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Risk Factors Associated With Poor Outcomes Following Temporomandibular Joint Discectomy and Fat Graft
Owen G Ellis1, Shreya Tocaciu2, Dean P McKenzie3
1Consultant Surgeon, Melbourne Dental School, University of Melbourne, Parkville, Australia.
Summary
TMJ discectomy success rates were 75.2%, with 11.7% requiring total joint replacement. Poor mouth opening improvement after surgery may indicate higher failure risk for temporomandibular joint discectomy.
Area of Science:
- Oral and Maxillofacial Surgery
- Orthopedic Surgery
- Regenerative Medicine
Background:
- Temporomandibular joint (TMJ) discectomy is a surgical procedure for degenerative joint disease when the disc is unsalvageable but the condylar head and glenoid fossa are salvageable.
- Abdominal fat grafting is often used in conjunction with TMJ discectomy.
Purpose of the Study:
- To estimate the incidence of poor postoperative outcomes after TMJ discectomy with abdominal fat grafting.
- To identify risk factors associated with these adverse outcomes.
Main Methods:
- Retrospective cohort study of 129 patients (132 TMJ discectomies) with a minimum 1-year follow-up.
- Analysis included demographics, preoperative findings (mouth opening, pain), operative findings (disc degeneration), and postoperative outcomes (pain, mouth opening).
- Statistical methods included Kaplan-Meier curves and Cox proportional hazards regression.
Main Results:
- The success rate for TMJ discectomy was 75.2%, with an 11.7% conversion rate to TMJ total joint replacement (TJR).
- A total of 24.8% of patients experienced a return of pain, with a median time to recurrence or second surgery of 94.4 months.
- No specific risk factors were statistically significant, though less than 10% improvement in mouth opening was associated with a higher risk of poor outcome.
Conclusions:
- Lower improvement in mouth opening at 1 year post-TMJ discectomy may indicate a higher likelihood of procedure failure.
- This outcome could potentially lead to the need for TMJ total joint replacement (TJR).
