Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, Madrid, Spain; Department of Oral and Maxillofacial Surgery, University Hospital Montepríncipe, San Pablo CEU University, Madrid, Spain.
Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autónoma University, Madrid, Spain.
Int J Oral Maxillofac Surg. 2020 Oct;49(10):1311-1318. doi: 10.1016/j.ijom.2020.03.004. Epub 2020 Mar 23.
The aim of this study was to present the results of a modification of the arthroscopic anterior myotomy for the treatment of internal derangement (ID) of the temporomandibular joint (TMJ): the minimally invasive arthroscopic anterior myotomy (MIAAM). Fifteen joints with Wilkes stages III-IV ID treated with this technique were studied. Clinical data evaluated were pain (visual analogue scale, VAS) and articular movements (preoperatively and at 1, 3, 6, 9, and 12 months postoperative). The position of the disc at 1 year after surgery was compared with the pre-surgical position, using magnetic resonance imaging (MRI). The mean pain level according to the VAS decreased from of 67.8 pre-surgery to 29.0 at the 12-month follow-up (P < 0.001). Functionally, mouth opening increased from a mean 27.8 mm to 36.0 mm (P < 0.001). Evaluation of the MRI images showed statistically significant improvements in disc position in both the closed (P = 0.00002) and open-mouth (P = 0.00001) position. The incidence of re-arthroscopy was 13.3% (2/15). This procedure is an effective method for the improvement of joint function and reduction of pain in patients with ID of the TMJ. However, MIAAM is moderately effective in regards to repositioning of the disc.
本研究旨在介绍一种治疗颞下颌关节（TMJ）内部紊乱（ID）的关节镜前切开术改良方法：微创关节镜前切开术（MIAAM）。研究了 15 个接受该技术治疗的 Wilkes 分期 III-IV 期 ID 的关节。评估的临床数据包括疼痛（视觉模拟评分，VAS）和关节运动（术前和术后 1、3、6、9 和 12 个月）。使用磁共振成像（MRI）比较手术后 1 年关节盘的位置与术前位置。根据 VAS 的平均疼痛水平从术前的 67.8 分降低到 12 个月随访时的 29.0 分（P<0.001）。功能上，张口度从平均 27.8mm 增加到 36.0mm（P<0.001）。MRI 图像评估显示，在闭口（P=0.00002）和张口（P=0.00001）位置，关节盘位置均有统计学显著改善。再次关节镜检查的发生率为 13.3%（2/15）。该手术是一种改善 TMJ ID 患者关节功能和减轻疼痛的有效方法。然而，MIAAM 在重新定位关节盘方面效果中等。
