Discectomy as an effective treatment for painful temporomandibular joint internal derangement: A 5-year clinical and radiographic follow-up

Purpose: The purpose of this prospective study was to compare the preoperat ive and 5 year postoperative status of patients after unilateral discectomy for painful internal derangement of the temporomandibular joint. Patients and Methods: The study was based on 64 patients. Fifty-six had dis c displacement without reduction and 8 had disc displacement with reduction . The patients were examined clinically and radiographically before and 5 y ears after the operation according to a standardized protocol. Results: Eighty-five percent of the patients (n = 52) had good results, 6% had acceptable results, and 9% had a poor outcome. Three patients (5%) were reoperated and 5 other patients (8%) needed a contralateral operation duri ng the 5-year follow-up. The median increase in maximum mouth opening was 1 1 mm (range, -8 to +35 mm) and 83% of the patients had more than 40 mm maxi mal mouth opening postoperatively. Seventy-five percent of the patients had crepitation at 5-year followup compared with 27% before the operation. Pos toperatively, the majority of the joints showed radiographic evidence of os teophytes, flattening, and sclerosis, The radiographic alterations did not correlate with the patients' symptoms, Conclusions: The results of this long-term follow-up after unilateral disce ctomy support the use of this operation in patients with painful internal d erangement who show no improvement after prior nonsurgical treatment. The p ostoperative radiographic alterations should be interpreted as adaptive cha nges rather than progressive degenerative joint disease. (C) 2001 American Association of Oral and Maxillofacial Surgeons.