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Background/purpose: Temporomandibular joint disc displacement is the most frequently reported temporomandibular disorder that may severely impair quality of life and can be challenging to treat. This study aimed to evaluate and compare the efficiency of intra-articular injection of injectable platelet rich fibrin (i-PRF) following arthrocentesis or arthrocentesis alone in treatment of patients with TMJ disc displacement with reduction. Materials and methods: Forty patients for a total of forty joints with reducible anterior disc displacement, as confirmed by Magnetic Resonance Imaging (MRI) were selected and divided into 2 equal groups. In group I (control group), arthrocentesis alone was performed with Ringer solution. In group II (study group), a combination of arthrocentesis and intra-articular injection with 1.5 ml i-PRF was performed. The outcome variables included pain intensity evaluated with a visual analogue scale, inter-incisal opening, lateral movement evaluated in millimeters, and clicking. Assessments were done pre-operatively, and 1 week, 3 months, and 6 months postoperatively. Results: There was statistically significant reduction in pain intensity and clicking sound and increase in mouth opening and lateral movement in i-PRF group when compared to arthrocentesis group. In addition, the differences between preoperative and postoperative status in all the measured parameters were statistically significant within the study and the control group throughout the postoperative period. Conclusion: The combination of i-PRF with arthrocentesis is a safe and effective method in the treatment of TMJ disc displacement with reduction.

This study aims to examine outcomes for temporomandibular joint (TMJ) arthroscopy in different Wilkes stages of internal derangement (ID) and factors relevant in relapse in those requiring further surgical management. A review was undertaken of patients who underwent TMJ arthroscopy from June 2017 until August 2019 at St George's Medical Centre, Christchurch, New Zealand. Those with a primary diagnosis of ID with adequate follow up were reviewed. Gender, pre-and post-operative visual analogue scale (VAS) pain scores and maximum incisal opening (MIO) according to Wilkes stages were statistically analysed. Parameters of those who underwent further surgery were assessed. Ninety-nine patients were reviewed with follow up time between 3 and 27 months. No difference in pre- and post-operative VAS pain scores occurred between Wilkes stages (p = 0.9527). Wilkes II patients had the lowest re-operation rates (6.7%). Twenty-one percent of patients underwent further surgery with either re-arthroscopy, arthrotomy or total joint replacement. Gender did not influence the risk of further surgery (p = 0.3451). Four Wilkes IV and 5 Wilkes V patients underwent TJR, with none from Wilkes II or III. This study shows TMJ arthroscopy should be considered a first line intervention in treating symptomatic ID regardless of initial Wilkes stage. A significant improvement in pain and functional levels occurred across all stages. No specific factors were identified for those undergoing further surgery. However, a trend towards open surgery and total joint replacement was seen in Wilkes IV and V patients.

The present study evaluated the literature regarding the clinical outcomes after discopexy using suture bone anchors for repositioning disc displacement. A systematic review was conducted according to the PRISMA statement and applied for the PROSPERO platform. The database searches were performed in the PubMed, Scopus, Web of Science, EMBASE, The Cochrane Library, and LILACS for full articles published from no restrictions of the initial period time to April 2022. Selection criteria included clinical studies in humans comparing maximal inter-incisal opening (MIO), pain by visual analogue scale (VAS), and protrusive and lateral excursions before and after discopexy. The screening process was performed by two independent reviewers, and if they did not agree with each other, a third reviewer was consulted before proceeding. The meta-analysis was carried out by Comprehensive Meta-Analysis software. Eleven studies met the inclusion criteria. A total of 327 patients were diagnosed with disc displacement, and 142 patients were refractory to conservative and minimally surgical therapies. Preauricular and endaural approaches were performed to place suture bone anchors on the posterior area of the condyle. A significant difference was found in MIO, which ranged from 15.5 mm pre-opeatively to 41.6 mm post-operatively (p = 0.001). Pain scores using the VAS ranged from 7.42 to 0.28 indicating improvement post-operatively (p = 0.001). Mandibular excursions were underestimated. The available results have shown that discopexy using suture anchors seemed to decrease pain and improve mouth opening. Clinical studies are required in a larger sample and lower variability of follow-up time to predict actual benefits., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships which could have appeared to influence the work reported in this article., (Copyright © 2023 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The purpose of this study was to compare the effectiveness of arthroscopic-assisted lateral pterygoid muscle release versus scarification of retrodiscal tissues in the treatment of temporomandibular joint internal derangement. A prospective, comparative, randomized clinical trial involved 16 patients with TMJ internal derangement. Arthroscopic assisted release of lateral pterygoid muscle was assigned to one group of patients (Group I). Group II patients received arthroscopic assisted scarification of retrodiscal tissues. Data collected through functional examination including visual analogue scale (VAS), maximum mouth opening, lateral excursion, and clicking sound immediately and after 3, 6, and 12 months. Pre- and post-operative MRI was used to assess disc position. The VAS scores decreased in both groups at the end of the follow-up period (0.45 vs 6.75, and 1.13 vs 6.50 in group I and II respectively; P<0.001). The maximum mouth opening improved to 32.9.50 ± 1.69 mm in group I, and 30.49 ± 0.93 in group II (P<0.001). Lateral excursion improved in both groups (P<0.001). Clicking sounds disappeared in all patients. Within the limitations of the study, it seems that arthroscopic assisted release of lateral pterygoid and scarification of retrodiscal tissues may be beneficial in management of anteriorly displaced discs that don't respond to conservative treatments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: This prospective study aimed at comparing dynamic T1W fast field echo sequence to the standard static sequences in the evaluation of TMJ disorders using 3T MRI., Methods: 8 patients, 14 with bilateral symptomatic internal derangement of TMJ and 4 with unilateral symptoms (32 TMJs) were examined, including 17 females and one male. Static T1W, T2W and PD turbo spin-echo sequences in closed and open mouth positions as well as dynamic T1W-FFE sequence were acquired on 3T MRI unit and images were assessed for the articular disc position, morphological disc changes, condylar morphology and translation. Marginal homogeneity test was used to analyze difference between dynamic and static imaging findings and significant results were considered at p ≤ 0.05., Results: The study shows statistically significant difference between static and dynamic MRI in the evaluation of condylar position (p < 0.005). Out of the examined 32 joints, 28 joints (87.5%) had normal condylar position and 4 joints (12.5%) had a subluxated condyle. Dynamic MRI showed 24 joints (75%) had normal condylar position and 8 joints (25%) had a subluxated condyle. Regarding disc morphology and position, dynamic MRI added no significant superior information compared to standard static images., Conclusion: Static MRI of TMJ provides proper accurate assessment of pathological changes in TMJ disorders and considered the gold standard. Dynamic MRI added superior information regarding joint biomechanics even in normal static MRI cases and valuable findings regarding the movement patterns of the condyle and disc in different types of TMJ internal derangement., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The purpose of the study was to assess the long-term oral health-related quality of life (oQoL) in patients with temporomandibular joint (TMJ) internal derangement (ID) after TMJ arthrocentesis plus hyaluronic acid (HA). Patients were analysed at different follow-up times using an analytical observational design. The Oral Health Impact Profile-14 (OHIP-14) score was evaluated according to age, sex, disc position, presence of degenerative joint disease (DJD), joint pain, maximum mouth opening and follow-up time. A total of 60 participants were enrolled, 88% female, with a mean age of 38 years (SD = 13.48). In an average follow-up of 25.02 months (SD = 5.32), the OHIP-14 total score decreased 8.67 (95% confidence interval [CI]: -11.21 to -6.11) after the intervention (Cohen's d = 1.22; 95% CI = 0.81 to 1.64). All OHIP-14 domain scores decreased (p < 0.05) except for the Functional limitation domain (p = 0.378). The oQoL after the intervention worsened in female patients (p = 0.039) and with a higher level of pain at baseline (p = 0.002). Self-perceived QoL improvement should be considered stable long term after temporomandibular joint arthrocentesis plus HA, regardless of concurrence with DJD or ID subtype. QoL should be used as clinical assessment measure of ID patients, with special attention to those with higher levels of pain., (Copyright © 2022 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The aim of the present study was to evaluate the use of the glenoid fossa as an anchorage for the temporomandibular joint (TMJ) disc repositioning in patients with a disc displacement (DD) without reduction. A prospective case series study included patients with DD without reduction. According to the Wilkes staging system for the TMJ internal derangement, preoperative magnetic resonance imaging (MRI) scans and clinical examinations determine the stage of the DD. The discopexy treatment consists of combined endaural/preauricular incision on the tragus, and freeing the anteromedial displaced disc from its attachments. An intra bony hole was drilled 2 mm away from the postero-lateral lip of the glenoid fossa and perpendicular to it. The disc was securely fixed to the roof of the fossa via a Prolene 0 suture in a double-pass suture fashion. The functional assessment was based on the pain visual analogue scale (VAS) and measurements of the maximum inter-incisal opening (MIO) after 1, 6, 12, and 18 months. P values ≤ 0.05 were considered significant. Thirteen of 25 joints were diagnosed with Wilkes stage III. The mean VAS score significantly decreased to 2.2 ± 1.0 and the MIO also significantly improved with a mean of 35.9 ± 3.5 mm after 18 months (P < 0.001). The rest of the cases (12 joints) were diagnosed with Wilkes stage IV, and the VAS score decreased to 1.6 ± 0.7. The MIO increased to 34.2 ± 3.3 mm at the end of the follow-up (P < 0.001). Within the limitations of the study, it seems that using the glenoid fossa as anchorage for the TMJ disc might have some clinical relevance and therefore might be taken into consideration whenever it is deemed appropriate., Competing Interests: Declaration of competing interest The authors have declared no conflict of interest., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to compare the efficacy of dextrose prolotherapy with that of occlusal splints in treating internal derangement of the temporomandibular joint., Patients and Methods: A total of 34 patients with temporomandibular joint internal derangement classed as Wilkes stages II or III were recruited for the study, and were randomly divided into study and control groups with 17 patients each. The patients in these control and study groups were treated with splints and prolotherapy, respectively. Outcome parameters, such as pain, mouth opening, clicking and deviation, were assessed using the Helkimo clinical dysfunction index for a review period of 1 year., Results: Nine patients in the study group had complete absence of pain, compared with only one patient in the control group. The results showed that patients who received prolotherapy demonstrated improvement in pain (p < 0.001), mouth opening (p = 0.032), and clicking (p < 0.001), but no significant difference in deviation was observed between the groups after 1 year (p = 0.862)., Conclusion: Prolotherapy was found to be superior in providing long-term clinical relief, with reduction in pain and clicking along with improved mouth opening., (Copyright © 2020. Published by Elsevier Ltd.)

Intra-Articular Temporo-Mandibular Disorders (TMD) are characterized by displacement of the disc that causes the condyles to slip back over the disc thus resulting in TMJ discal damage and erosion of the condyle's bone. The etiology of temporomandibular disorder (TMD) is multidimensional: biomechanical, neuromuscular, bio-psychosocial and biological factors may contribute to the disorder. The study involved 46 joints in 27 patients with a diagnosis of Intra-Articular Temporo-Mandibular Disorders (TMD) according to Axis I of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications and underwent surgery between 2011 and 2014. Patients were divided into three groups. Group 1 were included patients with Disc Displacement (DD) without reduction without limited opening, Group 2 patients with DD without reduction with limited opening. Finally, Group 3 included patients with Degenerative Joint Disease (DJD) TMD. In all cases, diagnosis of Intra-Articular Temporo-Mandibular Disorders (TMD) was confirmed by pre-operative examination (clinical, MRI and/or CT scan). Tissue specimens were obtained from all 50 joints for histopathology. The aim of this study was to analyse histological features of the surgical specimens obtained from patients with Intra-Articular Temporo-Mandibular Disorders who underwent surgery and assess the association with clinical findings and imaging. Preliminary results show in Group 1, fibrocartilage is preserved and regular, there are isolated outbreaks of bone resorption and focal sclerosis. In Groups 2 and 3 fibrocartilages are irregular and thickness varies widely and sclerosis is more pronounced. In early stages of TMD, the disc antero-medial displacement might play a fundamental role in the etiopathogenesis that can became an irreversible joint damage thus leading to a wide spectrum of articular symptoms and signs in TMD (Cohen et al., 2014; Hagandora and Almarza, 2012; Nah, 2012)., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: In temporomandibular disorders (TMDs), unless splints are effective, combined therapies are performed. The aim of this study is to show the effectiveness of the local anaesthethic injections (trigger point injections) to the masticatory muscles., Materials and Methods: The study was composed of TMD patients and the predictor variables were therapy combinations including stabilization splint (SS) therapy, SS+trigger point injection therapy (TPI) and arthrocentesis. The primary outcome variables were pain and jaw movements. The follow-ups were done at 1st and 3rd months. 56 patients who were treated for TMD with only SS or combined therapies were included in the study. The effects of additional TPIs were compared to SS therapy alone. Also the effect of arthrocentesis was evaluated too., Results: All groups revealed significant decreases in pain scores. Decreases in mouth openings were observed in some of the patients in the injection groups., Conclusion: The combined treatment method in which the injections were applied at shorter time intervals, was a more effective method for decreasing VAS scores in TMD patients in this study but further studies are required., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: Treatment of internal derangement is controversial. This study assessed the effectiveness of discectomy without replacement in improving jaw function and decreasing pain., Materials and Methods: A retrospective cohort study sample of subjects with internal derangement underwent discectomy without replacement by one surgeon at a single academic medical center. The primary predictor variables were preoperative maximal incisal opening (MIO) and Helkimo Clinical Dysfunction Index (CDI) score. The primary outcome variable was postoperative MIO and CDI score. A paired student's t-test assessed the difference between pre- and post-operative MIO and CDI scores., Results: Preoperatively, all patients had a clinical dysfunction index of DiIII, indicating severe dysfunction. Postoperatively 14 of 17 subjects (82%) showed marked improvement in mandibular function, and reduction in pain characterized as clinically symptom-free or only small dysfunction (DiO or DiI). One subject improved to DiII and two remained DiIII due to poor compliance. Preoperatively all subjects had an anamnestic index of AiII, representing TMJ locking or severe TMJ or muscle pain. Postoperatively 15 of 17 patients (88%) improved to AiO or AiI, and the two patients with poor compliance remained at AiII, but with marked pain reduction. Of the 17 subjects, the mean pre- and post-operative MIO was 24.2 mm and 34.9 mm, respectively (p < 0.001). There was a significant difference in pre- and post-operative MIO in subjects with Wilkes III (p = 0.005) and Wilkes IV (p = 0.008), but not Wilkes V (p = 0.7). Mean pre- and post-CDI scores were 17.3 and 3.8, respectively (p < 0.001). When stratifying by Wilkes stage, there was a significant difference in pre- and post-operative CDI in subjects with Wilkes III (p < 0.001) and Wilkes IV (p < 0.001), but not Wilkes V (p = 0.1)., Conclusions: In Wilkes III and IV subjects, discectomy without replacement is effective in improving MIO based upon improvement in objective and subjective assessments., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: To compare the outcomes achieved with eminectomy, discectomy alone, and discectomy with an abdominal dermis fat graft (D + ADFG) in the treatment of internal derangements (IDs) of the temporomandibular joint (TMJ), and to briefly discuss the failed cases in which a second operation was needed., Patients and Methods: This was a retrospective study of 31 patients (27 females, 4 males) who were unresponsive to conservative therapy and therefore underwent eminectomy (group A, n = 6), discectomy alone (group B, n = 8), or D + ADFG (group C, n = 17). All of the IDs of the TMJ were unilateral. Functional mandibular pain intensity on a visual analog scale (VAS) and maximum interincisal opening (MIO) were recorded preoperatively and at the latest postoperative examination (average, 30 months). The preoperative and postoperative results were compared between and within each group., Results: Overall, patients in groups B and C had better outcomes than those in group A in terms of TMJ symptom relief. Postoperative increases in MIO were statistically significant in groups A, B, and C (P < 0.027, P < 0.017, and P < 0.000, respectively). Patients with discectomized joints (groups B and C) had significantly improved pain scores (P < 0.05) at the latest follow-up. In 6 of the 31 (19.3%) patients (3 eminectomy, 1 discectomy, and 2 D + ADFG), the procedure was deemed unsuccessful because of persistent symptoms and a second operation was performed., Conclusions: Discectomy with or without ADFG was clearly superior to eminectomy in reducing pain and improving joint function. But there were no significant differences in the two-discectomy groups with respect to symptom improvement., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The main objective of our study was to evaluate the effectiveness of the injection of plasma rich in platelet-derived growth factors (PRGF) versus hyaluronic acid (HA) following arthroscopic surgery in patients diagnosed with internal derangement of the temporomandibular joint (TMJ) with osteoarthritis (OA)., Materials and Methods: A total of 100 patients were randomised into two study groups. Group A (n = 50) received an injection of PRGF, and Group B (n = 50) received an injection of HA. The mean age was 35.5 years (range 18-77 years), and 88% of the patients were women. The pain intensity (visual analogue scale) and the extent of maximum mouth opening before and after the procedure were statistically analysed., Results: Better results were observed in the group treated with PRGF, with a significant reduction in pain at 18 months, compared with HA treatment. Regarding mouth opening, an increase was observed in both groups, with no significant difference., Conclusions: The injection of PRGF following arthroscopy is more effective than the injection of HA with respect to pain in patients with advanced internal derangement of the TMJ., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: Arthroscopic lysis and lavage has been shown to be effective in the management of a variety of TMJ (Temporomandibular joint) diseases. The purpose of this study was to evaluate the medium to long-term outcomes of TMJ arthroscopic lysis and lavage and determine factors associated with progression to open surgery., Materials and Methods: A retrospective cohort study of a single operator series was performed over a 6-year period from 2006 to 2012. The variables of gender, age and category (Dimitroulis classification) were compared to evaluate factors associated with success of arthroscopy and progression to open surgery. The data were analysed via Kaplan Meier method for time-to event analyses and Chi-squared tests for trend analyses. Pre-operative and post-operative Visual analogue scores and maximum inter-incisal opening results were analysed with the Student's t-test., Results: A total of 167 patients and 216 joints underwent arthroscopy with a mean follow up of 6.9 years. Overall 77.7% of joints had a successful result and required no further surgery. There was no gender difference with respect to progression to surgery. Males underwent open surgery after a mean of 6.2 months from arthroscopy and Females after a mean of 15.6 months from arthroscopy (p < 0.005). The highest failure rate between age groups was in the 21-30 year age group (p < 0.04). There was a statistically significant rate of progression to open surgery depending on the classification at the time of arthroscopy, with all patients with category 4 and 5 disease progressing to open surgery (p < 0.0001)., Conclusion: Arthroscopic lysis and lavage of the TMJ is a reliable and effective operation for patients with early stage (i.e., Categories 1, 2 and 3) disorders of the TMJ. Patients with more advanced joint disease (i.e., Categories 4 & 5) gained only temporary relief from TMJ arthroscopy and often progress to open TMJ surgery., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Background: Temporomandibular joint (TMJ) internal derangements are progressive painful conditions and cause joint dysfunction, joint sound, malocclusion, and locking of the mouth. Conservative and invasive techniques can be used for the treatment of TMJ internal derangements. The objective of the present study was to examine the benefit of an intra-articular platelet-rich plasma (PRP) injection and to compare this with arthrocentesis., Methods: Twenty patients (female: male; 15:5; age 26, 3 ± 9.3 years) for a total of 32 joints with reducible anterior disc dislocation, as confirmed by Magnetic Resonance Imaging (MRI), were divided into two groups. PRP was used for the study group, and arthrocentesis was used for the control group. Pain intensity, maximal interincisal opening, and TMJ sounds were assessed and compared for evaluation of treatment success., Results: There was a statistically significant reduction in pain intensity and joint sound and an increase in mouth opening in the study group when compared with the control group., Conclusions: This study shows that intra-articular PRP injection for the treatment of reducible disc displacement of the TMJ is a more effective method than arthrocentesis., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to investigate the level of tumor necrosis factor-alpha (TNF-α) in the synovial fluid (SF) of patients with temporomandibular joint (TMJ) internal derangement and to show the relationship between the level of TNF-α and the severity of the disease., Materials and Methods: Arthrocentesis was performed on 32 female and five male patients (aged between 17 and 45) referred to our clinic with the complaint of TMJ pain and discomfort. TNF-α levels were determined in the SF samples obtained during arthrocentesis. As a measure of pain, visual analog scale (VAS) scores were also evaluated., Results: There were statistically significant differences in VAS scores between the stages. VAS scores were found to be elevated as the stage of disease progressed. Increased levels of TNF-α were found in progressive stages of internal derangement., Conclusion: In our study, both SF TNF-α levels and pain levels (VAS scores) were found to be increased in patients with internal derangement as the stage of the disease progresses. TNF-α might contribute to the pathogenesis of synovitis and the degeneration of the TMJ cartilage and bone., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)