title: Ruptured disc after arthroscopic repositioning in the temporomandibular joint: a retrospective magnetic resonance imaging study.
abstract: Our aim was to explore the incidence of rupture after arthroscopic repositioning of the disc of the temporomandibular joint (TMJ) by reviewing magnetic resonance images (MRI) of the TMJ taken before and after operation, and to investigate correlations retrospectively. We studied 247 patients with anterior disc displacement of the TMJ, and categorised them into 3 groups based on the postoperative MRI. The first group comprised those whose disc ruptured after repositioning, the second those who had a possible rupture of the disc after repositioning, and the third had no rupture of the disc after repositioning. Age, sex, duration of symptoms, maximum incisal mouth opening, whether the anterior disc displacement was unilateral or bilateral, and the Wilkes stage, were included in the analysis. The incidence of rupture (5/247) was 2%. Weak points at the intermediate zone of the disc were found in 4 of the 5 joints. The patients whose discs ruptured were significantly younger than the other 2 groups (p=0.001). There was no statistically significant difference in preoperative duration of symptoms and mouth opening among the groups. The proportions of unilateral and bilateral disc displacement (p=0.047) and Wilkes stage (p=0.027) differed among the 3 groups. The Wilkes stages was significantly more advanced in the ruptured group than in the other 2 groups (p=0.027) with 4/5 being bilateral. The weak point in the intermediate zone of the disc on MRI could be a sign of rupture. Teenagers and young adults with anterior disc displacement without reduction, particularly those in whom it is bilateral, are at a higher risk of a rupture after repositioning of the disc by arthroscopy.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Rd, 200011 Shanghai, People's Republic of China. Electronic address: lihui9x@163.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Rd, 200011 Shanghai, People's Republic of China. Electronic address: caixieyi27@126.com.
authors.forename: Xieyi
authors.initials: X
authors.lastname: Cai
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Rd, 200011 Shanghai, People's Republic of China. Electronic address: yangchi63@hotmail.com.
authors.forename: Chi
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Rd, 200011 Shanghai, People's Republic of China. Electronic address: wangshaoyi163@yahoo.com.cn.
authors.forename: Shaoyi
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhi-Zao-Ju Rd, 200011 Shanghai, People's Republic of China. Electronic address: dshuanglinjian@126.com.
authors.forename: Linjian
authors.initials: L
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000145:classification / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D019224:Temporomandibular Joint Disc / Q000293:injuries / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000145:classification / Q000601:surgery*; D055815:Young Adult
keywords: Anterior disc displacement; Arthroscopy; Disc repositioning; Disc rupture; MRI; Temporomandibular joint