SURGICAL-TREATMENT OF INTERNAL DERANGEMENT OF THE TEMPOROMANDIBULAR-JOINT - LONG-TERM EVALUATION OF 3 TECHNIQUES

Purpose: The long-term outcomes of three different surgical treatments for internal derangement of the temporomandibular joint (TMJ), ie, di scoplasty, discectomy without replacement, and discectomy with replace ment of the disc with a Proplast-Teflon (Vitek Inc, Houston, TX) inter positional implant (PTIPI) are compared. Materials and Methods: Forty- two cases of internal derangement of the TMJ were treated with disc re pair and eminectomy (group A, n = 13), simple discectomy (group B, n = 17) and discectomy combined with insertion of a PTIPI (group C, n = 1 2). Preoperative and postoperative findings (more than 5-year follow-u p) relating to pain, mouth opening, joint noise, and radiographic chan ges were compared. Results: Decrease of symptoms after surgery was rep orted by 77%, 94%, and 83% of the patients (groups A, B, and C, respec tively). The decrease in pain intensity ranged from 52% to 71%. Mouth opening increased in 50% to 60% of the patients. The percentage increa se ranged from 15% to 26% in the respective groups. Development of ost eoarthrosis after surgery was demonstrated in 93% and 100% of the case s in the discectomy and discectomy/disc implant group, respectively, b ut only in 62% of the discoplasty group. Conclusion: This study demons trates the importance of a functioning disc in the TMJ. There was no s ignificant difference between the groups concerning symptoms before an d after surgery. The discoplasty group, however, showed a high frequen cy of relapse, which necessitated secondary discectomy. PTIPIs clearly accelerated the development of osteoarthrosis, which may be classifie d as iatrogenic damage. The need for further research to establish the long-term performance of autogenous grafts and the development of imp roved alloplastic disc replacement materials is discussed.