Surgical treatment of internal derangement of the temporomandibular joint: long-term evaluation of three techniques.

PURPOSE: The long-term outcomes of three different surgical treatments for internal derangement of the temporomandibular joint (TMJ), ie, discoplasty, discectomy without replacement, and discectomy with replacement of the disc with a Proplast-Teflon (Vitek Inc, Houston, TX) interpositional implant (PTIPI) are compared.

MATERIALS AND METHODS: Forty-two cases of internal derangement of the TMJ were treated with disc repair and eminectomy (group A, n = 13), simple discectomy (group B, n = 17) and discectomy combined with insertion of a PTIPI (group C, n = 12). Preoperative and postoperative findings (more than 5-year follow-up) relating to pain, mouth opening, joint noise, and radiographic changes were compared.

RESULTS: Decrease of symptoms after surgery was reported by 77%, 94%, and 83% of the patients (groups A, B, and C, respectively). The decrease in pain intensity ranged from 52% to 71%. Mouth opening increased in 50% to 60% of the patients. The percentage increase ranged from 15% to 26% in the respective groups. Development of osteoarthrosis after surgery was demonstrated in 93% and 100% of the cases in the discectomy and discectomy/disc implant group, respectively, but only in 62% of the discoplasty group.

CONCLUSION: This study demonstrates the importance of a functioning disc in the TMJ. There was no significant difference between the groups concerning symptoms before and after surgery. The discoplasty group, however, showed a high frequency of relapse, which necessitated secondary discectomy. PTIPIs clearly accelerated the development of osteoarthrosis, which may be classified as iatrogenic damage. The need for further research to establish the long-term performance of autogenous grafts and the development of improved alloplastic disc replacement materials is discussed.