Is Modified Condylotomy a Better Surgical Option Compared With High-Condylar Shave With Eminectomy in Improving Symptoms of Internal Derangement of Temporomandibular Joint?

PURPOSE

A proper anatomical disc-condyle position is a prerequisite to prevent progressive deteriorating changes within the temporomandibular joint. Surgery becomes the primary treatment option for patients who do not recover with nonoperative management. The present study aimed to compare the clinical outcome of 2 different surgical procedures in patients with internal derangement of the temporomandibular joint.

METHODS

A prospective clinical cohort study was conducted among patients presenting to outpatient department of Oral and Maxillofacial Surgery at Maulana Azad Institute of Dental Sciences. The study sample was alternatively allocated into 2 treatment groups; Group I: modified condylotomy (MC) and Group II: high-condylar shave with eminectomy (HCSE). The primary outcome variables included pain on function, tenderness on palpation, and maximum mouth opening. The secondary outcome variables included joint sounds, jaw deviation on opening, maximum protrusive jaw movement, maximum ipsilateral jaw movement, and maximum contralateral jaw movement. The covariates were age, sex of the patient, duration of illness, the diagnosis based on Wilkes's staging, and the laterality (whether unilateral or bilateral). Descriptive, comparative, and regression analyses were conducted.

RESULTS

Twenty-one patients with Wilkes Stage II, III, and IV were included in the study (MC: 10 patients and HCSE: 11 patients). The mean age of the study sample was 32.67 (±11.66) years. Among 21 patients recruited in our study, 18 were females. It was observed that after 1-year follow-up, patients in Group I had significantly lower pain on function (0.30 ± 0.48) compared with Group II (3.00 ± 1.18). (P < .001). Similarly, tenderness on palpation was significantly decreased in Group I (0.80 ± 0.48) compared with Group II (2.45 ± 0.93; P < .001). Joint sounds were significantly lower in Group I (1.20 ± 0.63) compared with Group II (2.27 ± 0.90) after 1 year (P < .001). Maximum protrusive jaw movement and maximum ipsilateral jaw movement were significantly higher in Group I compared with Group II after 1 year.

CONCLUSION

MC is a comparatively better surgical procedure than HCSE in patients with internal derangement of the TMJ.