Arthroscopy versus arthrocentesis. A retrospective study of disc displacement management without reduction.

OBJECTIVES To compare the outcome of arthroscopic surgery and arthrocentesis of internal derangement (disc displacement without reduction) of the temporomandibular joint (TMJ). METHODS The charts of 48 patients with TMJ derangement and treated with arthroscopy or arthrocentesis were included in this study carried out in a specialized private clinic in Beirut, Lebanon, between January 2001 and July 2005. Inclusion criteria included patients with a history of clicking followed by a sudden onset of limited mouth opening without clicking, a complaint of TMJ pain with mouth opening or chewing difficulty, or both, or a positive magnetic resonance imaging diagnosis of TMJ disc displacement without reduction. Patients with limited mouth opening caused by only muscle spasm, prior TMJ surgery, bilateral joint involvement, or serious systemic diseases were excluded from the study. Twenty-eight patients underwent arthroscopy (group one) and 20 patients were treated with arthrocentesis (group 2). RESULTS Both methods showed a significant reduction in pain and an increase in maximal mouth opening on follow up (p<0.01). There was no statistical difference between the methods. CONCLUSIONS Further research should be conducted before one can definitely determine if real benefits are achieved through surgery in TMJ articular disorders. Within the limits of this study, less invasive procedures are highly recommended.