Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, BE-3000, Leuven, Belgium.
OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
Head Face Med. 2022 Jan 7;18(1):2. doi: 10.1186/s13005-021-00305-y.
Arthroscopy is a minimally invasive diagnostic tool and treatment strategy in patients suffering from temporomandibular disorders (TMD) when conservative treatment fails. This study aimed to find specific variables on pre-operative MRI or during arthroscopy that could predict success of arthroscopic lysis and lavage.
This retrospective analysis compared pre-operative maximum interincisal opening (MIO), pain and main complaint (pain, limited MIO or joint sounds) with results at short-term and medium-term follow-up (ST and MT respectively). Different variables scored on MRI or arthroscopy were used to make a stepwise regression model, subsequently a combined analysis was conducted using variables from both MRI and arthroscopy.
A total of 47 patients (50 joints) met the inclusion criteria. The main complaint improved by 62 and 53% at ST and MT respectively. The absolute or probable absence of a crumpled disc scored on MRI predicted success at ST and MT (p = 0.0112 and p = 0.0054), and remained significant at MT in the combined analysis (p = 0.0078). Arthroscopic findings of degenerative joint disease predicted success at ST (p = 0.0178), absolute or probable absence of discal reduction scored during arthroscopy significantly predicted success in the combined analysis at ST (p = 0.0474).
To improve selection criteria for patients undergoing an arthroscopic lysis and lavage of the TMJ, future research might focus on variables visualized on MRI. Although more research is needed, disc shape and in particular the absolute or probable absence of a crumpled disc might be used as predictive variable for success.
当保守治疗失败时，关节镜检查是治疗颞下颌关节紊乱（TMD）患者的一种微创诊断工具和治疗策略。本研究旨在寻找术前 MRI 或关节镜检查中特定的变量，这些变量可以预测关节镜松解和灌洗的成功率。
本回顾性分析比较了术前最大开口度（MIO）、疼痛和主要症状（疼痛、开口受限或关节弹响）与短期和中期随访（分别为 ST 和 MT）的结果。使用 MRI 或关节镜检查中评分的不同变量进行逐步回归模型，然后使用 MRI 和关节镜检查中的变量进行联合分析。
共有 47 例（50 个关节）符合纳入标准。主要症状在 ST 和 MT 时分别改善了 62%和 53%。MRI 上评分的盘状皱褶缺失或可能缺失预测了 ST 和 MT 的成功（p=0.0112 和 p=0.0054），并且在联合分析中在 MT 时仍然具有统计学意义（p=0.0078）。关节镜下退行性关节病的发现预测了 ST 的成功（p=0.0178），关节镜检查时盘状复位缺失或可能缺失评分显著预测了 ST 时的联合分析成功（p=0.0474）。
为了改善接受 TMJ 关节镜松解和灌洗的患者的选择标准，未来的研究可能集中在 MRI 上可视化的变量上。尽管需要更多的研究，但盘状形状，特别是盘状皱褶缺失或可能缺失，可能被用作成功的预测变量。
