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Bilateral arthroscopy of the temporomandibular joint: clinical outcomes and the role of a second intervention—a prospective study

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Abstract

Objective

Evaluate the efficacy of bilateral temporomandibular joint (TMJ) arthroscopy in patients with different categories of severity based on Dimitroulis classification (categories 2–4) and the role of a second TMJ intervention in primary failure.

Methods

A 3-year prospective study was designed, including patients submitted to bilateral TMJ arthroscopy. The primary outcome was TMJ pain (VAS, 0–10) and the secondary outcomes were the maximum mouth opening (MMO) and masticatory myalgia degree (0–3). In cases of symptomatic relapse, a second TMJ intervention was performed (TMJ arthrocentesis or TMJ open surgery).

Results

Eighty patients (93.4% women) were enrolled, with a mean age of 32.40 ± 11.41 years. With an average follow-up of 523.7 days (34–1606), a statistically significant improvement in TMJ pain, MMO, and myalgia degree was observed (P < 0.0001). The overall successful outcome of one-single bilateral arthroscopy was ~ 69%. Twenty-two patients relapsed: (1) arthralgia (n = 15, 68.18%); (2) arthralgia + myalgia (n = 4, 18.18%); (3) dislocated disc without reduction (DDwoR) (n = 2, 9.09%); (4) DDwoR + osteoarthrosis (OA) (n = 1, 4.55%). Arthralgia was re-managed with TMJ arthrocentesis with local anesthesia (n = 19, 86.36%). New DDwoR with or without OA was re-treated with TMJ open surgery (n = 3, 13.64%). After the second intervention, the success rate increased to 85%.

Conclusions

Bilateral TMJ arthroscopy presented overall benefit in all parameters evaluated.

Clinical relevance

This study highlights the importance of TMJ arthroscopy as the first line of treatment for moderate-severe temporomandibular disorders cases contributing to the reduction of TMJ open surgeries.

In cases of arthroscopy unsuccess, TMJ arthrocentesis under local anesthesia was an effective and safe intervention for patients with recurrent TMJ arthralgia.

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Data availability

The data that support the findings of this study are available from the corresponding author [David Ângelo] upon reasonable request.

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Authors and Affiliations

  1. Instituto Português da Face, Rua Tomás Ribeiro, nº71, 5º andar, 1150-227, Lisboa, Portugal

    David Faustino Ângelo, David Sanz & Henrique José Cardoso

  2. Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028, Marinha Grande, Portugal

    David Faustino Ângelo

  3. Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal

    David Faustino Ângelo

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  1. David Faustino Ângelo
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  3. Henrique José Cardoso
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Contributions

DFA: conceptualization, methodology, validation, investigation, resources, writing—original draft preparation, writing—review and editing, supervision, project administration. HJC: conceptualization, methodology, formal analysis, investigation, data curation, writing—original draft preparation, writing—review and editing, project administration. DS: conceptualization, methodology, validation, investigation, resources, writing—review and editing. All authors read and approved the manuscript.

Corresponding author

Correspondence to David Faustino Ângelo.

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The study was conducted with the ethical principles of the Helsinki Declaration and obtained the consent of the Instituto Português da Face ethics committee (PT/IPFace//RCT/02230/06).

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The authors declare no competing interests.

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Ângelo, D.F., Sanz, D. & Cardoso, H.J. Bilateral arthroscopy of the temporomandibular joint: clinical outcomes and the role of a second intervention—a prospective study. Clin Oral Invest 27, 6167–6176 (2023). https://doi.org/10.1007/s00784-023-05233-6

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