title: Temporomandibular joint disc perforation: long-term results after operative arthroscopy.
abstract: OBJECTIVE
  Disc perforation (DP) is one of the most important pathologic signs of intracapsular temporomandibular joint (TMJ) disease; however, few clinical studies have focused on the arthroscopic management of this feature. The purpose of the present study was to assess whether operative arthroscopy with abrasion of the perforation borders is effective for the treatment of this alteration of the internal derangement of the TMJ.
  
  
  METHODS
  Thirty-six patients (39 joints) who underwent TMJ arthroscopy under general anesthesia and presented with DP (Wilkes stages IV and V) from 1994 through 2006 were included in this study. The age range at the time of surgery was 14 to 59 years. DPs were classified into 3 groups according to size: small (SMA), medium (MED), or large (LAR). Pain (visual analog scale, scores 0 to 100), maximal interincisal opening, and lateral and protrusive excursions were assessed at 1, 3, 6, 12, 24 and 48 months after surgery. Preoperative and postoperative scores were compared and tested for statistically significant differences by the Student t test for paired data. The level of statistical significance was set at .05. Differences in the global, SMA, MED, and LAR groups were evaluated.
  
  
  RESULTS
  In the global group, the mean score of preoperative pain according to the visual analog scale was 53.97 mm, which decreased to 14.33 mm at 4-year follow-up. The maximal interincisal opening improved from a mean of 28.56 mm before surgery to 34.88 mm after the final follow-up. SMA perforations were found in 11 cases (28.20%), MED in 19 cases (48.71%), and LAR in 9 cases (23.07%). A significant decrease in pain (P < .01) was observed from the first postoperative month to the end of the follow-up period in the global and SMA groups. A statistically significant increase in mouth opening was observed in the global group from 6 months postoperatively; however, no significant differences were observed in the MED and LAR groups from before surgery to the different times of follow-up. After the final follow-up, 2 patients underwent open TMJ surgery owing to unfavorable results.
  
  
  CONCLUSIONS
  Operative arthroscopy of the TMJ is a reliable and effective procedure for the articular dysfunction associated with DP because this procedure alleviates pain and improves mouth opening. Patients with SMA perforations are better candidates for this surgical treatment.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, University Hospital Monteprincipe, CEU-San Pablo University, Madrid, Spain. maxmferm@gmail.com
authors.forename: Mario Fernando
authors.initials: MF
authors.lastname: Muñoz-Guerra
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Rodríguez-Campo
authors.forename: Verónica
authors.initials: V
authors.lastname: Escorial Hernández
authors.forename: Celia
authors.initials: C
authors.lastname: Sánchez-Acedo
authors.forename: José Luis
authors.initials: JL
authors.lastname: Gil-Díez Usandizaga
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D005157:Facial Pain / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D019224:Temporomandibular Joint Disc / Q000473:pathology* / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult