La influencia de la superficie articular y la membrana sinovial en la evolución de pacientes afectos por bloqueo crónico de la articulación temporomandibular tratados mediante artroscopia / Influence of the joint surface and the synovial membrane on the evolution of patients affected by chronic temporomandibular joint block who were treated with arthroscopic surgery

RESUMEN

Introducción: Se ha referido la artroscopia de la articulación temporomandibular (ATM)como una técnica efectiva en el tratamiento del bloqueo crónico (BC) articular. El propósitodel presente estudio es evaluar si el estado de la superficie articular y la membrana sinovial directamente visualizados por artroscopia pueden determinar el resultado posoperatorio de pacientes afectos por BC de la ATM. Pacientes y método: Doscientos cincuenta y siete de 500 pacientes (344 articulaciones) cumplieronlos criterios de inclusión para BC de la ATM. Para el presente estudio se seleccionaron 172 pacientes con afectación unilateral. Se eligieron los parámetros "sinovitis" y "condromalacia" para la evaluación de la membrana sinovial y la superficie articular, respectivamente. Se establecieron dos grupos de pacientes a) pacientes con afectación leve sinovitisgrados I/II más condromalacia I/II, y b) pacientes con afectación grave sinovitis gradosIII/IV más condromalacia grados III/IV. Se eligieron el dolor y la máxima apertura oral(MAO) interincisal como variables dependientes. Todos los pacientes se revisaron de modo posoperatorio al mes, 3, 6, 12 y 24 meses. Se utilizó la prueba de la “t” de Student paramuestras pareadas para comparar los valores medios de dolor (escala visual analógica, EVA) y función (MAO), de modo preoperatorio y posoperatorio. Se utilizó la “t” de Student para muestras independientes para la comparación de los diferentes grupos establecidos.Se consideró estadísticamente significativo un valor de p <= 0,05. Resultados: Artroscópicamente se observó sinovitis grados I/II en 87 (50,58%) pacientes, y sinovitis grados III/IV en 72 (41,86%), mientras que se objetivó condromalacia grados I/IIen 66 (38,37%) pacientes y condromalacia grados III/IV en 54 (31,39%)...(AU)

ABSTRACT

Introduction: Arthroscopy of the temporomandibular joint (TMJ) has been considered aneffective technique to treat close lock (CL). The purpose of this study is to evaluate if thestatus of the joint surface and the synovial membrane directly seen via arthroscopy candetermine the post operative results of patients with chronic block of the TMJ. Patients and methods: Two hundred and fifty-seven out of the 500 patients (344 joints) met thecriteria for chronic block of the TMJ. One hundred and seventy-two patients with unilateralaffectation were selected for this study. Synovitis and chondromalacia are the parameters chosen to evaluate the synovitis membrane and joint surface, respectively. Two groups ofpatients were formed a) patients with light affectation level I/II synovitis and level I/II chondromalacia, and b) patients with severe affectation level III/IV synovitis and level III/IV chondromalacia. The dependent variables were pain and interincisal maximum oralopening (MOO). All of the patients had post operative follow-up at 1, 3, 6, 12, and 24 months.The "t" Student test was used before and after surgery to match evidence to compare the average values of visual analogical scale (VAS) and function (MOO). The "t" Student test wasused for independent samples to compare the different groups that were established. Avalue of p <= 0.05 was considered statistically significant. Results: Level I/II synovitis was seen using arthroscopy in 87 (50.58%) patients, and level III/IV synovitis was seen in 54 (31.39%) of patients, while level I/II chondromalacia was observed in 66 (38.37%) patients and level III/IV chondromalacia was observed in 54 (31.39%).During the follow-up period a significant decrease in pain and a parallel increase in oral opening were observed after arthroscopy in patients affected by level I/II and III/IV synovitis and level I/II and III/IV chondromalacia (AU)