Categorizing temporomandibular joint arthroscopic procedures for a better clinical practice and teaching

To provide some clarity to the confusion in the terminology used to classify arthroscopic procedures for the treatment of temporomandibular joint (TMJ) internal derangement (ID) and osteoarthrosis (OA).

The author introduces a new method for categorizing TMJ arthroscopic procedures more accurately, intending to establish a reference point from which further clinical series may built their analyses.

Six categories are proposed for establishing a clear distinction among performed arthroscopic procedures: Level Ia, arthroscopic lavage (AL); Level Ib, arthroscopic lysis and lavage (ALL); Level Ic, ALL "needle-therapy"; Level IIa, simple operative arthroscopy (OA); Level IIb, advanced OA; and Level III, OA with discopexy. Several arthroscopic procedures, such as lysis of adherences, coblation of the retrodiscal tissue, anterior myotomy of the lateral pterigoid muscle, or discopexy, are classified in each category depending on the need (or not) to use of one or two working cannulas.

Teaching and training of maxillofacial surgeons in the acquisition of the skills to perform arthroscopy should be based on a step-by-step approach following this proposed classification. Besides, future clinical series on arthroscopy of the TMJ for the treatment of ID and/or osteoarthrosis may benefit from a clear distinction of the performed arthroscopic procedure in terms of evaluating outcomes and complications.