title: Rationale for early versus late intervention with arthroscopy for treatment of inflammatory/degenerative temporomandibular joint disorders.
abstract: OBJECTIVE
  The goal of this study was to determine if there were differences in outcomes of arthroscopic surgery in patients with inflammatory/degenerative temporomandibular joint (TMJ) disease who underwent early surgical intervention versus late surgical intervention.
  
  
  METHODS
  The study population included 44 consecutive patients who met the criteria for TMJ operative arthroscopy who were divided into early and late intervention groups. The time between the onset of symptoms and the performance of arthroscopy was used to determine entry into the early versus late intervention group. All groups were evaluated for changes in preoperative versus postoperative pain levels based on visual analog scale (VAS) scores and maximum interincisal opening distance. Statistical analyses included the Student t test to determine if there were significant differences between preoperative and postoperative assessments in the early and late intervention groups.
  
  
  RESULTS
  The mean time between onset of symptoms in the early intervention group (21 patients) was 5.4 months compared with 33 months in the late intervention group (23 patients). All patient groups had statistically significant decreases in pain and improvement in maximum interincisal opening distance after arthroscopy. The early intervention group had a mean decrease in VAS pain scores of 5.14 compared with the late intervention group with a mean decrease in VAS pain scores of 2.84, and this difference was significant (P = .012). The early intervention group had a mean increase in maximum interincisal opening of 12.38 mm compared with the late intervention group with a mean increase of 7.70. Although statistical significance was not achieved for increases in maximum interincisal opening between the early and late intervention groups (P = .089), the difference between the 2 groups was suggestive of a trend. There were no surgical complications for either group; however, 2 patients in the late intervention group developed persistent chronic neuropathic pain, requiring pain management.
  
  
  CONCLUSIONS
  TMJ arthroscopy reliably decreased pain and increased the maximum interincisal opening distance in the early and late intervention groups. The early intervention group had better surgical outcomes than the late intervention group. Arthroscopic surgery should be considered early in the management of patients with inflammatory/degenerative TMJ disease.
authors.affiliation: Department of Clinical Surgery, Weill-Cornell Medical College, Cornell University, Great Neck, NY 11021, USA. hoi2001@med.cornell.edu
authors.forename: Howard A
authors.initials: HA
authors.lastname: Israel
authors.forename: David A
authors.initials: DA
authors.lastname: Behrman
authors.forename: Joel M
authors.initials: JM
authors.lastname: Friedman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Silberstein
mesh_terms: D000328:Adult; D001168:Arthritis / Q000503:physiopathology / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008335:Mandibular Condyle / Q000601:surgery; D009437:Neuralgia / Q000209:etiology; D010003:Osteoarthritis / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications; D016059:Range of Motion, Articular / Q000502:physiology; D013585:Synovitis / Q000601:surgery; D019224:Temporomandibular Joint Disc / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D000267:Tissue Adhesions / Q000601:surgery; D016896:Treatment Outcome