +/- 4.2 to 27.8 +/- 5.1 mm after arthroscopy. Patients were followed for an average of 62 months and all were asymptomatic at their last review appointment.
  
  
  CONCLUSIONS
  For patients where conservative measures of treating TMD are not effective, arthroscopy is a minimally invasive surgical procedure that has been shown to result in a satisfactory outcome, with no need to resort to open joint surgery. This case series is limited by its size and further research on surgical intervention on EDS patients with temporomandibular disorders is recommended.
authors.affiliation: University College London Hospital Head and Neck Centre, London, United Kingdom. w.jerjes@ucl.ac.uk
authors.forename: Waseem
authors.initials: W
authors.lastname: Jerjes
authors.forename: Tahwinder
authors.initials: T
authors.lastname: Upile
authors.forename: Priya
authors.initials: P
authors.lastname: Shah
authors.forename: Syedda
authors.initials: S
authors.lastname: Abbas
authors.forename: Anna
authors.initials: A
authors.lastname: Vincent
authors.forename: Colin
authors.initials: C
authors.lastname: Hopper
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000209:etiology; D001182:Arthroscopy; D002404:Catheterization; D004535:Ehlers-Danlos Syndrome / Q000145:classification / Q000150:complications*; D005157:Facial Pain / Q000209:etiology; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D019152:Paracentesis; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013704:Temporomandibular Joint / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000145:classification / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009020:Morphine