Surgical treatment of internal derangements of the temporomandibular joint. A long-term study.

A long-term surgical follow-up study of 176 patients (211 joints) with documented internal derangements of the temporomandibular joint was carried out. Arthrograms and tomograms were used in all cases. Forty of the patients (49 joints) were nonsurgical control patients. Diagnostic staging of the cases was accomplished as previously published. A clinical/radiologic assessment index was derived, which included seven measured parameters. Surgical patients, grouped by diagnostic stages and selected operations, were compared with each other and with control patients over the follow-up period (average, 8.1 years; range, 5 to 14 years). The surgical procedures included meniscectomy, reconstructive arthroplasty, and arthroplasty with temporary Silastic (Dow Corning Wright, Arlington, Tenn) implant. The overall success rate for surgical cases with all stages and procedures was 93.8%. In contrast, the control group demonstrated significant clinical and radiographic progression. The surgical results were stage dependent for the same operative procedure. Significantly better success rates were obtained in early-stage cases (96.9%) than in late-stage cases (89.4%). With respect to comparison of operative procedures, it was found that reconstructive arthroplasty provided results superior to those of meniscectomy. There was no significant difference between results obtained by meniscectomy and those by arthroplasty with a temporary Silastic implant. Long-term stability was excellent in most cases. Follow-up radiographic changes for the surgical group were less than expected. On the other hand, radiographic analysis of the control group demonstrated progressive degenerative changes in 73.5% of cases. Complications over the entire study were rare. It was concluded that surgery can provide successful long-term results in the treatment of internal derangements.