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Arthroscopy for temporomandibular disorders.

Marcelo Rigon¹, Ligia M Pereira, Marcelo C Bortoluzzi

¹Universidade Estadual de Londrina, Rua Espirito Santo, 536, Londrina, Brazil, 86010 510.

The Cochrane Database of Systematic Reviews

|May 13, 2011

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Arthroscopy and nonsurgical treatments for temporomandibular disorders (TMDs) both reduced pain at 6 months. Open surgery was more effective than arthroscopy for pain relief at 12 months, but arthroscopy improved jaw opening more than arthrocentesis.

Area of Science:

Oral and Maxillofacial Surgery
Orthodontics
Pain Management

Background:

Temporomandibular disorders (TMDs) encompass a range of conditions affecting the jaw joint and masticatory muscles, influenced by organic, psychological, and psychosocial factors.
Signs of TMDs are prevalent, with 40%-75% of the population exhibiting symptoms, and 33% reporting discomfort.
Arthroscopy is a surgical procedure used for TMD management, but its overall effectiveness requires further clarification.

Purpose of the Study:

To systematically evaluate the efficacy of arthroscopy in managing the signs and symptoms associated with temporomandibular disorders (TMDs).

Main Methods:

A comprehensive literature search was conducted across multiple databases, including Cochrane, MEDLINE, EMBASE, LILACS, AMED, and CINAHL, up to December 2010.

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Included studies were randomized controlled clinical trials (RCTs) investigating arthroscopy for TMD treatment, with no language or publication date restrictions.

Data extraction and risk of bias assessment were performed independently by multiple reviewers, with efforts to obtain additional information from study authors.

Main Results:

Seven RCTs involving 349 patients were analyzed, all exhibiting high or unclear risk of bias.
Arthroscopy showed no statistically significant difference in pain reduction compared to nonsurgical treatments at 6 months (SMD = 0.004; P = 0.81) or compared to arthrocentesis at 12 months (MD = 0.10; P = 0.90).
Open surgery demonstrated a statistically significant advantage over arthroscopy in pain reduction at 12 months (SMD = 0.45; P = 0.05), while arthroscopy resulted in significantly greater improvement in maximum interincisal opening compared to arthrocentesis (MD = 5.28; P < 0.0001).

Conclusions:

Both arthroscopy and nonsurgical interventions effectively alleviate pain at 6 months post-treatment.
Open surgery offers superior pain relief compared to arthroscopy at the 12-month follow-up.
While arthroscopy enhances maximum interincisal opening more than arthrocentesis, no significant differences were observed in mandibular functionality or other clinical outcomes between the compared procedures.