Open versus arthroscopic surgery for internal derangement of the temporomandibular joint: a retrospective study comparing two centres' results using the Jaw Pain and Function Questionnaire.

OBJECTIVES: Surgical procedures currently used for treating of internal derangement of the temporomandibular joint vary widely. Although different studies present favourable results following open or arthroscopic TMJ surgery, the criteria for a successful treatment outcome are not always defined identically. In a retrospective study, two groups of patients who underwent either open or arthroscopic surgery for internal derangement (stages III-V according to Wilkes' classification) were investigated using the so-called JPF-Questionnaire. PATIENTS AND METHODS: The Kyoto collective (group 1) consisted of 28 patients, 2 men and 26 women, who underwent arthroscopic surgery. At the time of surgery, age ranged from 13 to 77 years (mean 32.8 y). The postoperative follow-up period ranged from 4 years and 4 months to 5 years and 9 months. Twelve of the 28 patients were classified as stage III, 10 as stage IV and 6 were classified as stage V (according to Wilkes) at the time of surgery. The Vienna collective (group 2) also consisted of 28 patients, 2 men and 26 women, who underwent open meniscoplasty or discectomy. At the time of surgery age ranged from 17 to 55 years (mean 31.6 years). The postoperative follow-up ranged from 5 to 6 years and 9 months. Fourteen of the 28 patients were classified as stage III, 11 as stage IV and 3 were classified as stage V (according to Wilkes) at the time of surgery. The results of the JPF-Questionnaire of the two groups were compared by Wilcoxon 2-sample tests. The Japanese version was applied, while in Austria the German version of this questionnaire was applied. RESULTS: At a level of significance alpha=0.05 no significant difference was found when comparing the subgroups (Wilkes stages III, IV and V) or both groups of patients 5 years after temporomandibular joint surgery. CONCLUSION: There cannot be any clear indication for only one of the treatment modalities as similar results were noted following open or arthroscopic temporomandibular joint surgery. Nevertheless, arthroscopic surgery is a minimally invasive procedure resulting in a shorter or no time of hospitalization when compared with open surgery and therefore is preferred by many surgeons nowadays.

Cross-cultural adaptation of the JPF-Questionnaire for German-speaking patients with functional temporomandibular joint disorders.

OBJECTIVES: Clinical research related to the management of the syndrome of temporomandibular joint pain and dysfunction would be facilitated enormously between researchers in different locations around the world if a small number of patient-oriented questionnaires were to achieve wide acceptance. It would make comparison of therapeutic results possible. For this reason, a cross-cultural version of the Jaw Pain and Function (JPF)-Questionnaire was developed and validated for use in German-speaking patients with functional temporomandibular disorders. MATERIAL AND METHODS: The scale was translated from the English into the German language and translated back into English again, pretested and reviewed by a committee. The German version of the JPF-Questionnaire was tested on 137 patients with temporomandibular disorders. Reliability and concurrent construct validity were assessed using Pearson's correlation coefficients. RESULTS: The concurrent validity was assessed by evaluating the relation of the questionnaire's summary score (the internal criterion) to data on maximum interincisal distance (the external criterion). Spearman's and correlation coefficients were statistically significant for the comparison of the summary score with maximal mouth opening (r=-0.213; p=0.036). Test-retest reliability for the JPF-Questionnaire was also assessed by Spearman's correlation coefficients: at first admission at the clinic (time a, mean=20.23+/-16.42, median=16), then at the time of administration 1 day later at home (time b, mean=17.98+/-16.29, median=13), and 7 days later at home (time c, mean=17.90+/-15.77, median=13). They were r=0.91 (p=0.0001) for the initial administration with the repetition 1 day later, r=0.90 (p=0.0001) for the initial administration with the repetition 1 week later, and r=0.93 (p=0.0001) for the correlation between the two repetitions. Test - retest reliability measured by mean-against-difference graphs was not satisfactory for time (a) versus time (b) and time (a) versus time (c) but there was a good test-retest reliability for time (b) versus time (c). CONCLUSION: The use of this instrument can be recommended in future clinical trials, as the German version of the JPF-Questionnaire seems to be valid and--under the same test-retest conditions--reliable for the assessment of temporomandibular joint disorders.

Ten-year outcome of nonsurgical treatment for the internal derangement of the temporomandibular joint with closed lock.

OBJECTIVE: The objective of this study was to assess long-term 10-year results in comparison with the short-term outcomes of nonsurgical treatment for the internal derangement of the temporomandibular joint (TMJ) with closed lock. PATIENTS AND METHODS: The survey was conducted on 56 patients, 50 of whom responded. The age at first examination ranged from 13 to 75 years (mean, 33.2 years), and the pretreatment jaw opening was 30.3 mm on average. The short-term clinical outcome of nonsurgical treatment for 56 patients consisted of 42 successful and 14 unsuccessful cases. The mean follow-up period was 9 years and 10 months. All patients rated their pain level on a visual analog scale (VAS) and filled out a pain, jaw-dysfunction, and activities-of-daily-limiting (ADL) questionnaire before and at time of the survey. Jaw opening was also self-assessed. Pretreatment and post-treatment scores were compared and statistically tested, and the treatment outcome was judged according to our success criteria. The patients were also asked for a global rating of the subjective outcome at the survey. Last, long-term outcomes were compared with short-term clinical outcomes. RESULTS: VAS was significantly reduced from 4.91 to 0.17 (P <.01). Pain, dysfunction, and ADL scores also decreased from 5.89 to 1.07, from 5.34 to 2.0, and from 5.55 to 1.36, respectively (P <.01). Jaw opening also improved. Consequently, 40 patients were assessed as excellent, 10 patients as good, and none as poor. The overall success rate was 89.3% when the 6 nonrespondents were included. The patients' self-rated outcome showed that 31 patients rated good, 10 patients rated neither, and 9 patients did not rate, but none replied not good. Finally, the short-term clinical outcomes did not relate to the long-term outcomes. CONCLUSIONS: The long-term (10-year) outcomes of nonsurgical treatment for TMJ internal derangement with closed lock were considered to be acceptable and stable when compared with those of other treatment modalities. Short-term results had little effect on the long-term outcomes.

Outcomes of 152 temporomandibular joints following arthroscopic anterolateral capsular release by holmium: YAG laser or electrocautery.

OBJECTIVE: The aim of this study was to investigate the clinical results and efficacy of arthroscopic anterolateral capsular release achieved through the use of a holmium:YAG laser or electrocautery for the management of patients with internal derangements of the temporomandibular joint (TMJ). STUDY DESIGN: We studied internal derangement (106 joints) and osteoarthritis (46 joints) of the TMJ in 129 patients. Preoperatively, the mean mouth-opening degree was 31 mm and 129 TMJs exhibited moderate to severe arthralgia. All patients underwent arthroscopic anterolateral capsular release achieved with a holmium:YAG laser (84 TMJs) or through electrocautery (68 TMJs). RESULTS: At the end of each patient's respective follow-up period, which ranged from 2 to 72 months (mean, 19 months), the mean mouth-opening degree was 43 mm (P<.0001). Also during that time, 105 joints were discovered to exhibit no arthralgia and 36 had mild arthralgia. The total success rates with 2 sets of criteria were 92.8% and 95.6%. CONCLUSIONS: Arthroscopic anterolateral capsular release is a minimally invasive and effective surgical method for the treatment of patients with TMJ intracapsular disorders.

Does joint effusion on T2 magnetic resonance images reflect synovitis? Part 2. Comparison of concentration levels of proinflammatory cytokines and total protein in synovial fluid of the temporomandibular joint with internal derangements and osteoarthrosis.

OBJECTIVE: We sought to clarify the nature of joint effusion (JE) on T2-weighted magnetic resonance images of the temporomandibular joint (TMJ) by analysis of the synovial fluid in the superior compartment of patients with internal derangement and osteoarthrosis. STUDY DESIGN: One hundred symptomatic TMJs (100 patients) with 65 internal derangements and 35 osteoarthroses were scanned by means of magnetic resonance imaging, and, the synovial fluid was sampled on the same day. The amount of JE was evaluated on a scale of 0 to 3. Grades 0 and 1 indicated absence of JE or a negligible amount of JE, respectively, and grades 2 and 3 indicated the presence of JE. Correlation was evaluated among the amount of JE and the concentrations of the total protein and interleukin-1beta(IL-1beta), IL-6, IL-8, and tumor necrosis factor-alpha in the synovial fluid. RESULTS: Magnetic resonance imaging revealed the absence of JE in 40 joints (grade 0, 17 joints; grade 1, 23 joints) and the presence of JE in 60 joints (grade 2, 31 joints; grade 3, 29 joints). The joints with JE had, on average, significantly higher concentrations of total protein (1,675 microg vs 714 microg; P = .0001) and IL-6 (42.9 pg vs 10.6 pg; P = .009) than did the joints without JE. Furthermore, there were significant correlations between the JE grade and the concentrations of the total protein (P = .0001), IL-6 (P = .001), and IL-8 (P = .004). The detection ratio of cytokines among the presence-absence groups of JE showed a significant difference in tumor necrosis factor-alpha (68.3% vs 47.5%; P = .037) and IL-6 (86.7% vs 67.5%; P = .012). Conclusions. JE may contain the released products when there is pronounced synovitis. It is probably composed of high concentrations of total protein with inflammatory cytokines. Furthermore, IL-6 and IL-8 seem to have an important role in the pathogenesis of JE in TMJ disorders.

Immunohistochemical study of matrilin-1 in arthritic articular cartilage of the mandibular condyle.

BACKGROUND: The objective of this study was to investigate the expression of matrilin-1 in arthritic articular cartilage of the mandibular condyle by means of immunohistochemical methods. METHODS: Condylar cartilage specimens were obtained from temporomandibular joints (TMJs) of 12 patients with arthritis (osteoarthritis and internal derangement) (mean age 51.8 years; age range 28-71 years) and four patients with TMJ ankylosis (mean age 44.0 years; age range 16-64 years), diagnosed clinically and with imaging examinations. Paraffin sections were immunostained with anti-matrilin-1 antibodies. RESULTS: Matrilin-1 expression was detected in both patient groups with TMJ ankylosis and arthritis, and the level was remarkably higher in arthritic cartilage. The mean percentage of matrilin-1-producing cells to the total chondrocytes was significantly (P < 0.05) greater in the arthritic group (43.9 +/- 19.2%) than in subjects with TMJ ankylosis (28.0 +/- 8.7%). CONCLUSIONS: Articular chondrocytes in the TMJ condyle can express matrilin-1 and the expression is enhanced in arthritic cartilage, suggesting a presence of functional or adaptive remodeling in the condyle in response to degenerative changes in the TMJ structures.