Arthroscopic lysis and lavage versus operative arthroscopy in the outcome of temporomandibular joint internal derangement: a comparative study based on Wilkes stages.

PURPOSE: To assess whether arthroscopic lysis and lavage (ALL) or operative arthroscopy (OA) is more effective for the treatment of temporomandibular joint (TMJ) internal derangement at any stage of involvement. PATIENTS AND METHODS: In 458 patients (611 joints) with internal derangement of the TMJ classified as Wilkes stages II through V, arthroscopy was performed. Pain (visual analog scale score, 0-100) and maximal interincisal opening were assessed at 1, 3, 6, 9, 12, and 24 months after surgery. RESULTS: ALL was performed in 308 of 611 arthroscopies (50.4%), and OA was performed in 303 arthroscopies (49.59%). A significant decrease in pain (P < .001) was observed for all patients at any time during the follow-up period from the first month postoperatively to the end of the 2-year follow-up period. A highly significant increase in mouth opening greater than 13 mm was observed in the group of patients classified as Wilkes stage IV from the first month postoperatively. When we compared ALL versus OA among Wilkes stages, no significant differences in terms of pain were observed during the entire follow-up period. CONCLUSIONS: Both ALL and OA are equally effective at decreasing pain in patients with TMJ internal derangement of any Wilkes stage. Patients classified as Wilkes stage IV presenting with chronic closed lock of the TMJ had the highest decrease in pain and the highest increase in mouth opening among the stages, thus confirming these patients as the best candidates for arthroscopy.