Temporomandibular Joint Disc Perforation: Long-Term Results After Operative Arthroscopy

Treatment of Intermittent Locking of the Jaw in Wilkes Stage II Derangement by Arthroscopic Lysis and Lavage

“…32 Review of the literature on arthroscopic lysis and lavage of the TMJ shows that most studies evaluated patients with advanced stages of internal derangement, namely chronic closed lock (corresponding to Wilkes stage IV) and derangement with degenerative changes (corresponding to Wilkes stage V). [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Based on these studies, it is well-established that arthroscopic lysis and lavage is an effective treatment modality for advanced stages of internal derangement (stages IV and V). To the authors' knowledge, there are only 5 studies in the literature that evaluated the efficacy of arthroscopic lysis and lavage in treating specifically mild internal derangement of the TMJ, namely Wilkes stage II.…”

“…[2][3][4] Most studies evaluated patients with advanced stages of internal derangement, namely chronic closed lock (Wilkes stage IV) and derangement with degenerative changes (Wilkes stage V). [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Many studies evaluated various arthroscopic procedures ranging from simple lysis and lavage to advanced operative arthroscopies without differentiation between the different treatments. [22][23][24][25][26][27][28][29][30][31] Many studies did not report clear diagnoses for the study population or did not differentiate between the different diagnoses and stages when reporting the results.…”

Remaining Hurdles for Tissue-Engineering the Temporomandibular Joint Disc

“…ID affects about 70% of TMD patients [15]. Severe cases of ID present with disc thinning and eventual disc perforation ( Figure 2) in 5-15% of ID patients [5,16,17]. However, ID and disc perforation can occur independently; the independent cases of disc perforation can be due to age-related wear [5].…”

“…These discal pathologies are the most prevalent manifestation of TMDs [15]. Osteoarthritis (OA) is also commonly seen in conjunction with ID [16,18], but the relationship between ID and OA is not understood; it is not known whether one precedes the other or if both share common causative events [18]. However, it is thought that TMJ disc pathologies such as ID or disc perforation are the first steps in a series of degenerative changes (i.e., OA) seen throughout the adjacent articulating, soft tissue surfaces [19].…”

Rationale of arthroscopic surgery of the temporomandibular joint

“…Whereas, the long-term followup study of the arthroscopic lysis and lavage for different stage 3e5 disclosed that there was comparable good outcome. 48,49 Somehow, Muñ oz-Guerra et al (2013) 50 published the long-term results after operative arthroscopy for TMJ disc perforation, and the results indicated that the procedure was favorable in cases with small perforations, but not for medium/large disc perforations. Although, operative arthroscopy is a reliable endoscopic surgery for the advanced intra-articular pathology, it has a limitation.…”