EFFICACY OF ARTHROSCOPIC SURGERY AND MIDLASER TREATMENTS FOR CHRONIC TEMPOROMANDIBULAR-JOINT ARTICULAR DISC DERANGEMENT FOLLOWING MOTOR-VEHICLE ACCIDENT

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.