Arthroscopic Lysis and Lavage Versus Operative ...

Journal of Oral and Maxillofacial Surgery Copy of e-mail Notification

zgf2424

RUSH: Journal of Oral and Maxillofacial Surgery article [YJOMS_55097] for proofing by GonzÃ¡lezGarcÃ-a _______________________ Dear Author: The proof of your article to be published by Elsevier in Journal of Oral and Maxillofacial Surgery, is available as a PDF file at the following URL: http://rapidproof.cadmus.com/RapidProof/retrieval/index.jsp Login: your e-mail address Password: BiEsVcZgmsm7 Also attached are instructions on the annotation of PDF files, as well as a Query Form if we have any questions regarding your article. Proof corrections can now be annotated on-screen, which allows you to indicate your correction directly on the PDF proof. Annotating and returning your PDF proof as an email attachment will ensure quick and accurate publication of your article. To read these files and annotate the electronic proof with corrections you will need the latest version of Adobe Reader, which is available for free at: http://www.adobe.com/products/acrobat/readstep.html. Please also see the accompanying instructions for further information. If PDF annotations are not feasible, please consider one of the following methods of returning proof corrections: * List the corrections (including replies to any author queries) in an e-mail and return to me at [email protected] or simply use the Reply button. Using this option, please refer to the line numbers on the proof. * Mark corrections and any other comments (including replies to any author queries) on a printout of the PDF file and fax it to Gwyn Driskill (fax #: 215-239-3388). * If none of the above options are possible, please express mail a marked up copy of your article to the address below. After accessing the PDF proof, please: * carefully proofread the entire article, including tables, equations, figure legends, and references; * confirm that all references, tables, and figures match up correctly with their citations in text; * ensure accuracy and spelling of affiliations, addresses, and author names; * check that any Greek letters (such as "mu") have been translated correctly; * verify scientific notations, drug dosages, and manufacturer names and locations; * be sure permission has been procured for any reprinted materials; and * answer all author queries completely (these are listed on the last page). Changes that significantly alter the content of the article, such as new figures and tables or rewritten sections, will only be considered at this stage with the Editor's approval. It is important that all of your corrections are sent back to us in one communication. Please check your proof carefully before replying, as inclusion of any subsequent corrections cannot be guaranteed and there will be no further opportunity to proofread your article.

If you submitted usable color figures with your article they will appear in color on the web and in print, at no extra charge. If your article contains color illustrations and you would like to receive proofs of these illustrations, please contact us within 48 hours. Any 'supplementary' material to your article (i.e., not appearing in print) will be accessible after your corrected article is placed online; such material is not part of the proofing process and is therefore not attached here. PLEASE RESPOND WITHIN 48 HOURS, even if you have no corrections, and include the journal name and article number on any correspondence. Kind regards, Gwyn Driskill Journal Manager Elsevier, Inc. 855 Peachtree St NE, Unit 2505 Atlanta, GA 30308 (p) 404.961.0574 (f) 215.239.3388 [email protected]

!Ͳ"##$%"%&!'(Ͳ)*+,

!"#$%&'$!("#("$)*+""($+$!("(,-.,,!/*# -$ ).&/0 12.#% "#3 "##$%"%& 4$52 "2%.67& 4$5 /.77 #&&3 83$9& :&"3&2 )&2;.$# .?>&2@+ ->.; 12$?2"A .; B2&&74 ")".7"97& B$2 " />$7& ;&2.&; $B 17"%B$2A; %>"% .#6753& !C0 D"60 "#3 EFGH "#3 6"# 9& 3$/#7$"3&3 B2$A >%%1IJJ?&%+"3$9&+6$AJ2&"3&2J+ ->& &K"6% ;4;%&A 2&L5.2&A&#%; "2& ?.)&# "% %>& 83$9& ;.%&I >%%1IJJ///+"3$9&+6$AJ12$356%;J2&"3&2J%&6>Ͳ;1&6;+>%A7+ -.,+""($+$!("# +0123%340356357819:;

-$A"M&"##$%"%.$#;.#%>&!'(B.7&0?$%$%>&A".#83$9& -$A"M&"##$%"%.$#;.#%>&!'(B.7&0$1&#%>&!'(B.7&5;.#? %$$79"2"#36>"#?&%>&652;$2B2$A">"#3;4A9$7%$%>& 83$9&:&"3&2H067.6M$#NC$AA&#%P+ .# GB%>.;$1%.$#.;#$%")".7"97&.#4$5283$9&:&"3&2A %>&#.%.;1$;;.97&%>"%4$5283$9&862$9"%)&2;.$#.;7$/&2 %>"#H$2%>&!'(>";#$%9&&1"2&312$1&274+ R>&# 4$5 $1&# %>& !'( B.7& 5;.#? 83$9& :&"3&20 %>& C$AA&#%.#?%$$79"2;>$5739&3.;17"4&3"5%$A"%.6"774S.B #$%0 67.6M $# N-$$7;P0 ;&7&6% NC$AA&#% T D"2M51P =$2 NC$AA&#%.#?P .# )&2;.$# &# 67.6M $# NO>$/ C$AA&#% ->.; $1&#; " %";M 1"#& "#30 9&7$/ %>"%0 " 7.;% $B "77 TD"2M51%$$79"2P=$2NC$AA&#%.#?%$$79"2P.#)&2;.$#& %&K%+ ->&;& 6$AA&#%; .#.%."774 ;>$/ "77 $2NO>$/C$AA&#%.#?9"2P$#%>&D"6@+GB%>&;&$1%.$#;"2& %>&6>"#?&;A"3&94$526$14&3.%$2%$4$52B.7&+ #$% ")".7"97& .# 4$52 83$9& :&"3&2 A %>&# .% .; 1$;;.97&%>"%4$5283$9&862$9"%)&2;.$#.;7$/&2%>"#&!'(>";#$%9&&1"2&312$1&274+ #$2A"7652;$29467.6M.#?$#%>&NO&7&6%P95%%$# %>&A;"2"%%>&%$1=)&2;.$#;& C$AA&#%.#? %$$7 9"2 .; ;&% %$ N$BBP .# )&2;.$#*+-$6>"#?&%>.;;&%%.#?;&7&6%NU3.%V!2&B&2&;P0 %>&# N'$65A&#%;P ="% 7&B% 5#3&2 NC"%&?$2.&;P@0 %>&# ;&7&6% %>&$1%.$#NF&)&2PB$2N!'(J8W.&/D$3&P=%>&C$AA&#%.#? %$$79"2.;%>&;"A&";.#)&2;.$#Q@+

=C>"#?.#?%>&3&B"57%;&%%.#?083$9&)&2;.$#*@

)(A$(BBB +CD819 !9735DD3ED

+0123%340356357819:;

C7.6M%>&N-&K%U3.%;P95%%$# $#%>& C$AA&#%.#? %$$7 9"2+ C7.6M %$ ;&% %>& 652;$2 7$6"%.$# .# %>& %&K% "#3 ;.A174 ;%"2% %41.#?+ ->& %&K% /.77 "11&"2 .# " 6$AA&#%.#? 9$K+ X$5 A"4 "7;$ 65%Ͳ"#3Ͳ1";%& %&K% B2$A "#$%>&2 B.7& .#%$ %>& 6$AA&#%.#?9$K+C7$;&%>&9$K9467.6M.#?$#NKP.# %>&%$12.?>%Ͳ>"#36$2#&2+

$#%>&C$AA&#% C7.6M%>&NG#;&2%-&K%P.6$# %$$79"2+C7.6M%$;&%%>&652;$27$6"%.$#.#%>&%&K% "#3 ;.A174 ;%"2% %41.#?+ ->& %&K% /.77 "11&"2 .# " 6$AA&#%.#?9$K+X$5A"4"7;$65%Ͳ"#3Ͳ1";%&%&K% B2$A"#$%>&2B.7&.#%$%>&6$AA&#%.#?9$K+C7$;&

C7.6M%>&N-&K%U3.%;P95%%$# $#%>& C$AA&#%.#? %$$7 9"2+ -$ >.?>7.?>% %>& %&K% %$ 9& 2&17"6&30 67.6M "#3 32"? %>& 652;$2 $)&2 %>& %&K%+ ->&# ;.A174 %41& .# %>& 2&17"6&A&#% %&K%+ ->& 2&17"6&A&#%%&K%/.77"11&"2.#"6$AA&#%.#?9$K+ X$5A"4"7;$65%Ͳ"#3Ͳ1";%&%&K%B2$A"#$%>&2B.7& .#%$ %>.; 9$K+ -$ 2&17"6& B$2A"%%&3 %&K% ="# &L5"%.$# B$2 &K"A17&@ 17&";& 8%%"6> " B.7& =;&& 9&7$/@+

$# %>& C7.6M %>& N:&17"6& =G#;@P .6$# C$AA&#% %$$7 9"2+ -$ >.?>7.?>% %>& %&K% %$ 9& 2&17"6&30 67.6M "#3 32"? %>& 652;$2 $)&2 %>& %&K%+ ->&# ;.A174 %41& .# %>& 2&17"6&A&#% %&K%+ ->& 2&17"6&A&#%%&K%/.77"11&"2.#"6$AA&#%.#?9$K+ X$5A"4"7;$65%Ͳ"#3Ͳ1";%&%&K%B2$A"#$%>&2B.7& .#%$ %>.; 9$K+ -$ 2&17"6& B$2A"%%&3 %&K% ="# &L5"%.$# B$2 &K"A17&@ 17&";& 8%%"6> " B.7& =;&& 9&7$/@+

C7.6M%>&N-&K%U3.%;P95%%$# $#%>& C$AA&#%.#?%$$79"2+C7.6M"#332"?$)&2%>&%&K% %$ 9& 3&7&%&3+ ->&# 12&;; %>& 3&7&%& 95%%$# $# 4$52M&49$"23+->&%&K%%$9&3&7&%&3/.77%> & ;%256M%>2$5?>+

$# %>& C7.6M %>& NO%2.M&%>2$5?> ='&7@P .6$# C$AA&#%%$$79"2+C7.6M"#332"?$)&2%>&%&K%%$ 9&3&7&%&3+->&;;%>&3&7&%&95%%$#$#4$52 M&49$"23+ ->& %&K% %$ 9& 3&7&%&3 /.77 %>&# 9& ;%256M%>2$5?>+

$# %>& C7.6M $# %>& NZ.?>7.?>%P 95%%$# C$AA&#%.#?%$$79"2+C7.6M"#332"?$)&2%>&%&K%+ -$ A"M& " 6$AA&#%0 3$597& 67.6M $# %>& >.?>7.?>%&3%&K%"#3;.A174;%"2%%41.#?+

$# %>& C7.6M $# %>& NZ.?>7.?>% -&K%P .6$# C$AA&#%%$$79"2+C7.6M"#332"?$)&2%>&%&K%+-$ A"M& " 6$AA&#%0 3$597&67.6M $# %>& >.?>7.?>%&3 %&K%"#3;.A174;%"2%%41.#?+

$#%>& C7.6M$#%>&N8%%"6>"(.7&P95%%$# C$AA&#%.#?%$$79"2+C7.6M$#%>&B.?52&0%"97&$2 B$2A"%%&3 %&K% %$ 9& 2&17"6&3+ 8 /.#3$/ /.77 "5%$A"%.6"774$1&#"77$/.#?4$5%$"%%"6>%>&B.7&+ -$ A"M& " 6$AA&#%0 ?$ %$ N[&#&2"7P .# %>& N!2$1&2%.&;P /.#3$/0 "#3 %>&# N'&;62.1%.$#P+ 8 ?2"1>.6 /.77 "11&"2 .# %>& !'( B.7& .#3.6"%.#? %>& .#;&2%.$#$B"B.7&+

$# %>& C7.6M $# %>& N8%%"6> (.7&P .6$# C$AA&#% %$$7 9"2+ C7.6M $# %>& B.?52&0 %"97& $2 B$2A"%%&3 %&K% %$ 9& 2&17"6&3+ 8 /.#3$/ /.77 "5%$A"%.6"774$1&#"77$/.#?4$5%$"%%"6>%>&B.7&+ 8 ?2"1>.6 /.77 "11&"2 .#3.6"%.#? %>& .#;&2%.$# $B " B.7&+

$# C7.6M$#%>&NF$%&-$$7P95%%$# %>&C$AA&#%.#?%$$79"2+C7.6M%$;&%%>&7$6"%.$# $B %>& #$%& $# %>& 3$65A&#% "#3 ;.A174 ;%"2% %41.#?+'$#$%5;&%>.;B&"%52&%$A"M&%&K%&3.%;+

$# %>& C7.6M $# %>& N833 O%.6M4 F$%&P .6$# C$AA&#%%$$79"2+C7.6M%$;&%%>&7$6"%.$#$B%>& #$%&$#%>&3$65A&#%"#3;.A174;%"2%%41.#?+'$ #$%5;&%>.;B&"%52&%$A"M&%&K%&3.%;+

%>&9$K9467.6M.#?$#NYP 6$2#&2+

.#%>&%$12.?>%Ͳ>"#3

%3FG4C3D3ED

%3H163D3ED

)8IJG8IJDD3EDK H4L34 C1HH39D

+DD4CJ4M8G3

/3463491D3K C1HH39D

)(A$(BBB +CD819 %3683N

+0123%340356357819:; -$ 2&).&/ 4$52 6>"#?&;0 67.6M $# %>& NO>$/P X$52 6>"#?&; /.77 "11&"2 "5%$A"%.6"774 .# " 7.;% 9&7$/ %>& C$AA&#% %$$7 9"2+ F").?"%& 94 $# %>& C$AA&#%.#? %$$7 67.6M.#?$#"6$22&6%.$#.#%>&7.;%+87%&2#"%.)&740 95%%$# 9"2+C>$$;&NO>$/C$AA&#%;\.;%P+F").?"%&94 3$597& 67.6M $# "#4 A"2MͲ51 %$ $1&# %>& 67.6M.#?$#"6$22&6%.$#.#%>&7.;%+87%&2#"%.)&740 6$AA&#%.#?9$K+ 3$597& 67.6M $# "#4 A"2MͲ51 %$ $1&# %>& 6$AA&#%.#?9$K+

&901K03G3D3 CJ49I3

-$ 5#3$ "#4 6>"#?&; A"3&0 5;& %>& 2.?>% 67.6M 95%%$#$#4$52A$5;&=B$2!C;0C%27ͲC7.6MB$2%>& D"6@+ 87%&2#"%.)&74 67.6M $# NU3.%P .# %>& A".# 83$9& A "#3 %>&# NE#3$P+ X$5 6"# "7;$ 3&7&%& &3.%; 5;.#? %>& 2.?>% 67.6M =C%27Ͳ67.6M $# %>&D"6@"#3;&7&6%.#?N'&7&%&P+

-$ 5#3$ "#4 6>"#?&; A"3&0 5;& %>& 2.?>% 67.6M 95%%$#$#4$52A$5;&=B$2!C;0C%27ͲC7.6MB$2%>& D"6@+ 87%&2#"%.)&74 67.6M $# NU3.%P .# %>& A".# 83$9& A "#3 %>&# NE#3$P+ X$5 6"# "7;$ 3&7&%& &3.%; 5;.#? %>& 2.?>% 67.6M =C%27Ͳ67.6M $# %>&D"6@"#3;&7&6%.#?N'&7&%&P+

!"#$%#&'(&)(*&$**#+!*&*(&#',*&*-#&$.*,/"#&*#0*&,*%#"1&

#*".O(&%+""($+$*.-.,,!/*P+'Q$(*/#*R!*% O")&%>&"##$%"%.$#;%$4$52B.7&"#32&%52#";"#&ͲA".7"%%"6>A&#%5;.#?%>&N2&174P95%%$#%$%>&$2.?.#"7A".7+ ]&B$2& 2&%52#.#?0 17&";& &#;52& 4$5 >")& "#;/&2&3 "#4 L5&;%.$#; 2".;&3 $# %>& ^5&24 ($2A "#3 %>"% 4$5 >")& .#;&2%&3"776$22&6%.$#;I7"%&2.#675;.$#$B"#4;59;&L5&#%6$22&6%.$#;6"##$%9&?5"2"#%&&3+ ,&%$)*%-(!"$# x

8#4=?2&4@>"7B%$#&;=1>$%$?2"1>;0A.62$?2"1>;0&%6+@"2&9&;%).&/&3$#;62&�B$2/>.6>%>&4"2&$1%.A._&30 "#34$527$6"712.#%&2A"4#$%9&"97&%$$5%15%%>&?2&4;6$22&6%74+

x

GB%>&!'(B.7&;6$#%".#6$7$52.A"?&;0"#3.B4$53$>")&"7$6"76$7$5212.#%&2")".7"97&0%>&#.%/.779&7.M&74%>"% 4$5/.77#$%9&"97&%$6$22&6%742&12$356&%>&6$7$52;$#.%0";7$6"7)"2."%.$#;6"#$6652+

x

GB4$512.#%%>&!'(B.7&"%%"6>&30"#3#$%.6&;$A&N#$#Ͳ;%"#3"23P$5%15%017&";&6>&6M.B%>&12$97&A.;"7;$ 12&;&#%$#;62&&#+GB%>&6$22&6%12.#%&232.)&2B$24$5212.#%&2.;#$%.#;%"77&3$#4$52!C0%>&12.#%&3$5%15%/.77 9&3.;%$2%&3+

JOBNAME: AUTHOR QUERIES PAGE: 1 SESS: 1 OUTPUT: Tue Jul 19 01:35:01 2011 /tapraid2/zgf-joms/zgf-joms/zgf99908/zgf2424d08z Our reference: YJOMS 55097

ce: 33

AUTHOR QUERY FORM Journal: YJOMS

Please email or fax your responses and any corrections to: E-mail:

Article Number: 55097

Fax:

[email protected]

215-239-3388

Dear Author: Please check your proof carefully and mark all corrections at the appropriate place in the proof (e.g., by using on-screen annotation in the PDF file) or compile them in a separate list. To ensure fast publication of your paper please return your corrections within 48 hours. For correction or revision of any artwork, please consult www.elsevier.com/artworkinstructions. Any queries or remarks that have arisen during the processing of your manuscript are listed below and highlighted by flags in the proof. Click on the ‘AQ’ link to go to the location in the proof. Location in article

Query / Remark: click on the AQ link to go Please insert your reply or correction at the corresponding line in the proof

AQ1

Please check the short title that has been created, or suggest an alternative of fewer than 46 characters (including spaces).

AQ2

Degree abbreviations are verified against a list of degrees in the AMA Manual of Style, edn 10. FEBOMFS is not yet on this list. Please verify that this degree abbreviation is correct.

AQ3

This manuscript was heavily edited for clarity. Please check that nothing was changed to alter your intended meaning throughout.

AQ4

In sentence beginning “ALL was performed!.,” please verify all of the numbers/percentages: the number of ALL procedures (307) and the number of OA procedures (303) does not add up to 611, nor do the percentages add up to 100%.

AQ5

Please note that the “Introduction” heading and key words were deleted, per journal style.

AQ6

In sentence beginning “In 1978 Wilkes2 first!,” the year was changed from 1989 to 1978, as listed in reference 2. Please check, and correct if necessary.

AQ7

Please cite tables in numerical order or renumber the tables according to order cited at first mention in text.

AQ8

In sentence beginning “Of 458 evaluated patients!,” please check the first percentage (ie, may be 66.37% rather than 66.6%) and correct if necessary.

AQ9

In sentence beginning “The mean preoperative!,” please verify the mean value listed because this sentence says “29.43 ! 7.61” but Table 1 says “29.43 ! 7.76.”.

AQ10

In sentence beginning “Interestingly, a final increase!,” the phrase “upper than 13 mm” was changed to “by more than 13 mm.” Please check, and correct if necessary.

AQ11

In sentence beginning “In these last!,” please clarify the phrase “these last 2 time points” by specifying to which 2 time points you are referring.

AQ12

In sentence beginning “For Wilkes stage IV!,” please change “significant minor MIO” to “a significantly lower MIO” if applicable. If not, clarify this phrase.

AQ13

In sentence beginning “In relation to!,” the phrase “progressively minor MIO” was changed to “progressively lower MIO.” Please check, and correct if necessary.

AQ14

In paragraph beginning “In relation to arthroscopic findings!,” please delete the term “joints” in parentheses (used 3 times) or explain why this term is used.

AQ15

In sentence beginning “These results contrast!,” please change “minor percentages” to “lower percentages” if that is what is meant. If not, please clarify original sentence.

Thank you for your assistance.


ce: 33




Fax:

[email protected]

215-239-3388



AQ16

Could sentence beginning “These results also confirm!” be changed as follows: “These results also confirm, as depicted in Figure 1, that although pain relief was documented for all Wilkes stages, the greatest amount of decrease occurred in patients with CCL at Wilkes stage IV.”? If not, please clarify original sentence.

AQ17

In sentence beginning “Holmlund et al16!.,” could the phrase “Murakami et al17 reported a success rate of approximately 90% for ALL in stages III and IV, and needed OA for a success rate of 93% in stage V” be changed to “Murakami et al17 reported a success rate of approximately 90% for ALL in stages III and IV and OA yielded a success rate of 93% in stage V”? If not, please clarify original sentence.

AQ18

In sentence beginning “White,22 in a recent!,” please clarify the meaning of the phrase “in the last years” (for example, “in the last few years” or “in the last several decades”).

AQ19

In sentence beginning “Explanation should be!,” could the phrase “Explanation should be looked in the presence of” be changed to “One explanation that should be considered is the presence of”? If not, please clarify original sentence.

AQ20

For reference 8, please provide inclusive page numbers for the chapter cited.

AQ21

For reference 13, please provide the chapter name (and authors if different than editors), as well as inclusive page numbers, if applicable.

AQ22

Please check the edits made in each table title, body, and footnote section, and correct if necessary.

AQ23

In Table 3, please add a section symbol to the table body or delete the following footnote: “Results obtained in 7 of 17 patients”.

AQ24

In Table 7, the “Preop” column was deleted because it contained no data. Please check, and correct if necessary.



ce: 33




Fax:

[email protected]

215-239-3388



AQ25

Author affiliations will appear differently in the print and online versions of your paper. The PDF shows how the affiliations will present following journal style, whereas the searchable online version will present as follows in order to provide complete unabridged affiliations. Please check the accuracy of the affiliation(s) of each author and make changes as appropriate. !

Attending Surgeon, Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital Infanta Cristina, Badajoz, Spain

†

Attending Surgeon, Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital La Princesa, Madrid, Spain


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17AQ: 2 18 19 20 21AQ: 3 22 23 24 25 26AQ: 4 27 28 29 30 31 32 33 34 35 AQ: 5 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59

J Oral Maxillofac Surg xx:xxx, 2011

Arthroscopic Lysis and Lavage Versus Operative Arthroscopy in the Outcome of Temporomandibular Joint Internal Derangement: A Comparative Study Based on Wilkes Stages Raúl González-García, MD, PhD, FEBOMFS,* and Francisco J. Rodríguez-Campo, MD† 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.

50.4%

308

Results: ALL was performed in 307 of 611 arthroscopies (50.24%), 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. © 2011 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg xx:xxx, 2011 Internal derangement of the temporomandibular joint (TMJ) was defined by Dolwick and Riggs1 as an abnormal relation between the temporomandibular disc with respect to the mandibular condyle, the temporal fossa, and the temporal eminence of the TMJ. Clini-

cally, it may be accompanied by pain, limitation of mouth opening, clicking, and locking. In 1978 Wilkes2 first established a classification to correlate clinical and radiologic signs with surgical findings. Later, with the advent of minimally invasive surgical approaches, Bronstein and Merrill3 correlated Wilkes stages with arthroscopic findings. Since then, several arthroscopic approaches have also been used, with most of them being classified as isolated arthroscopic lysis and lavage (ALL) or a more complex operative arthroscopy (OA). The term “lysis” was first used by Sanders,4 meaning “sweeping with a blunt probe to eliminate the suction cup effect of the disc to the fossa and to lyse adhesions.” The technique consists of performing a lysis, or breaking of adherences, between the articular surfaces, as well as lavage with abundant serum and intraoperative mandibular movements, or “sweeping.” In our series ALL was per-

*Attending Surgeon, Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital Infanta Cristina, Badajoz, Spain. †Attending Surgeon, Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital La Princesa, Madrid, Spain. Address correspondence and reprint requests to Dr GonzálezGarcía: Calle Los Yébenes 35, 8C, 28047, Madrid, Spain; e-mail: [email protected] © 2011 Published by Elsevier Inc on behalf of the American Association of

Oral and Maxillofacial Surgeons 0278-2391/11/xx0x-0$36.00/0 doi:10.1016/j.joms.2011.05.027

1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 AQ: 6 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59

2 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115

formed by a single-puncture technique where lysis was directly performed with the arthroscope, and an outflow needle was used for lavage. In our series OA consisted of a double-puncture technique for the introduction of the arthroscope and a working cannula to perform electrocoagulation of the posterior ligament, injection of substances, and/or myotomy of the lateral pterygoid muscle. Comparison of ALL versus OA for the treatment of chronic closed lock (CCL) of the TMJ was previously performed by our group.5 In this study no differences in relation to pain relief or increase in maximal interincisal opening (MIO) between ALL and OA for the treatment of CCL of the TMJ were observed. We also observed that arthroscopy of the TMJ was a useful technique for the treatment of patients with CCL of the TMJ regardless of the status of the upper joint surface or the synovial lining,6 with a significant decrease in pain and a parallel increase in MIO from the first month postoperatively in patients with any grade of synovitis and/or chondromalacia. Despite these previous findings in patients with CCL classified as Wilkes stage IV,7 controversy exists in relation to which technique—ALL or OA—is more effective for the treatment of TMJ internal derangement. This may be generalized to the rest of the Wilkes stages,2 because a systematic review of arthroscopic results among stages is still absent. In a review of the literature, Laskin8 showed that the results of OA were no better than isolated ALL. It was believed that restoring joint mobility rather than disc position was the most important factor, because it produced a better distribution of forces within the joint, providing the perfusion of nutrients and the elimination of inflammatory tissue breakdown products.9 However, Indresano10 recognized that lavage only treated inflammation and questioned the ability of simple ALL to correct mechanical aspects of internal derangement, and thus he advocated for advanced double-puncture techniques for OA to treat both mechanical and inflammatory aspects of TMJ internal derangement. Moses and Poker11 and Segami et al12 reported that improvement in MIO was significantly better when extensive techniques involving anterior release of the disc and lateral capsular release were used than when only conventional ALL was used. The purpose of this study was to compare ALL versus OA in relation to the clinically established Wilkes classification.2,3 The efficacy of both arthroscopic methods was also evaluated in relation to precise follow-up intervals among stages. We hypothesize that there is no difference between OA and ALL in the treatment of TMJ disorders.

TEMPOROMANDIBULAR JOINT INTERNAL DERANGEMENT

Patients and Methods PATIENTS

Our series consisted of 670 joints (341 right and 329 left joints) in 500 consecutive patients (49 male and 451 female patients) undergoing arthroscopic procedures in our department between 1995 and 2004. Data were analyzed retrospectively. All the patients had undergone previous unsuccessful nonsurgical treatment and had a variety of grades of internal derangement according to Wilkes staging. Preoperative conservative treatment consisted of nonsteroidal anti-inflammatory drugs, together with muscle relaxants, for 2 weeks. Medical treatment was followed by splint therapy up to 12 weeks if no improvement was observed. Surgery was considered if an adequate trial of nonoperative treatments failed in patients. To eliminate possible selection bias, included patients had unilateral involvement or had bilateral involvement with similar Wilkes stages in both TMJs. Some of the patients were excluded from this study because of lack of similar Wilkes stages bilaterally. Some other patients had unilateral involvement and were classified as Wilkes stage I, so they were also excluded. Therefore 458 patients (611 joints) classified as Wilkes stages II through V and also presenting unilateral involvement or presenting bilateral involvement with similar Wilkes stages were finally selected. This research was approved by the local institutional review board. All patients received 1 g of amoxicillin– clavulanic acid intraoperatively. One gram of amoxicillin– clavulanic acid was also administered every 8 hours during the early postoperative period for 5 days. We also administered 4 mg of dexamethasone 4 times a day during the first 24 hours postoperatively. Patients began physiotherapy, consisting of active exercises for mouth opening, laterality, and protrusion, on day 2 postoperatively. A 100-mm visual analog scale (VAS) (range, 0-100) was used for the evaluation of TMJ pain before and after the procedure. The absence of pain was scored as 0. If pain was present, the patient was asked to select a score from 1 to 100. MIO, mandibular protrusion, and lateral excursion movements were also measured. Surgical procedures and evaluation of the patients were done by the 2 main surgeons (F.J.R.-C. and R.G.-G.). Patients in Wilkes stages II through IV were assessed at 1, 3, 6, 9, 12, and 24 months after surgery. The number of patients for each Wilkes stage at each follow-up period is shown in parentheses in Table 5. Success for ALL and OA was evaluated according to criteria of the American Association of Oral and Maxillofacial Surgeons,13 later modified by Eriksson and Westesson,14 who considered the technique success-

AQ: 1

60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 AQ:7,T5 111 112 113 114 115

3 20.54 ! 22.0 38.04 ! 6.20 6.38 ! 4.36 7.42 ! 2.53 7.86 ! 6.09 23.79 ! 23.97 36.18 ! 6.62 5.72 ! 2.54 6.99 ! 2.80 7.23 ! 2.60 González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011.

25.10 ! 23.27 35.86 ! 7.13 5.82 ! 2.31 7.10 ! 2.59 7.53 ! 2.52 25.02 ! 22.88 35.52 ! 6.35 5.48 ! 2.30 6.88 ! 2.66 7.07 ! 2.44 28.90 ! 23.80 32.59 ! 7.22 5.06 ! 2.59 6.45 ! 2.82 6.39 ! 2.72

24 mo (mean ! SD) 12 mo (mean ! SD) 9 mo (mean ! SD) 6 mo (mean ! SD) 3 mo (mean ! SD) 1 mo (mean ! SD)

32.99 ! 23.49 29.59 ! 6.38 4.35 ! 2.26 5.49 ! 2.63 5.87 ! 2.81 54.47 ! 22.98 29.43 ! 7.76 4.39 ! 2.36 6.24 ! 3.04 6.15 ! 3.21 Pain score on VAS MIO (mm) Protrusion (mm) Right lateral excursion (mm) Left lateral excursion (mm)

7.76

Preoperative (mean ! SD)

116 ful when a VAS score of less than 20 and MIO of 35 117 mm or more were obtained. 118 SURGICAL TECHNIQUE 119 120 Nasoendotracheal intubation with the patient un121 der general anesthesia was initially performed. After 122 the entrance of a 23-gauge needle into the superior 123 joint space, distension of the capsule was performed 124 with lactated Ringer solution. This maneuver favored 125 the introduction of a cannula within the superior joint 126 space by means of punctures with sharp- and blunt127 tipped trocars. Continuous lavage with lactated 128 Ringer solution was maintained with an irrigation 129 line. A Dyonics 2.2-mm 30° arthroscope (Smith & 130 Nephew, Andover, MA) was used in all patients. Ar131 throscopic procedures were classified into 2 main 132 groups: ALL and OA. Within the latter group, several 133 techniques were performed, such as electrocautery of 134 the posterior ligament, myotomy of the lateral ptery135 goid muscle attachments, myotomy together with 136 electrocautery, motor debridement, and disc sutur137 ing. 138 STATISTICS 139 140 We used SPSS statistical software (version 13.0; 141 SPSS, Chicago, IL) to analyze the data. Descriptive 142 statistics for continuous and categorical variables 143 were obtained. For the whole group of patients with144 out considering Wilkes staging, the Student t test for 145 paired data was used to compare mean values for pain 146 (VAS) and MIO preoperatively and postoperatively. In 147 an attempt to compare isolated ALL of the TMJ versus 148 OA with respect to pain (VAS) and MIO values after 149 arthroscopy, 2 independent groups were established, 150 and subsequently, the Student t test for unpaired data 151 was applied. One-way analysis of variance (ANOVA) 152 was used to compare pain and MIO among Wilkes 153 stages II through V at each time point in each group 154 (ALL and OA), with VAS and MIO as dependent fac155 tors and Wilkes stage as an independent factor. P " 156 .05 was considered statistically significant. 157 158 Results 159 160 The mean age was 29.76 years (range, 14-69 years) 161 for the whole series, although the most prevalent 162 group comprised patients aged between 20 and 29 163 years. Of 458 evaluated patients, 419 (91.5%) were 164 female patients and 39 (8.5%) were male patients. 165 Unilateral TMJ involvement was present in 305 pa166 66.6% tients (66.37%), whereas bilateral TMJ involvement 167 was present in 153 (33.4%), with a total number of 168 AQ: 8 611 joints evaluated. The mean preoperative VAS 169 score was 54.47 ! 22.98 (Table 1). The mean preopAQ:22,T1 170 erative MIO for the whole series was 29.43 ! 7.61 171 mm (95% confidence interval, 1-35 mm), as shown in

Table 1. VAS AND FUNCTION (MIO, LATERAL EXCURSION MOVEMENTS, AND PROTRUSION) OF WHOLE SERIES INCLUDING ALL WILKES STAGES FROM II THROUGH V AND ARTHROSCOPIC PROCEDURES

GONZÁLEZ-GARCÍA AND RODRÍGUEZ-CAMPO

116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171

4 172 AQ: 9 Table 1. Mean preoperative mandibular protrusion 173 and mandibular lateral excursion are also shown in 174 Table 1. 175 ALL was performed in 156 patients (34.06%), 176 whereas OA was performed in 302 patients (65.93%). 177 Within the latter group, electrocautery of the poste17881.12% rior ligament was performed in 245 OA procedures 179 (80.85%). Isolated myotomy of the lateral pterygoid 180 muscle attachments was performed in 13 of 303302 OA 181 4.3%procedures (4.29%), whereas myotomy together with 182 electrocoagulation of the posterior ligament was per183 7.94%formed in 24 (7.92%). Motor debridement was per11.92% 184 formed in 36 OA procedures (11.88%), whereas disc 185 suturing was performed in 37 OA procedures 186 (12.21%). 12.25% 187 Several arthroscopic findings were observed, al188 though TMJ was completely normal in 38 (6.21%) of 189 the procedures. Grade I and grade II synovitis15 was observed in 270 (44.18%) of the TMJs, whereas grade 190 III and grade IV synovitis was observed in 212 191 (34.69%). Grade I and grade II chondromalacia16 was 192 present in 238 (38.95%) of the TMJs, whereas grade 193 III and grade IV chondromalacia was observed in 147 194 (24.05%). Fibrous adherences within the upper joint 195 space were present in 18.03% of the TMJs, whereas 196 obliteration of the superior joint space was only ob197 served in 4.75%. Osteophytes and loose bodies were 198 only observed in 2.29% and 0.65% of the arthrosco199 pies, respectively. 200 In relation to TMJ pain, the mean VAS score de201 creased to 32.99, 28.90, 25.02, 25.10, 23.79, and 202 20.54 at 1, 3, 6, 9, 12, and 24 months after surgery, 203 respectively. After the application of the Student t test 204 for paired data, we could observe a significant de205 crease in TMJ pain after arthroscopy (P " .001) from 206 the first month postoperatively to the end of the 207 follow-up period (Table 1). With respect to MIO, the 208 mean values changed to 29.59 mm, 32.59 mm, 35.52 209 mm, 35.86 mm, 36.18 mm, and 38.04 mm at 1, 3, 6, 210 9, 12, and 24 months postoperatively, respectively. 211 Values for mandibular protrusion and mandibular lat212 eral excursion are shown in Table 1. We could ob213 serve a significant increase in MIO after arthroscopy 214 (P " .001) from the third month after surgery to the 215 end of the follow-up period. A significant increase in 216 lateral excursion movements after arthroscopy (P " 217 .05) was achieved from the sixth month after surgery 218 to the end of the follow-up period. Similarly, a signif219 icant increase in mandibular protrusion after arthros220 copy (P " .001) was also observed from the third 221 month after surgery to the end of the follow-up pe222 riod. 223 Of 458 patients, 57 (12.44%), 132 (28.82%), 252 224 (51.95%), and 17 (3.50%) were classified as Wilkes 225 stages II, III, IV, and V, respectively. In relation to the 226 number of involved joints, 72 (11.78%), 183 (29.95%), 227


333 (54.50%), and 23 (3.76%) were classified as Wilkes stages II, III, IV, and V, respectively (Tables 2 and 3). The mean preoperative VAS score was 54.96, 56.62, 53.33, and 53.18 for Wilkes stages II, III, IV, and V, respectively. A significant decrease in pain (P " .001) was observed for every group of patients at any time during the follow-up period from the first month after surgery to the end of the 2-year follow-up period (Table 4). For Wilkes stages II, III, IV, and V, VAS values decreased to 24.26, 29.85, 29.47, and 29.10, respectively, at the third month, and they further changed to 24.31, 25.89, 16.06, and 28.29, respectively, at the second year (Table 2, Fig 1). In relation to mandibular function, mean preoperative MIO was 38.72 mm, 34.86 mm, 24.68 mm, and 26.47 mm for Wilkes stages II, III, IV, and V, respectively. For Wilkes stages II and III, only a slight increase in mouth opening was observed (39.57 mm and 36.50 mm, respectively) from the sixth month after surgery, with an endpoint increase of less than 4 mm for both groups. A similar increase in MIO was observed for Wilkes stage V patients, although the values at 6 months and 24 months (29.30 mm and 30.14 mm, respectively) were lower than those for stages II and III, in a similar fashion to preoperative differences in MIO values between Wilkes stages II and III and Wilkes stage V (Table 3). In the group of patients with Wilkes stage II, no significant increase in mouth opening was observed at any time during the follow-up period. In fact, a significant decrease in MIO (P " .001) was observed at the first month, which disappeared starting with the third month. This phenomenon was also observed in Wilkes stage III patients. However, patients within this group showed a significant increase in mouth opening from 9 months to 24 months, at which time no significant differences were again observed. In the group of patients with Wilkes stage IV, significant differences (P " .001) in terms of mouth opening were observed from the first month postoperatively to the end of the follow-up period (Table 4). Interestingly, a final increase by more than 13 mm was observed in this group from the first month after surgery (34.85 mm and 37.79 mm at 6 months and 24 months, respectively), despite the fact that preoperative MIO values were lower than those for Wilkes stages II and III (Table 3, Fig 2). In the group of patients with Wilkes stage V, no significant differences in terms of mouth opening were observed at any time during the follow-up period. Table 5 summarizes mean VAS and MIO values for ALL versus OA for Wilkes stages II through V. When comparing ALL versus OA, we observed no significant differences in terms of pain among Wilkes stages during the whole follow-up period, except for a significant difference (P # .03) at 9 months in the group of patients classified as Wilkes stage III (Table 6).

172 173 AQ:23,T2,T 174 175 176 177 178 179 T4180 181 182 183 F1 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 F2,AQ:10 217 218 219 220 221 222 223 224 225 226 T6227

228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 Wilkes Stage II (57 patients [12.44%], 72 joints [11.78%]) III (132 patients [28.82%], 183 joints [29.95%]) IV (252 patients [51.95%], 333 joints [54.50%]) V (17 patients [3.50%], 23 joints [3.76%])

VAS (Mean ! SD)

Gender (F/M)

Mean Age (yr)

Preoperative

1 mo

3 mo

6 mo

9 mo

12 mo

24 mo

18:1

28.95

54.96 ! 23.10

29.48 ! 22.68

24.26 ! 21.16

21.38 ! 18.67

33.39 ! 27.31

35.32 ! 29.91

24.31 ! 24.24

10:1

27.61

56.62 ! 21.53

30.32 ! 22.62

29.85 ! 25.15

26.45 ! 22.92

28.39 ! 23.60

23.78 ! 21.99

25.89 ! 25.05

11:1

30.25

53.33 ! 23.17

34.46 ! 24.08

29.47 ! 23.94

25.62 ! 23.91

21.74 ! 21.81

20.78 ! 22.47

16.06 ! 18.48

4:1

41.82

53.18 ! 30.45

46.15 ! 19.75

29.10 ! 21.24*

15.20 ! 14.35*

36.75 ! 28.20†

34.56 ! 30.15‡

28.29 ! 25.45§

Abbreviations: F, female; M, male. *Results obtained in 10 of 17 patients. †Results obtained in 4 of 17 patients. ‡Results obtained in 9 of 17 patients. §Results obtained in 7 of 17 patients.


Table 2. PAIN SCORE ON VAS PREOPERATIVELY AND AT FOLLOW-UP ACCORDING TO WILKES STAGES

González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011.

Table 3. MIO PREOPERATIVELY AND AT FOLLOW-UP ACCORDING TO WILKES STAGES§

Wilkes Stage II (57 patients [12.44%], 72 joints [11.78%]) III (132 patients [28.82%], 183 joints [29.95%]) IV (252 patients [51.95%], 333 joints [54.50%]) V (17 patients [3.50%], 23 joints [3.76%])

MIO (Mean ! SD)

Gender (F/M)

Mean Age (yr)

Preoperative

1 mo

3 mo

6 mo

9 mo

12 mo

24 mo

18:1

28.95

38.72 ! 4.48

33.23 ! 6.28

37.26 ! 5.81

39.57 ! 5.64

39.06 ! 5.09

39.50 ! 6.13

40.19 ! 5.59

10:1

27.61

34.86 ! 6.09

30.04 ! 6.57

34.08 ! 6.93

36.50 ! 5.88

37.95 ! 6.23

37.31 ! 5.67

38.49 ! 5.76

11:1

30.25

24.68 ! 4.87

28.60 ! 6.02

31.18 ! 7.06

34.85 ! 6.36

34.82 ! 7.25

35.51 ! 6.67

37.79 ! 6.25

4:1

41.82

26.47 ! 7.68

27.62 ! 5.63

27.60 ! 6.78*

29.30 ! 4.39*

26.00 ! 7.61†

27.89 ! 5.55‡

30.14 ! 4.67

Abbreviations: F, female; M, male. *Results obtained in 10 of 17 patients. †Results obtained in 4 of 17 patients. ‡Results obtained in 9 of 17 patients. §Results obtained in 7 of 17 patients. González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011.

5 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283

6


284 Table 4. STATISTICAL ASSOCIATION BETWEEN PREOPERATIVE AND POSTOPERATIVE PAIN SCORE ON VAS AND 285 BETWEEN PREOPERATIVE AND POSTOPERATIVE MIO ACCORDING TO WILKES STAGE DETERMINED WITH STUDENT t TEST FOR PAIRED DATA (P VALUES) 286 287 P Value 288 Preoperative vs Preoperative vs Preoperative vs Preoperative vs Preoperative vs Preoperative vs 289 1 mo 3 mo 6 mo 9 mo 12 mo 24 mo Wilkes Stage 290 II 291 VAS " .001*† " .001*† " .001*† " .001*† " .001*† " .001*† 292 MIO " .001*‡ .30 .47 .46 .56 .14 293 III 294 VAS " .001*† " .001*† " .001*† " .001*† " .001*† " .001*† 295 MIO " .001*‡ .42 .32 " .01*† " .01*† .06 IV 296 VAS " .001*† " .001*† " .001*† " .001*† " .001*† " .001*† 297 MIO " .001*† " .001*† " .001*† " .001*† " .001*† " .001*† 298 V 299 VAS " .001*† " .001*† " .001*† " .001*† " .001*† " .001*† 300 MIO .92 .31 .74 .33 .62 .17 301 *Statistically significant (P " .05). 302 †Significant decrease in pain or significant increase in MIO. 303 ‡Significant decrease in MIO. 304 González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011. 305 306 307 However, this difference did not persist during the were quite similar for ALL and OA during the whole 308 rest of the follow-up and was not considered clinically follow-up period for the group of patients classified as 309 relevant. In relation to mouth opening, significant Wilkes stage IV. Success rates for patients classified as 310 differences between ALL and OA were observed 1) at Wilkes stage V were not considered relevant because 311 24 months in Wilkes stage II, 2) at 1 month in Wilkes of the low number of patients within this group. 312 stage III, and 3) at 1 month in Wilkes stage IV. In To compare pain and MIO among Wilkes stages at 313 these last 2 time points, mouth opening was signifieach time point for each group (ALL and OA), we 314 cantly lower for the OA group in comparison to the used 1-way ANOVA. In relation to the decrease in pain 315 AQ: 11 ALL group. For Wilkes stage II patients, those underfor the group of patients treated by ALL, no significant 316 going OA showed significantly better MIO values than differences between Wilkes stages were observed at 317 those undergoing ALL at the second year, although any time during the follow-up period. For patients 318 this difference was not evident at any other time point treated by OA, no significant differences between 319 during the follow-up period. For Wilkes stage III paWilkes stages were observed at any time during the 320 tients, preoperative mouth opening was significantly follow-up period, except at 24 months (global P # 321 lower in those undergoing OA than those undergoing .01) between Wilkes stages II and IV (P # .04) and 322 ALL. This difference persisted at the first month postbetween Wilkes stages III and IV (P # .01) (Table 8). 323 operatively but disappeared from the third month In relation to the increase in MIO for the group of 324 forward. For Wilkes stage IV patients, significant mipatients treated by ALL, significant differences be325 lowernor MIO was observed in the OA group at the first tween Wilkes stages were observed preoperatively 326 month postoperatively, although this difference did and at 1, 3, 6, 9, and 12 months postoperatively. AQ: 12 327 not persist during the rest of the follow-up period. No These differences disappeared at the end of the fol328 differences were observed for patients classified as low-up period. In relation to the increase in MIO for 329 Wilkes stage V during the follow-up period evaluated the group of patients treated by OA, significant differ330 (Table 6). ences between Wilkes stages were observed preop331 In relation to pain and function, success rates (pereratively and at 1, 3, and 6 months postoperatively. 332 centages) for ALL/OA at each time point of the folThese differences disappeared at 9 and 12 months but 333 low-up period in relation to Wilkes stages are summapersisted at the end of the follow-up period (Table 8). 334T7 rized in Table 7. Although some differences were 335 observed, mostly for Wilkes stages II and III, success Discussion 336 rates for pain and mouth opening did not follow any 337 fixed pattern, globally showing that ALL and OA did Under a general approach, several items can be 338 not essentially differ in terms of success during the highlighted from the results of our study: 1) patients 339 follow-up period. Success rates for pain and MIO with advanced disease, classified as Wilkes stages IV

284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 T8322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339

340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 Wilkes Stage II (n # 57)

Arthroscopic Technique VAS/MIO ALL

VAS MIO

OA

VAS MIO

III (n # 132)

ALL

VAS MIO

OA

VAS MIO

IV (n # 252)

ALL

VAS MIO

OA

VAS

MIO V (n # 17)

ALL

VAS MIO

OA

VAS MIO

Preoperative

1 mo

3 mo

6 mo

9 mo

12 mo

24 mo

(mean ! SD)

(mean ! SD)

(mean ! SD)

(mean ! SD)

(mean ! SD)

(mean ! SD)

(mean ! SD)

51.81 ! 24.36 (n # 26) 38.96 ! 4.60 (n # 26) 57.61 ! 22.04 (n # 31) 38.52 ! 4.45 (n # 31) 55.63 ! 16.30 (n # 40) 36.63 ! 5.36 (n # 40) 57.11 ! 23.41 (n # 92) 34.09 ! 6.25 (n # 92) 53.39 ! 23.74 (n # 84) 25.20 ! 5.54 (n # 84) 53.30 ! 22.95 (n # 168) 24.42 ! 4.49 (n # 168) 37.50 ! 31.09 (n # 6) 29.00 ! 11.41 (n # 6) 61.73 ! 27.79 (n # 11) 25.09 ! 4.82 (n # 11)




33.57 ! 25.33 (n # 7) 39.29 ! 16.32 (n # 7) 33.60 ! 29.97 (n # 10) 38.90 ! 5.23 (n # 10) 18.40 ! 21.78 (n # 15) 39.67 ! 5.79 (n # 15) 34.15 ! 23.05 (n # 26) 36.96 ! 6.37 (n # 26) 19.69 ! 18.34 (n # 45) 34.91 ! 7.43 (n # 45) 23.52 ! 24.43 (n # 52) 34.75 ! 7.17 (n # 52) —

35.63 ! 28.5 (n # 16) 39.19 ! 5.18 (n # 16) 34.92 ! 32.99 (n # 12) 39.92 ! 7.45 (n # 12) 26.52 ! 24.56 (n # 23) 38.17 ! 5.64 (n # 23) 22.34 ! 20.68 (n # 44) 36.86 ! 5.70 (n # 44) 22.09 ! 23.21 (n # 53) 35.44 ! 6.38 (n # 53) 19.97 ! 22.10 (n # 86) 35.56 ! 6.84 (n # 86) —

20.27 ! 20.62 (n # 15) 38.20 ! 5.00 (n # 15) 29.82 ! 28.56 (n # 11) 42.91 ! 5.39 (n # 11) 22.81 ! 24.70 (n # 16) 39.31 ! 5.10 (n # 16) 27.48 ! 25.48 (n # 31) 38.06 ! 6.11 (n # 31) 17.27 ! 21.18 (n # 33) 37.88 ! 7.03 (n # 33) 15.35 ! 16.88 (n # 57) 37.74 ! 5.82 (n # 57) —

—

—

—

—

—

—

—

—

—


Table 5. VAS AND MIO MEAN VALUES FOR ALL AND OA IN WILKES STAGES II THROUGH V

NOTE. Numbers in parentheses indicate the number of patients with available data for each group and period of time. González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011.

7 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395

8

Mean VAS values according to Wilkes stage 60

50 Wilkes II

VAS score (0-100)

40

Wilkes III Wilkes IV

30

Wilkes V

Lineal (Wilkes II) Lineal (Wilkes III)

20

Lineal (Wilkes IV) Lineal (Wilkes V)

10

0 Pre-op

1 month

3 months

6 months

9 months

12 months 24 months

FIGURE 1. Evolution of pain according to Wilkes stage. (Pre-op, preoperatively.) González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011.

and V, were significantly older than patients with early disease, classified as Wilkes stages II and III; 2) the presence of bilateral involvement of the TMJ was high, occurring in one-third of the patients; and 3) the distribution of arthroscopic techniques performed was almost equal, with approximately 50% of the joints treated with each technique (ALL and OA), although no randomization was performed. Although several techniques were used and combined within the group of patients treated with OA, electrocoagulation of the posterior ligament was performed in more than 88% of the cases, thus providing some homogeneity in this otherwise heterogeneous group. However, the objective of our study was not to assess which operative technique was better; our objective

was to perform a direct comparison of the overall group with respect to the group of patients treated with isolated ALL. Further randomized controlled studies are necessary to properly assess the effectiveness of each OA technique. The main limitation of this study was its retrospective design and the absence of a controlled randomized distribution of patients for each treatment group. Although a large number of patients in the ALL group had bilateral involvement, selection of patients with the same Wilkes stage may have alleviated a possible selection bias. The main strength of our study was the high number of operated patients. The presence of a high mean VAS score of 54 together with a severe decrease in mean MIO to 29

Mean MIO values according to Wilkes stage 50

45

40

MIO (mm)

396 397 398 399 400 401 402 403 404 405 406 407 C 408O 409L 410O 411R 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445C 446O L 447O 448R 449 450 451


Wilkes II Wilkes III

35

Wilkes IV Wilkes V

30

Lineal (Wilkes II) Lineal (Wilkes III)

25

Lineal (Wilkes IV) Lineal (Wilkes V)

20

15

Pre-op

1 month

3 months

6 monts

9 months

12 months 24 months

FIGURE 2. Evolution of mouth opening according to Wilkes stage. (Pre-op, preoperatively.) González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011.

396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451

9


452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 AQ: 13 485 486 487 488 489 AQ: 14 490 491 492 493 494 495 496 497 498 AQ: 15 499 500 501 502 503 504 505 506 507

Table 6. COMPARISON OF VAS AND MIO BETWEEN ALL AND OA FOR WILKES STAGES II THROUGH V DETERMINED WITH STUDENT t TEST FOR UNPAIRED DATA (P VALUES)

Wilkes Stage

P Value Preoperative

1 mo

3 mo

6 mo

9 mo

12 mo

24 mo

VAS MIO

.34 .71

.81 .32

.42 .30

.45 .08

.99 .88

.95 .76

.33 .03*

VAS MIO

.87 .02*

.14 .02*

.25 .22

.97 .12

.03* .18

.46 .37

.55 .48

VAS MIO

.97 .23

.67 .01*

.49 .11

.76 .95

.38 .91

.58 .92

.63 .91

VAS MIO

.12 .45

.71 .65

.42 .69

.72 .47

II III IV V

*Statistically significant (P " .05).

seems to be present more frequently in advanced stages. A significant decrease (P " .001) in pain was observed from the first month postoperatively to the end of the follow-up period in all Wilkes stages. As depicted in Figure 1, evolution of pain according to Wilkes stage showed some particularities, with higher pain values for Wilkes stages III and IV in comparison to Wilkes stage II but also with a higher decrease in pain for Wilkes stages III and IV than for Wilkes stage II. It seems that arthroscopy ultimately shows less benefit for stage II than for the more severely affected stages (ie, stages III and IV). Improvement in relation to pain was not followed by a parallel significant increase in mouth opening for Wilkes stage II at any time during the follow-up period, as well as for Wilkes stage III before 9 months. In contrast, a highly significant increase in mouth opening was observed for the

González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011.

mm for the whole series validated the inclusion of patients for arthroscopy. Interestingly, no statistically significant differences between mean values were observed for preoperative pain among Wilkes stages, thus indicating that pain may not necessarily be more severe in advanced stages than in early stages. In relation to preoperative mouth opening, a highly statistically significant difference (P " .001) was observed for both ALL and OA among Wilkes stages, with advanced stages showing progressively lower MIO values. In relation to arthroscopic findings, despite the presence of clinical symptoms and signs, in up to 6% of the cases, no morphologic or structural alteration within the upper joint space was observed after arthroscopy. In a previous study by our group concerning the influence of the upper joint surface and synovial lining in 257 patients (joints) affected by CCL of the TMJ treated with arthroscopy, grade I or II synovitis and grade III or IV synovitis were present in 50.58% and 41.86% of patients (joints), respectively.8 lower These results contrast with minor percentages for grade I or II synovitis and grade III or IV synovitis observed in the present study, when considering all Wilkes stages and not only stage IV. It can be concluded that both scarce and severe involvement of the synovial lining seem to be more frequent in advanced disease, such as cases with CCL of the TMJ. Otherwise, severe chondromalacia has been reported to occur in approximately 31% of the cases (joints) affected by CCL of the TMJ. In this study 24.09% of the joints showed severe chondromalacia, also indicating that severe involvement of the upper joint surface

Table 7. SUCCESS RATE (VAS SCORE 30 MM) ACCORDING TO AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS CRITERIA FOR ALL AND OA AT EACH TIME POINT DURING FOLLOW-UP PERIOD IN RELATION TO WILKES STAGE

Wilkes Stage

1 mo

3 mo

6 mo

12 mo

24 mo

38% 58%

61% 70%

75% 61%

60% 75%

88% 74%

43% 40%

65% 66%

91% 91%

74% 71%

78% 91%

56% 33%

71% 68%

71% 73%

75% 79%

86% 78%

40% 20%

59% 50%

69% 64%

69% 74%

74% 74%

46% 21%

57% 35%

71% 52%

73% 61%

87% 66%

40% 11%

61% 29%

69% 53%

76% 62%

86% 71%

— —

— —

— —

— —

— —

— —

— —

— —

— —

— —

II ALL VAS MIO OA VAS MIO III ALL VAS MIO OA VAS MIO IV ALL VAS MIO OA VAS MIO V* ALL VAS MIO OA VAS MIO

*Success rates in group with Wilkes stage V were not considered because of the small number of patients within this group. González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011.

452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 AQ: 24 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507

10 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563


Table 8. ONE-WAY ANOVA FOR COMPARISON OF PAIN AND MIO AMONG WILKES STAGES AT EACH TIME POINT IN EACH GROUP (ALL AND OA) (P VALUES)

P Values Preoperative

ALL VAS MIO Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes OA VAS MIO Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes

stage stage stage stage stage stage

stage stage stage stage stage stage

1 mo

3 mo

II vs stage III II vs stage IV II vs stage V III vs stage IV III vs stage V IV vs stage V

.32 " .001* — " .001* — " .001* — —

.24 .01* — .04* — — — —

.66 .002* — — — — — —

II vs stage III II vs stage IV II vs stage V III vs stage IV III vs stage V IV vs stage V

.53 " .001* " .001* " .001 — " .001* .001* —

.26 .007* — .04* — — — —

.46 .001* — .02* .008* — .04* —

6 mo

9 mo

.83 .20 .15* .01* .04* — — — — — — — .24* .02* .04* — — — .47 .003* .02* — " .001* .01* — .002*

.15 .13 NA NA NA NA NA NA

12 mo

24 mo

.16 .02* — .02* — — — —



.01*† .02* — .02* — — — —

NOTE. Wilkes stages II, III, IV, and V were compared preoperatively and at 1, 3, and 6 months. Wilkes stages II, III, and IV were compared at 9, 12, and 24 months. Wilkes stage V was not included for evaluation at 9, 12, and 24 months because of the low number of patients within this group at these time points. Global P values are given for VAS and MIO. Specific P values resulting from paired comparison of Wilkes stages for significant MIO values are also shown below the global P value for MIO. Dashes indicate no significant difference for a specific Wilkes stage pair. Abbreviation: NA, not applicable. *Statistically significant (P " .05). †Specific P values resulting from paired comparison of Wilkes stages for significant VAS score at 24 months were as follows: P # .04 for comparison of Wilkes stages II and IV and P # .01 for comparison of Wilkes stages III and IV. González-García and Rodríguez-Campo. Temporomandibular Joint Internal Derangement. J Oral Maxillofac Surg 2011.

group of patients classified as Wilkes stage IV from the first month postoperatively. These results are quite similar to previously published data in patients affected by CCL of the TMJ and classified as Wilkes stage IV.5,6 Figure 2 shows how the increase in mouth opening was more pronounced in Wilkes stage IV than in Wilkes stage II or III, thus leading to similar mean MIO values at the end of the follow-up period despite the fact that preoperative MIO values were significantly lower. Maximum effectiveness regarding both decrease in pain and increase in mouth opening makes arthroscopy especially suitable for the treatment of Wilkes stage IV internal derangement of the TMJ. The fact that no significant increase in MIO values was observed at any time during the follow-up period for patients classified as Wilkes stage V would lead us to conclude that arthroscopy, though effective in terms of pain relief, seems to be not effective when considering mandibular function within this group. However, caution has to be maintained in relation to this finding because of the low number of patients classified as Wilkes stage V in this study. From the ANOVA test, it can be concluded that mean VAS values did not statistically differ among

Wilkes stages for patients treated with ALL. A similar conclusion can be assumed for the group of patients treated with OA in relation to pain, except for mean VAS values at 24 months, which statistically differed between Wilkes stages II and IV (29.82 and 15.35, respectively; P # .04) and between Wilkes stages III and IV (27.48 and 15.35, respectively; P # .01). These results also confirm, as depicted in Figure 1, that although pain relief was a fact for all Wilkes stages, it reached the highest amount of decrease for patients with CCL at Wilkes stage IV. In relation to variance of mean MIO values among Wilkes stages, significant differences were observed preoperatively and at different time points for both ALL and OA. In the ALL group, the most important contrasts were observed between Wilkes stages II and IV preoperatively and at 1 and 12 months and between Wilkes stages III and IV preoperatively and at 6 months. In both cases, significantly lower mean MIO values were observed for Wilkes stage IV. These lower MIO values at particular time points did not appear during the other periods of follow-up, and ultimately, the differences among stages disappeared. However, the presence of lower mean MIO values for Wilkes stage IV in comparison to

508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 AQ: 16 551 552 553 554 555 556 557 558 559 560 561 562 563


564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 AQ: 17 582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 608 609 610 611 612 613 614 615 616 617 618 619

Wilkes stages II and III at particular time points seems comprehensible because the mean preoperative MIO value for stage IV was much lower. Moreover, the lineal increase in MIO for Wilkes stage IV is considerably higher than that for Wilkes stages II and III, with a global disappearance of any significant difference at the end of the follow-up period (Fig 2). The aim of performing an analysis of success rate according to the stage of internal derangement is based on variable results previously reported in the literature. Bronstein and Merrill3 observed a success rate of 96% for stage II, 83% for stage III, 88% for stage IV, and 63% for stage V. Holmlund et al16 reported a success rate of only 50% for patients with CCL with osteoarthrosis, corresponding to Wilkes stage V, whereas Murakami et al17 reported a success rate of approximately 90% for ALL in stages III and IV, and needed OA for a success rate of 93% in stage V. In our study, with strict success criteria of a VAS pain score of less than 20 and mouth opening of 35 mm or greater, we observed an increasing success rate for both ALL and OA at each time point of the follow-up period. From the results of this study, it can be concluded that both ALL and OA are equally effective at decreasing pain in patients with TMJ internal derangement at any Wilkes stage. Moreover, ALL and OA did not differ with respect to mouth opening from the first month postoperatively for Wilkes stages II and V and from the third month postoperatively for Wilkes stages III and IV. Within these results, significantly lower MIO values for OA at 1 month postoperatively could be attributable to the higher inflammatory response within the upper compartment of the TMJ after more complex arthroscopic maneuvers. Similar conclusions can be highlighted from success rates in relation to pain and function for ALL and OA among Wilkes stages. Recently, Smolka and Iizuka,18 in a study of 26 joints that underwent ALL, found an acceptable overall success rate of 78.3%, although the treatment was less successful for stages IV and V (71.4% and 75%, respectively) than for stages II and III (80% and 85.7%, respectively). One OA was introduced as anterior release of the joint capsule or the pterygoid muscle to allow for posterior repositioning of the disc, as well as electrocautery of the posterior ligament. Good preliminary results with OA were obtained by Davis et al,7 McCain and de la Rua,19 and Tarro,20 although direct comparison studies between OA and ALL were still absent. In a subsequent study by Indresano,10 103 of 188 patients who underwent ALL and 121 of 212 patients who underwent OA were evaluated and compared with regard to pain and function. Within the group of patients with ALL, who were followed up for 8.3 years, pain was reduced by 71% and disability was reduced by 66%. In comparison, patients undergoing

11 OA, with a mean follow-up of 4.8 years, showed a 564 pain reduction of 81% and a disability improvement of 565 86%. The differences were statistically significant. In566 terestingly, within the ALL group, 37% of the patients 567 had further surgery and, therefore, the first procedure 568 had failed, in contrast to only 9% of the patients in the 569 OA group. Although the study was retrospective, the 570 results were consistent with previously published 571 data. 572 In contrast, Miyamoto et al,21 in a comparison study 573 of 41 joints treated with ALL and 73 joints treated 574 with arthroscopic anterolateral capsular release 575 (AALCR) in patients with advanced internal derange576 ment (Wilkes stages III through V), found similar good 577 results in terms of pain and function for both treat578 ment modalities, except for MIO at 1 month after 579 surgery, with AALCR providing significantly better 580 results. They concluded that ALL within the superior 581 joint space was suitable and effective for patients with 582 advanced internal derangement with locking and that 583 AALCR was necessary only if early wide mouth open584 ing was required. These results are in concordance 585 with data previously published by González-García et 586 al5 on the treatment of patients with Wilkes stage 587 IV internal derangement and CCL, in which no statis588 tical differences were observed between both ar589 throscopic techniques at any time point. Moreover, 590 the results from the present study confirm these ob591 servations among all Wilkes stages. White,22 in a re592 fewyears, cent review of articles published in the last 593 supports the idea that despite the use of advanced 594 arthroscopic techniques for internal derangement, no 595 definitive differences in outcome—range of motion, 596 postoperative pain, or time required to rehabilitate 597 the joint—were observed, whether these procedures 598 were used or only ALL was used. In contrast to Miy599 AQ: 18 amoto et al,21 we observed slightly significantly lower 600 values for mouth opening in patients undergoing OA 601 in comparison to patients undergoing ALL in Wilkes 602 stages III and IV in the early postoperative period, as 603 well as lower success rates. However, these differ604 ences did not persist at the third month after surgery 605 explanation that should be be considered is presthe presence and later. Explanation should looked in the 606 ence of a higher joint inflammatory response after OA 607 that may limit mouth opening in the early postoper608 ative period. 609 AQ: 19 Both ALL and OA are equally effective at decreasing 610 pain in patients with TMJ internal derangement at any 611 Wilkes stage. A highly significant increase in mouth 612 opening was observed in the group of patients clas613 sified as Wilkes stage IV from the first month postop614 eratively. While directly comparing ALL and OA, we 615 found that both techniques did not differ with respect 616 to mouth opening from the first month postopera617 tively for Wilkes stages II and V and from 3 months for 618 Wilkes stages III and IV. Patients classified as Wilkes 619

of

12 620 621 622 623 624 625 626 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 644 645 646 647 AQ: 20 648 649 650 651 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 672 673 674 675

stage IV presenting with CCL of the TMJ had the highest decrease in pain and the highest increase in mouth opening among the stages, thus confirming that these patients are the best candidates for arthroscopy.

References 1. Dolwick MF, Riggs RR: Diagnosis and treatment of internal derangements of the temporomandibular joint. Dent Clin North Am 27:561, 1983 2. Wilkes CH: Structural and functional alterations of the temporomandibular joint. Northwest Dent 57:287, 1978 3. Bronstein SL, Merrill RG: Clinical staging for TMJ internal derangement: Application to arthroscopy. J Craniomandib Disord 6:7, 1992 4. Sanders B: Arthroscopic surgery of the temporomandibular joint: Treatment of internal derangement with persistent closed lock. Oral Surg Oral Med Oral Pathol 62:361, 1986 5. González-García R, Rodríguez-Campo FJ, Monje F, et al: Operative versus simple arthroscopic surgery for chronic closed lock of the temporomandibular joint: A clinical study of 344 arthroscopic procedures. Int J Oral Maxillofac Surg 37:790, 2008 6. González-García R, Rodríguez-Campo FJ, Monje F, et al: The influence of the upper joint surface and synovial lining in the outcome of chronic closed lock of the TMJ treated with arthroscopy. Int J Oral Maxillofac Surg 68:35, 2010 7. Davis CL, Kaminishi RM, Marshall MW: Arthroscopic surgery for treatment of closed lock. J Oral Maxillofac Surg 49:704, 1991 8. Laskin DM: Internal derangements, in Laskin DM, Greene CS, Hylander W (eds): Temporomandibular Disorders: An Evidence-Based Approach to Diagnosis and Treatment. Chicago, IL, Quintessence Publishing, 2006, p 249, -253 9. Laskin DM: Arthrocentesis for the treatment of internal derangements of the temporomandibular joint. Alpha Omegan 102:46, 2009

TEMPOROMANDIBULAR JOINT INTERNAL DERANGEMENT 10. Indresano AT: Surgical arthroscopy as the preferred treatment for internal derangements of the temporomandibular joint. J Oral Maxillofac Surg 59:308, 2001 11. Moses JJ, Poker ID: TMJ arthroscopic surgery: An analysis of 237 patients. J Oral Maxillofac Surg 47:790, 1989 12. Segami N, Murakami K, Hosaka H, et al: Arthroscopic anterolateral capsular release for internal derangement of the temporomandibular joint. Jpn Arthrosc Assoc 18:105, 1993 13. Dolwick MF, Reid S, Sanders B, et al: Criteria for TMJ Meniscus Surgery. Chicago, IL, American Association of Oral and Maxillofacial Surgeons, 1984, p 31 14. Eriksson L, Westesson PL: Temporomandibular joint diskectomy. No positive effect of temporary silicone implant in a 5-year follow-up. Oral Surg Oral Med Oral Pathol 74:259, 1992 15. Sanders B, Buoncristiani R: Diagnostic and surgical arthroscopy of the temporomandibular joint: Clinical experience with 137 procedures over a 2-year period. J Craniomandib Disord 1:202, 1987 16. Holmlund A, Gynther G, Axelsson S: Efficacy of arthroscopic lysis and lavage in patients with chronic locking of the temporomandibular joint. Int J Oral Maxillofac Surg 23:262, 1994 17. Murakami K, Moriya Y, Goto K, et al: Four-year follow-up study of temporomandibular joint arthroscopic surgery for advanced stage internal derangements. J Oral Maxillofac Surg 54:285, 1996 18. Smolka W, Iizuka T: Arthroscopic lysis and lavage in different stages of internal derangement of the temporomandibular joint: Correlation of preoperative staging to arthroscopic findings and treatment outcome. J Oral Maxillofac Surg 63:471, 2005 19. McCain JP, de la Rua H: Principles and practice of operative arthroscopy of the human temporomandibular joint. Oral Maxillofac Surg Clin North Am 1:135, 1989 20. Tarro AW: Arthroscopic treatment of anterior disc displacement: A preliminary report. J Oral Maxillofac Surg 47:353, 1989 21. Miyamoto H, Sakashita H, Miyata M, et al: Arthroscopic surgery of the temporomandibular joint: Comparison of two successful techniques. Br J Oral Maxillofac Surg 37:397, 1999 22. White RD: Arthroscopic lysis and lavage as the preferred treatment for internal derangement of the temporomandibular joint. J Oral Maxillofac Surg 59:313, 2001

620 621 622 623 624 625 626 627 AQ: 21 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 644 645 646 647 648 649 650 651 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 672 673 674 675