Unilateral temporomandibular joint discectomy without interposal material in patients with disc perforation or fragmentation: a prospective study

Abstract

Objective: Temporomandibular joint (TMJ) discectomy is one of the most popular surgical techniques for patients with an unsalvageable disc. Previous studies have demonstrated predictable results of dis- cectomy with optimal results in pain reduction and maximum mouth opening (MMO) improvement. However, those studies had most of the times wide-ranging inclusion criteria. This study was therefore conducted to assess the role of unilateral TMJ discectomy in a well defined diagnosis. Methods: A 6-year prospective study was designed including patients treated with unilateral TMJ dis- cectomy without interposal material, preserving condyle and temporal fibrocartilage, for two specific intra-articular diagnosis: disc perforation and disc fragmentation. Results: A total of 19 patients were enrolled, with a mean age of 51.05 ± 13.71 (mean ± SD) years. Preoperative pain was 7.63 ± 1.89 (mean ± SD), MMO was 25.95 ± 10.27 mm (mean ± SD) and muscle tenderness (MT) was 2.53 ± 0.77 (mean ± SD). The most common diagnosis was disc perforation. After an average of 37.9 months of follow-up time (range from 10 to 71 months), a statistically significant improvement of pain (P < 0.0001), MMO (P < 0.0001) and MT (P = 0.00011) was observed. Postoperatively, 16 of 18 patients (89 %) showed a reduction in pain and improvement in MMO, fulfilling the criteria for a successful outcome of TMJ surgery. No second surgery was necessary. Conclusion: Unilateral TMJ discectomy without interposal material in patients with disc perforation or fragmentation seems to be an adequate technique. However, we encourage rigorous long-term studies and new preclinical trials to pursuit a disc substitute, as relevant preclinical trials have demonstrated significant degenerative changes after TMJ discectomy.