TMJ arthroscopic level 1 vs arthrocentesis in the management of internal derangement of the temporomandibular joint

Objectives: The technique of lysis and lavage has shown excellent success rates in treating internal derangement of the temporomandibular joint (TMJ). This procedure has been shown to reduce pain and improve joint mobility, sometimes even in patients suffering from advanced stages of degenerative joint disease (Wilkes IV to V). There are two different approaches to lavage and arthrolysis: arthrocentesis and TMJ arthroscopy. The objective was to assess both approaches' efficacy inman¬ aging internal derangement of TMJ. Method and materials: In total, 92 patients with clinical and radiographic documentation of internal derangement of the TMJ unresponsive to nonsurgical therapy were randomized to one of two surgical groups: arthroscopic lysis and lavage level 1 (64 patients) and arthrocentesis (28 patients). Radiologic changes in the joint, pain (visual analog scale), interincisal distance, lateral and protrusive movements, and clicks and sounds of the joints were recorded. Data were compared presurgically (T0) and in postoperative periods of 1 week (T1), and 1 (T2), 3 (T3), and 6 (T4) months. Results: Both surgical modalities achieved a similar outcome. A gradual improvement was demonstrated during the fol¬ low-up periods with no reliance on radiologic changes to the joint or the TMJ diagnosis. More than that, significant differ¬ ences were encountered in all parameters but protrusion be¬ tween T0 and T4. Pain decreased from 7.16 ± 2.48 to 1.75 ± 1.98 for the arthroscopic group and from 7.53 ± 2.69 to 1.00 ± 1.86 for the arthrocentesis group (P = .000). Conclusion: Both the approaches of arthrocentesis and arthroscopic level 1 reduced pain and improved mouth opening and lateral and protrusive movements over time.