Nabeela Ahmed

Prospective outcome assessment of the therapeutic benefits of arthroscopy and arthrocentesis of the temporomandibular joint

Patients who fail to respond to routine conservative measures to treat pain, restriction, and locking in the temporomandibular joint (TMJ) may have therapeutic arthroscopy or arthrocentesis, both of which are associated with symptomatic improvement in 86% of patients. To our knowledge there are no current data on improvements in mouth opening and lateral deviations after these procedures. This prospective audit includes 244 patients treated between 2005 and 2010 from one surgeons practice, who were followed up at least once at 6 weeks after arthroscopy or arthrocentesis. They had various conditions but all had tender joints. Measurements of interincisal opening, left and right lateral excursions, and protrusion were taken before and during operation with callipers (mm). Opening and pain scores were also recorded on 10 cm analogue scales before operation and at 6 weeks. Pain scores improved with intervention from a mean score of 37.1-16.1 (range 0-100). The improvement in mouth opening ranged from 0 to 78% (as some patients had locking or pain with normal opening before operation), and 86% had improved enough to be discharged at 6 weeks. Temporary forehead weakness in two patients resolved within the timescale of the study. The study shows improvements in mouth opening, and confirms that pain scores can be improved after arthroscopy or arthrocentesis when conservative approaches have failed. In the hands of a skilled practitioner, arthroscopy can be a useful diagnostic and therapeutic adjunct, which can be used repeatedly with low morbidity.

Prospective assessment of outcomes following disposable arthroscopy of the temporomandibular joint

Temporomandibular disorder (TMD) is a common cause of chronic facial pain that is often treated successfully without operation, but when no improvement is seen arthroscopy may be considered as a therapeutic and diagnostic tool. We prospectively assessed the outcome of 115 arthroscopic procedures to assess the effectiveness and reliability of a 1.2mm disposable arthroscope (OnPoint, Biomet Microfixation, Jacksonville, USA). All patients included had not improved after standard conservative management. Discharge from clinic was classed as a successful outcome. Measurements taken before, during, and after operation included mouth opening and lateral deviations (mm). Pain was assessed before and after operation using a 10 cm visual analogue scale. Mean improvement in pain scores was 69% and in mouth opening was 19%, and overall success was 76%. Compared with a previous study using a 1.9 mm scope there were fewer complications after arthroscopy with the small diameter scope.

Current thinking about the management of dysfunction of the temporomandibular joint: a review

Increasingly the management of TMJ pathology is becoming a subspecialist interest. The number of patients having TMJ joint replacement had steadily increased over the last decade and there is now NICE guidance on this matter. Whilst the evidence of the management of TMJ disease is limited and there are few randomised controlled trials, the incidence of TMJ pathology has not changed and there is a requirement for guidance on the management. Whilst previously patients with TMJ pain were managed surgically, this is changing, and the vast bulk of initial management is non-surgical/medical. This paper will review the literature on TMD and provide guidance for management.

Current thinking articles in BJOMS: are they for everyone?

Staying up to date in all aspects of our discipline is essential, both for trainees and consultants, if we are to manage our patients to the best of our abilities in the most up-to-date, evidence-based manner. Treatment by subspecialists is now the norm, and in an increasingly litigious society, updates that reflect current thinking should help us avoid complaints. Unfortunately, in this ever-evolving complex specialty, it is becoming increasingly difficult to remain conversant with the latest guidelines and management protocols, and this is essential for our trainees if they are to succeed in the exit examination.