Moreover TMJ arthroscopy has provided

Moreover, TMJ arthroscopy has provided insight that not all feeding needles with adequate outflow are intracapsular “Arthrocentesis”. To be noted that the single patient in the current study that did not meet the designated success criteria was the oldest (48 years) in our studied sample. However, despite not meeting our success criteria this patient had a MIO of 37 mm and VAS for pain 2 at the end of the follow up period; that is considered a successful outcome by others [24]. [28] This denotes that age and the longevity of the standing condition could be contributing factors to arthroscopic prognosis. In one of the most comprehensive reviews of literature [29] reviewed 11 studies of TMJ arthroscopic outcomes that were published between 1987 and 1996. In a cumulative total of 6071 joints in 3955 patients, calculated a mean success rate of 84% across the 11 studies. He also reported a mean improvement in interincisal opening of 10.4 mm, which compares closely with the 18.9 mm reported in this study. In terms of pain scores on the visual analog scale of 0–10, calculated a mean (RS)-CPP of 4.6 units, which is lower than that recorded in this study 7.1 units. Moreover, in this study 92% of patients reported an improvement in their pain levels after arthroscopy, which is higher than the average of 82% reported by for the 11 studies combined. However, despite the superior outcome of the current study compared to review of 11 studies, this does not imply better results were obtained in the current study. This is attributed to a) the difference in the study designs and arthroscopic protocols used; b) the other studies included patients with different entities of TMD compared to the current study specifically targeting DDWOR not complying to conservative treatment for a minimum of 3 months; c) the larger sample size in the other studies and over a larger time interval providing them with much more leverage over the current study. A more reasonably comparable study to the current would be [28] whom included 16 joints with internal derangement (DDWOR) and reported an 86% success rate using TMJ arthroscopic lysis and lavage. On the other hand, [30] reported only 50% success rates using also lysis and lavage; yet they attributed such lower success rates to concomitant osteoarthrosis that involved 30 of their studied 42 TMJ. It is pertinent to conclude that proper diagnosis and classification of ID with the aid of MRI is crucial and influential on the treatment planning and consequently the clinical outcome. Arthroscopic surgery in the current study was directed at the restoration of normal function and alleviation of pain associated with TMJ closed lock by lysis and lavage of the superior compartment adhesions. Once the joint was arthroscopically released, a maintenance phase of physiotherapy (jaw exercises) was an integral part of the rehabilitation program to help maintain the results achieved with TMJ arthroscopy and to prevent recurrent episodes of locking. Although TMJ arthroscopy is a highly effective treatment for closed lock of the TMJ, Nonsense suppresser is best used as part of a wider treatment regimen that includes physiotherapy and occlusal splints to prevent recurrences. The distinctly unique advantage of TMJ arthroscopic lavage and lysis is that it provides early and dramatic improvement in mandibular function and immediate relief of painful symptoms associated with closed lock and therefore should be pivotal, but not exclusive, in the management of this disorder. On the other hand open surgical management of ID of the TMJ should be reserved for patients who fail to respond to conservative and minimally invasive treatment [16].
Introduction The temporomandibular joint (TMJ) is a unique joint; despite advanced degenerative changes being present in the joint, it allows a range of movement of the associated structures to achieve a modified function [1]. TMJ Internal Derangement (ID) is a common form of temporomandibular disorders (TMDs), almost 80% of adult symptomatic patients with TMD have some form of ID [2].