ARTHROSCOPIC MANAGEMENT OF TEMPOROMANDIBULAR CLOSED LOCK

Sixty-three consecutive patients with painful closed lock involving 83 temporomandibular joints were treated by surgery and followed up for at least 24 months. Prior to surgical treatment all had imaging to dem onstrate that the cause of their painful jaw locking was an anterior d isplaced disc without reduction. All patients had received at least th ree months non-surgical treatment without response. The arthroscopic s urgery consisted of release of adhesions, manipulation and placement o f 25 mg hyaluronic acid into the joint space. No significant surgical complications occurred. Postoperative treatment involved physical ther apy and stabilization splints. At 24 months after surgery 57 patients (90.5 per cent) had no pain and mouth opening had improved from preope rative 27.2+/-5.4 mm to 44.4+/-4.1 mm (p<0.001). This study shows that arthroscopic surgery with continuing non-surgical therapy is a highly effective treatment for painful closed lock.