Results of temporomandibular joint diskectomies in Sweden 1965-85.

There have been divergent opinions about the prognosis of temporomandibular joint diskectomy. Therefore we have retrospectively evaluated all diskectomies performed in Sweden during the period from 1965 to 1985. Eighty-seven patients had been operated upon with this technique and 69, with a follow-up time of 6 months or longer (median 20 months), were analyzed. The median of maximal opening increased and 74% of the patients had less frequent and less intensive pain at the follow-up examination than before surgery. The overall results of the operations were good in 51% of the patients (none or mild pain and opening greater than or equal to 35 mm and horizontal movements greater than or equal to 5 mm), acceptable in 22% of the patients (none or mild pain and opening greater than or equal to 30 mm) and bad in 28% of the patients (severe pain or opening less than 30 mm). The preoperative pain was found to be more diffuse in the patients with bad postoperative results than in the patients with good and acceptable results. This emphasizes the importance of avoiding operating on patients with sources of pain and functional limitation other than the temporomandibular joint proper. The operation should be used restrictively and only on accurately diagnosed patients with severe pain and functional limitation that originate in the joint and have not been alleviated by adequate nonsurgical treatment. The risk of residual pain or limitation of opening should be included in the preoperative evaluation.