Yoshiyuki Moriya

Short-term treatment outcome study for the management of temporomandibular joint closed lock. A comparison of arthrocentesis to nonsurgical therapy and arthroscopic lysis and lavage.

OBJECTIVE The aim of this study is to compare the clinical short-term results and efficacy of arthrocentesis with those of nonsurgical treatments and arthroscopic surgery for the management of temporomandibular joint closed lock. STUDY DESIGN The three groups consisted of 63 consecutive patients treated nonsurgically, 20 patients treated with arthrocentesis, and 25 patients treated with arthroscopic surgery. All patients rated their pain level on a visual analogue scale and completed a pain, jaw dysfunction, and activity-limiting questionnaire before and 6 months after the procedure. Each patients jaw opening was also scaled. The success rate of each procedure was calculated according to our success criteria. The clinical efficacy of each procedure was evaluated in successfully treated subgroups in which the between-group and within-group differences of the obtained data were statistically tested. RESULTS The success rate was 55.6% in the nonsurgically treated group, 70% in the arthrocentesis group, and 91% in the arthroscopy group. With respect to efficacy, all posttreatment scores showed significant improvements in within-group differences, but no between-group differences were found between the arthrocentesis group and the other two groups. CONCLUSION Arthrocentesis was considered as an intervening treatment modality between nonsurgical treatment and arthroscopic surgery on the basis of its short-term outcome. Although the treatment efficacy was comparable with arthroscopic surgery, this procedure was thought to be indicated for the patients with acute temporomandibular joint closed lock who were refractory to medication and mandibular manipulation rather than the alternative of arthroscopic surgery.

Correlation between pain and dysfunction and intra-articular adhesions in patients with internal derangement of the temporomandibular joint

The correlation between pain and dysfunction scores obtained by questionnaire and an adhesions index obtained via arthroscopic inspection was investigated in 28 patients with internal derangements (closed lock) of the temporomandibular joint (TMJ). A weak correlation was found between pain scores and the adhesions index. However, joint noise had a negative correlation with both severity and distribution of adhesions in the TMJ. A weak, but statistically significant, negative correlation also was found between the degree of interincisal opening and the adhesions index. This study indicates that intra-articular adhesions are one of the factors contributing to limited mouth opening in patients with closed lock, but that they do not cause TMJ pain.

Four-year follow-up study of temporomandibular joint arthroscopic surgery for advanced stage internal derangements

PURPOSE This study evaluated the long-term outcome after temporomandibular joint (TMJ) arthroscopic surgery for patients with internal derangement with stage V disease. MATERIALS AND METHODS Fifteen female patients (24 TMJs) who underwent arthroscopic surgery were evaluated by a questionnaire preoperatively and postoperatively 3 to 5 years later (mean: 4 years, 2 months). The questionnaires consisted of a visual analog scale, pain and jaw dysfunction scores, and self-measured interincisal opening. Clinical examination and conventional radiographic evaluation were done in nine patients (13 joints). Postoperative magnetic resonance imaging was done in two patients (3 joints). RESULTS All post-treatment scores showed a statistically significant improvement, although joint noise remained in some patients. The radiographic examination revealed mild to moderate degenerative changes, but no abnormal resorption was detected. The surgical success rate was 93.3%. CONCLUSION Arthroscopic surgery is a useful, minimal invasive, surgical procedure for advanced stage internal derangement of the TMJ.

Clinical study of internal derangement of the temporomandibular joint with closed lock. Second report: Correlation of the disk configuration at MR imaging with clinical parameters.

Fifty-three closed lock cases of internal derangement of the temporomandibular joint (TMJ) were studied on the correlation between disk configuration at MR imaging and nine clinical parameters composed of opening degree, age, clicking and locking duration, visual analogue scale of pain (VAS), pain score, jaw dysfunction score, life activity limited score, and TMJ X-ray photo findings. Disk configuration and degree of anterior disk displacement were assessed on MR imaging in closed mouth position: the antero-posterior length of disk and the distance from condyle to anterior and posterior portion of disk were measured, respectively. Results were obtained as follows;1. Duration of clicking and locking were not correlated with MR index except that there was a strong correlation between clicking duration and the distance from condyle to anterior portion of the disk at MR imaging.2. Opening degree was related to the disk deformity and the access of posterior portion of the disk to condyle.3. Disk configuration and degree of antrior disk displacemnt were not correlatd with TMJ pain, but jaw dysfunction was related to the disk deformity and the distance from posterior portion of the disk to condyle.4. TMJ X-ray photo findings were not correlated with clicking duration (below 3 years), locking duration (below 30 weeks), opening degree and disk configuration at MR imging.5. In evaluation of factors related to opening degree in 53 patients with closed lock by means of multiple regression analysis, age, locking and clicking duration, TMJ pain, life activiy limited score were more strongly correlated to opening degree than the others.