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Comparison of Arthroscopy and Arthrocentesis in the Management of Internal Derangement of Temporomandibular Joint
Oral Abstract Session 5 Elias FM, Birman EG, Matsuda CK, Oliveira IRS, Jorge WA. Ultrasonographic findings in normal temporomandibular joints. Braz Oral Res. 2006 Jan-Mar 20(1):25-32.
Comparison of Arthroscopy and Arthrocentesis in the Management of Internal Derangement of Temporomandibular Joint R. Kisnisci: Oral and Maxillofacial Surgery Department, Ankara University, U. Dede, O. Ozkaynak Statement of the Problem: Arthroscopy and arthrocentesis are minimally invasive treatment modalities for the management of temporomandibular joint internal derangement cases. The aim of this study was to evaluate the results and efficacy of these two techniques in a prospective randomized patient population. Materials and Methods: Forty-seven patients who were recalcitrant to non-surgical treatment were randomly assigned to 2 groups. In one group there were 25 joints of 22 patients which were treated with arthroscopic lysis and lavage. In the other group where arthrocentesis was instituted 31 joints of 25 patients were included. Methods of Data Analysis: Maximum interincisal opening (MIIO) and joint pain (VAS) were recorded preoperatively and postoperatively. Wilcoxon ranked sign tests were used for statistical analyses within the groups, and Mann-Whitney U tests were used for analyses between two groups (p⬍0.05). Results of Investigation: In the arthroscopic lysis and lavage group the mean VAS decreased from 67.31 to 39.9 and was statistically significant (p⫽0.0001). Postoperative MIIO changes were also evident and an increase was obtained from 29.05 mm to 37.86 mm which was statistically significant (p⬍ 0.05). In the arthrocentesis group VAS mean decreased from 68.29 to 41.95 (p⬍ 0.05) and MIIO was increased from 30.92 mm to 35.08 mm (p⬍ 0.05). Between two groups there was no statistically significant difference in preoperative and postoperative mean VAS scores (p⫽0.350) (p⬎0.05) and MIO changes (p⫽0.847). Conclusion: Results of the study reveal that arthroscopy yielded better outcome but was not found to be statistically significant in comparison to arthrocentesis. References: Yura S, Totsuka Y, Yoshikawa T, Inoue N. Can arthrocentesis release intracapsular adhesions? Arthroscopic findings before and after irrigation under sufficient hydraulic pressure. J Oral Maxillofac Surg. 2003 Nov;61(11):1253-6 Hobeiche J, Salameh Z, Tashkandi E, Almas K. Arthroscopy vs. open-joint surgery for the management of internal derangement of the temporomandibular joint: a retrospective study comparing female subjects from two centers. J Contemp Dent Pract. 2008 Mar 1;9(3):48-55
AAOMS • 2010
Temporomandibular Joint Arthroscopy in the Operating Room versus Office: Is There a Difference in Outcomes? H. Israel: Weill-Cornell Medical College, A. Lee, J. Shum, D. Behrman, J. Friedman, J. Silberstein Statement of the Problem: The success of traditional temporomandibular joint (TMJ) arthroscopy in the operating room (OR) setting is well documented. Recent development of smaller diameter instruments and refinement of less invasive techniques have facilitated in-office arthroscopy, permitting easier scheduling and reduced costs. In the OR, the surgeon performs advanced arthroscopic techniques, such as motorized shaving and removal of pathologic tissue, with muscle paralysis and general anesthesia. In-office arthroscopy involves more basic instrumentation and lighter depth of anesthesia. The purpose of this investigation is to determine whether there are differences in outcomes when arthroscopy is performed in an office compared to OR setting. Materials and Methods: The study population included 44 consecutive patients who met the criteria for TMJ arthroscopy. All patients had diagnoses consistent with inflammatory/degenerative temporomandibular joint disease including synovitis, osteoarthritis and internal derangement, had failed conservative therapy and underwent MRIs confirming intra-articular pathology. Patients were divided into two groups based on whether the procedure was performed in an office versus OR setting. Key factors determining the setting were: 1. financial - those who did not have adequate insurance coverage for the costs relating to the OR, and 2. anesthetic requirements - those who required a general anesthetic technique had the procedure performed in the OR. Patients in the OR group underwent advanced operative arthroscopy (two cannulas as portals) with lysis and removal of adhesions, motorized shaving of fibrillation and adhesions, direct sub-synovial steroid injection and disc mobilization. The office group underwent simple operative arthroscopy using a #18 gauge needle as a working instrument to lyse adhesions, direct sub-synovial steroid injection and disc mobilization. All groups were evaluated for changes in preoperative versus postoperative pain levels based on visual analog scale (VAS) scores and maximum interincisal opening (MIO) distance. The mean follow-up period was 7.2 months. Methods of Data Analysis: Statistical analyses included Student’s t-test to determine if there were significant differences between preoperative and postoperative assessments in the office and the OR groups. Results of Investigation: The office arthroscopy group included 13 patients (mean age 35) and the OR group 31 patients (mean age 38). The office group had a mean preoperative VAS of 7.15 and a 1.88 postoperative VAS, a 74% reduction in pain scores. The OR group had e-55
Comparison of Arthroscopy and Arthrocentesis in the Management of Internal Derangement of Temporomandibular Joint R. Kisnisci: Oral and Maxillofacial Surgery Department, Ankara University, U. Dede, O. Ozkaynak Statement of the Problem: Arthroscopy and arthrocentesis are minimally invasive treatment modalities for the management of temporomandibular joint internal derangement cases. The aim of this study was to evaluate the results and efficacy of these two techniques in a prospective randomized patient population. Materials and Methods: Forty-seven patients who were recalcitrant to non-surgical treatment were randomly assigned to 2 groups. In one group there were 25 joints of 22 patients which were treated with arthroscopic lysis and lavage. In the other group where arthrocentesis was instituted 31 joints of 25 patients were included. Methods of Data Analysis: Maximum interincisal opening (MIIO) and joint pain (VAS) were recorded preoperatively and postoperatively. Wilcoxon ranked sign tests were used for statistical analyses within the groups, and Mann-Whitney U tests were used for analyses between two groups (p⬍0.05). Results of Investigation: In the arthroscopic lysis and lavage group the mean VAS decreased from 67.31 to 39.9 and was statistically significant (p⫽0.0001). Postoperative MIIO changes were also evident and an increase was obtained from 29.05 mm to 37.86 mm which was statistically significant (p⬍ 0.05). In the arthrocentesis group VAS mean decreased from 68.29 to 41.95 (p⬍ 0.05) and MIIO was increased from 30.92 mm to 35.08 mm (p⬍ 0.05). Between two groups there was no statistically significant difference in preoperative and postoperative mean VAS scores (p⫽0.350) (p⬎0.05) and MIO changes (p⫽0.847). Conclusion: Results of the study reveal that arthroscopy yielded better outcome but was not found to be statistically significant in comparison to arthrocentesis. References: Yura S, Totsuka Y, Yoshikawa T, Inoue N. Can arthrocentesis release intracapsular adhesions? Arthroscopic findings before and after irrigation under sufficient hydraulic pressure. J Oral Maxillofac Surg. 2003 Nov;61(11):1253-6 Hobeiche J, Salameh Z, Tashkandi E, Almas K. Arthroscopy vs. open-joint surgery for the management of internal derangement of the temporomandibular joint: a retrospective study comparing female subjects from two centers. J Contemp Dent Pract. 2008 Mar 1;9(3):48-55
AAOMS • 2010
Temporomandibular Joint Arthroscopy in the Operating Room versus Office: Is There a Difference in Outcomes? H. Israel: Weill-Cornell Medical College, A. Lee, J. Shum, D. Behrman, J. Friedman, J. Silberstein Statement of the Problem: The success of traditional temporomandibular joint (TMJ) arthroscopy in the operating room (OR) setting is well documented. Recent development of smaller diameter instruments and refinement of less invasive techniques have facilitated in-office arthroscopy, permitting easier scheduling and reduced costs. In the OR, the surgeon performs advanced arthroscopic techniques, such as motorized shaving and removal of pathologic tissue, with muscle paralysis and general anesthesia. In-office arthroscopy involves more basic instrumentation and lighter depth of anesthesia. The purpose of this investigation is to determine whether there are differences in outcomes when arthroscopy is performed in an office compared to OR setting. Materials and Methods: The study population included 44 consecutive patients who met the criteria for TMJ arthroscopy. All patients had diagnoses consistent with inflammatory/degenerative temporomandibular joint disease including synovitis, osteoarthritis and internal derangement, had failed conservative therapy and underwent MRIs confirming intra-articular pathology. Patients were divided into two groups based on whether the procedure was performed in an office versus OR setting. Key factors determining the setting were: 1. financial - those who did not have adequate insurance coverage for the costs relating to the OR, and 2. anesthetic requirements - those who required a general anesthetic technique had the procedure performed in the OR. Patients in the OR group underwent advanced operative arthroscopy (two cannulas as portals) with lysis and removal of adhesions, motorized shaving of fibrillation and adhesions, direct sub-synovial steroid injection and disc mobilization. The office group underwent simple operative arthroscopy using a #18 gauge needle as a working instrument to lyse adhesions, direct sub-synovial steroid injection and disc mobilization. All groups were evaluated for changes in preoperative versus postoperative pain levels based on visual analog scale (VAS) scores and maximum interincisal opening (MIO) distance. The mean follow-up period was 7.2 months. Methods of Data Analysis: Statistical analyses included Student’s t-test to determine if there were significant differences between preoperative and postoperative assessments in the office and the OR groups. Results of Investigation: The office arthroscopy group included 13 patients (mean age 35) and the OR group 31 patients (mean age 38). The office group had a mean preoperative VAS of 7.15 and a 1.88 postoperative VAS, a 74% reduction in pain scores. The OR group had e-55