A comparison of discectomy and arthroscopic lysis and lavage for the treatment of chronic closed lock of the temporomandibular joint: a randomized outcome study.

PURPOSE: The study compared the efficacy of discectomy or arthroscopic lysis and lavage in patients with chronic closed lock of the temporomandibular joint (TMJ) in a prospective, randomized clinical trial.

PATIENTS AND METHODS: Twenty-two patients with a clinical diagnosis of chronic closed lock were prospectively randomized to either discectomy or arthroscopic lysis and lavage. The individual outcome in each patient was evaluated with a visual analog scale for pain and a questionnaire concerning mandibular functional impairment. The clinical evaluation included measurement of maximum interincisal opening and protrusion, recording of clicking and crepitation, and palpation for tenderness of the TMJ and jaw muscles. Recordings were made before the operation (baseline) and at the 1-year follow-up.

RESULTS: Twenty patients completed the study. Discectomy and arthroscopic lysis and lavage significantly reduced pain and improved mandibular function. Discectomy reduced pain somewhat more effectively than arthroscopic lysis and lavage. The clinical recordings at the 1-year follow-up indicated similarly good outcomes after both procedures.

CONCLUSION: Both discectomy and arthroscopic lysis and lavage are effective surgical methods for treatment of chronic closed lock of the TMJ. Considering that arthroscopic lysis and lavage is a minimally invasive outpatient procedure, it should be used as the first choice in surgical treatment of this condition.