Temporomandibular joint (TMJ) arthroscopic lysis and lavage: Outcomes and rate of progression to open surgery.
OBJECTIVE
Arthroscopic lysis and lavage has been shown to be effective in the management of a variety of TMJ (Temporomandibular joint) diseases. The purpose of this study was to evaluate the medium to long-term outcomes of TMJ arthroscopic lysis and lavage and determine factors associated with progression to open surgery.


METHODS
A retrospective cohort study of a single operator series was performed over a 6-year period from 2006 to 2012. The variables of gender, age and category (Dimitroulis classification) were compared to evaluate factors associated with success of arthroscopy and progression to open surgery. The data were analysed via Kaplan Meier method for time-to event analyses and Chi-squared tests for trend analyses. Pre-operative and post-operative Visual analogue scores and maximum inter-incisal opening results were analysed with the Student's t-test.


RESULTS
A total of 167 patients and 216 joints underwent arthroscopy with a mean follow up of 6.9 years. Overall 77.7% of joints had a successful result and required no further surgery. There was no gender difference with respect to progression to surgery. Males underwent open surgery after a mean of 6.2 months from arthroscopy and Females after a mean of 15.6 months from arthroscopy (p < 0.005). The highest failure rate between age groups was in the 21-30 year age group (p < 0.04). There was a statistically significant rate of progression to open surgery depending on the classification at the time of arthroscopy, with all patients with category 4 and 5 disease progressing to open surgery (p < 0.0001).


CONCLUSIONS
Arthroscopic lysis and lavage of the TMJ is a reliable and effective operation for patients with early stage (i.e., Categories 1, 2 and 3) disorders of the TMJ. Patients with more advanced joint disease (i.e., Categories 4 & 5) gained only temporary relief from TMJ arthroscopy and often progress to open TMJ surgery.
Oral and Maxillofacial Surgery Unit, Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia. Electronic address: Omar.breik@gmail.com.
Omar
O
Breik
Oral and Maxillofacial Surgery Unit, Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia.
Vishakha
V
Devrukhkar
Oral and Maxillofacial Surgery Unit, Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia.
George
G
Dimitroulis
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013705:Temporomandibular Joint Disorders / Q000601:surgery / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
Arthroscopy; Arthrotomy; Internal derangement; TMJ