Retrospective evaluation of three different joint surgeries for internal derangements of the temporomandibular joint.
OBJECTIVE
To compare the outcomes achieved with eminectomy, discectomy alone, and discectomy with an abdominal dermis fat graft (D + ADFG) in the treatment of internal derangements (IDs) of the temporomandibular joint (TMJ), and to briefly discuss the failed cases in which a second operation was needed.


METHODS
This was a retrospective study of 31 patients (27 females, 4 males) who were unresponsive to conservative therapy and therefore underwent eminectomy (group A, n = 6), discectomy alone (group B, n = 8), or D + ADFG (group C, n = 17). All of the IDs of the TMJ were unilateral. Functional mandibular pain intensity on a visual analog scale (VAS) and maximum interincisal opening (MIO) were recorded preoperatively and at the latest postoperative examination (average, 30 months). The preoperative and postoperative results were compared between and within each group.


RESULTS
Overall, patients in groups B and C had better outcomes than those in group A in terms of TMJ symptom relief. Postoperative increases in MIO were statistically significant in groups A, B, and C (P < 0.027, P < 0.017, and P < 0.000, respectively). Patients with discectomized joints (groups B and C) had significantly improved pain scores (P < 0.05) at the latest follow-up. In 6 of the 31 (19.3%) patients (3 eminectomy, 1 discectomy, and 2 D + ADFG), the procedure was deemed unsuccessful because of persistent symptoms and a second operation was performed.


CONCLUSIONS
Discectomy with or without ADFG was clearly superior to eminectomy in reducing pain and improving joint function. But there were no significant differences in the two-discectomy groups with respect to symptom improvement.
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey.
Celal
C
Candirli
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey. Electronic address: drmehmetdemirkol@hotmail.com.
Mehmet
M
Demirkol
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey.
Onur
O
Yilmaz
Private Practice, Izmit, Turkey.
Sadi
S
Memis
D000328:Adult; D018771:Arthralgia / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D013704:Temporomandibular Joint / Q000601:surgery; D019224:Temporomandibular Joint Disc / Q000601:surgery*; D016896:Treatment Outcome
Abdominal dermis fat graft; Internal derangement; TMJ discectomy; Temporomandibular joint