EFFICACY OF ARTHROSCOPIC SURGERY AND MIDLASER TREATMENTS FOR CHRONIC TEMPOROMANDIBULAR-JOINT ARTICULAR DISC DERANGEMENT FOLLOWING MOTOR-VEHICLE ACCIDENT
Dc. Mcnamara et al., EFFICACY OF ARTHROSCOPIC SURGERY AND MIDLASER TREATMENTS FOR CHRONIC TEMPOROMANDIBULAR-JOINT ARTICULAR DISC DERANGEMENT FOLLOWING MOTOR-VEHICLE ACCIDENT, Australian dental journal, 41(6), 1996, pp. 377-387
As a result of motor vehicle accident soft-tissue injury, temporomandi
bular joint articular disc derangement may develop and persist despite
symptomatic treatment and medication. This study reports the effectiv
eness of management directed at controlling the TMJ and masticatory ne
uromuscular pain dysfunction with a TMJ/interocclusal stabilization ap
pliance, specific biofeedback and ultrasound therapy. Following these
conservative measures residual articular disc derangement was present
in some subjects who were offered arthroscopic surgery and infrared mi
dlaser with TMJ/occlusal stabilization. Twenty subjects with residual
disc derangement were randomly selected into two groups with and witho
ut arthroscopic surgery, and analyses of variance made before treatmen
t, 12 months after conservative procedures, 3 months following arthros
copic surgery and midlaser therapy and 3 years since commencement of m
anagement. Dependent variables compared were pain-discomfort, Clinical
Dysfunction Index, articular disc derangement and maximal voluntary j
aw opening. Conservative management alone provided significant reducti
on of pain-discomfort and clinical dysfunction, while arthroscopic sur
gery resulted in significant reduction in articular disc derangement.
The midlaser with TMJ/occlusal stabilization maintained significant im
provement in the variables (p<0.01) for both groups. The common articu
lar deviations in form found at arthroscopy were soft tissue alteratio
n with hyperaemia, synovial membrane and posterior folding with connec
tive tissue hyperplasia, and disc displacement with fibrous adhesions.
The Global Status Score of pain behaviour compared with residual func
tion, confirmed the presence of greater pain before treatment commence
d.