“…Cochrane review of arthroscopy for TMJ disorders identifies a reduction in pain after 6 months but in comparison to open surgery it was more effective after 12 months. No difference was noted in mandibular function [31].…”
Temporomandibular joint (TMJ) disorder (TMD) is a collection of medical and dental conditions affecting the joint and muscles of mastication, as well as contiguous tissue components. This leads to pain and altered oral function and can lead to a poor quality of life. The majority of the population can be affected to some degree. Management of TMD is often simple in the first instance, but may involve complex decision making. This article summarizes the current investigative and treatment options available.Magnetic Resonance Imaging is the recommended radiological investigation of choice for soft tissue assessment whilst TMJ arthroscopy supersedes most other invasive treatments available in relation management of symptoms and more accurate diagnosis. Should arthroscopy fail to achieve satisfactory resolution of symptoms a standardised treatment pathway based on arthroscopic findings involves appropriate assessment, possible open surgery or even TMJ replacement. This latter procedure is governed by NICE guidelines and delivers an excellent short and medium term outcome up to 20 years.
“…Cochrane review of arthroscopy for TMJ disorders identifies a reduction in pain after 6 months but in comparison to open surgery it was more effective after 12 months. No difference was noted in mandibular function [31].…”
Temporomandibular joint (TMJ) disorder (TMD) is a collection of medical and dental conditions affecting the joint and muscles of mastication, as well as contiguous tissue components. This leads to pain and altered oral function and can lead to a poor quality of life. The majority of the population can be affected to some degree. Management of TMD is often simple in the first instance, but may involve complex decision making. This article summarizes the current investigative and treatment options available.Magnetic Resonance Imaging is the recommended radiological investigation of choice for soft tissue assessment whilst TMJ arthroscopy supersedes most other invasive treatments available in relation management of symptoms and more accurate diagnosis. Should arthroscopy fail to achieve satisfactory resolution of symptoms a standardised treatment pathway based on arthroscopic findings involves appropriate assessment, possible open surgery or even TMJ replacement. This latter procedure is governed by NICE guidelines and delivers an excellent short and medium term outcome up to 20 years.
“…A small subset of this sample are patients with TMDs that are re- fractory to conservative therapy. These patients are often subjected to MRI and subsequently arthroscopy 21 . This study investigated whether the diagnostic findings of the two examinations match and how they contribute to a final diagnosis.…”
The aim of this retrospective observational study was to assess the potential agreement between independent magnetic resonance imaging (MRI) and arthroscopic findings and their respective contributions to a final diagnosis in patients with refractory temporomandibular joint disorders. Two dentomaxillofacial radiologists and two oral and maxillofacial surgeons scored 50 joints. All observers, who were blinded to additional clinical information, used a specific scoring form and selected one or more diagnostic labels. Agreement between MRI and arthroscopy and their contributions to the final diagnosis were assessed as primary outcomes using Fleiss' kappa. Intra-modality agreement and the correlation between signal intensity ratio (SIR) measurements on MRI and synovitis grading on arthroscopy were assessed as secondary outcomes. Agreement between MRI and arthroscopy was poor. A fair level of agreement was only reached for reduction capacity of the disc and disc perforation. Arthroscopic diagnostic labels matched better with the final diagnosis, suggesting a bigger contribution to that diagnosis. Higher SIR measurements correlated with higher synovitis grading scores for the retrodiscal tissue and the posterior band of the disc. Intra-modality agreement was better in arthroscopy. When blinded to clinical information, arthroscopy and MRI observations can lead to different conclusions. The diagnostic outcomes of both examinations should be considered and integrated into a final diagnosis.
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