title: Arthroscopic discopexy is effective in managing temporomandibular joint internal derangement in patients with Wilkes stage II and III.
abstract: OBJECTIVE
  Disc repositioning for temporomandibular joint (TMJ) internal derangement (ID) is a well-established surgical technique with variable success. The purpose of the present study was to assess the outcomes after arthroscopic disc repositioning (discopexy) for TMJ ID.
  
  
  METHODS
  This was a prospective, cohort, single-institutional clinical study. The study included patients with TMJ ID in whom diagnostic arthroscopy had failed. These patients were presented and treated at Miami Oral and Maxillofacial Surgery, Baptist Hospital (Miami FL). The predictive variable was the Wilkes diagnostic categories, presented in 2 groups: II and III versus IV and V. The primary outcome variable was the absence of joint pain at 12 months postoperatively. The secondary outcome variables included joint function, maximum interincisal opening, medication use, joint loading sign, and muscle pain. The patients were followed for 1 year postoperatively. The statistical analyses included paired and independent sample Student's t test, χ(2) test, and logistic regression analysis.
  
  
  RESULTS
  A total of 32 subjects (42 joints), with a mean age of 31 years, were included in the present study; 28 (87.5%) were women. Of the 42 joints, 71.4% were classified as Wilkes stage II and III. A successful outcome was seen in 69% of the studied subjects and in 86.7% of the Wilkes II and III group versus 25% of the Wilkes IV and V group (P = .001).
  
  
  CONCLUSIONS
  The results of the present study have shown that TMJ arthroscopic discopexy is an effective and predictable treatment of patients with TMJ ID in whom primary TMJ arthroscopy failed. Our results have also shown that patients with Wilkes II or III TMD will have the most successful outcome.
authors.affiliation: Oral & Maxillofacial Surgeon, Private Practice, Oral and Maxillofacial Surgery, Miami, FL; Chief, Department of Oral and Maxillofacial Surgery, Baptist Health Systems, Jacksonville, FL; Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Nova Southeastern School of Dental Medicine, Fort Lauderdale, FL.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McCain
authors.affiliation: Assistant Lecturer, Department of Oral and Maxillofacial Surgery, Cairo University School of Dental Medicine, Cairo, Egypt; Research Scholar, Department of Oral and Maxillofacial Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL. Electronic address: reemhamdy@hotmail.com.
authors.forename: Reem H
authors.initials: RH
authors.lastname: Hossameldin
authors.affiliation: Surgeon, Department of Oral and Maxillofacial Surgery, Carmel Medical Center, Haifa, Israel; Department of Anatomy and Cell Biology, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
authors.forename: Samer
authors.initials: S
authors.lastname: Srouji
authors.affiliation: Anesthesia Consultant, Cairo University School of Dental Medicine, Cairo, Egypt; Biostatistician, Cairo University, Cairo, Egypt.
authors.forename: Amr
authors.initials: A
authors.lastname: Maher
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D018771:Arthralgia / Q000517:prevention & control; D001182:Arthroscopy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000145:classification / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods; D008297:Male; D008335:Mandibular Condyle / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D063806:Myalgia / Q000517:prevention & control; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D000074402:Synovectomy; D019224:Temporomandibular Joint Disc / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000145:classification / Q000601:surgery*; D016896:Treatment Outcome; D064232:Visual Analog Scale
chemical_list: D000700:Analgesics