Rodrigues Ana Lúcia Pereira, Cardoso Henrique José, Ângelo David Faustino
Faculty of Medicine, Lisboa University, Portugal.
Instituto Português da Face, Lisboa, Portugal.
J Craniomaxillofac Surg. 2023 Jan;51(1):44-51. doi: 10.1016/j.jcms.2023.01.006. Epub 2023 Jan 23.
This retrospective study aimed to evaluate patient satisfaction with different temporomandibular joint (TMJ) treatments. Patients were included in the study according to the following inclusion criteria: 1) arthrogenous and/or myogenous temporomandibular disorders (TMD); 2) Dimitroulis classification category between 1-4; 3) conservative treatment without any improvement at least for 3 months; 4) indication for one of the following TMD treatments: injection of botulinum toxin; arthrocentesis; arthroscopy, and open surgery without alloplastic material; and 5) age ≥16 years. An independent satisfaction questionnaire with 11 queries was applied via phone call to all patients, which included 6 questions using a 10-point Likert scale and 5 yes-or-no questions. The principal outcome was the overall satisfaction with the clinical result of the treatment, and the secondary outcomes were specific satisfaction with the following: 1) pain reduction; 2) range of mouth opening; 3) chewing ability; 4) postoperative recovery; 5) the fulfillment of expectations; 6) treatment choice; 7) treatment recommendation to a friend; and 8) the need for another intervention. Anxiety and depression were also included as variables. Data were analyzed using descriptive statistics, non-parametric Kruskal-Wallis and Spearman rank correlation coefficient tests. A total of 120 patients (mean age 41.20 ± 17.78 years) were enrolled, comprising 109 women (90%) and 11 men (10%). The overall clinical satisfaction of all patients was 8.24 ± 2.23 (mean ± SD), and 97 patients (80.8%) stated that they would repeat the treatment. Patients submitted to TMJ arthrocentesis and arthroscopy had higher overall clinical satisfaction (9.09 ± 0.971 and 9.03 ± 1.13, p = 0.021) followed by open surgery (8.38 ± 1.84). The authors observed three statistically significant correlations: 1) overall clinical satisfaction and patient expectations (r = 0.803; p < 0.0001); 2) overall clinical satisfaction and post-treatment pain (r = -0.299; p = 0.003); and (3) the presence of depression and the need for further TMJ treatment (r = 0.186; p = 0.043). Within the limitations of the study it seems that patient expectations should be addressed ad initium, and the presence of a diagnosis of depression with concomitant TMD must alert the clinical team and patient for the possible need of additional treatment.
这项回顾性研究旨在评估患者对不同颞下颌关节（TMJ）治疗方法的满意度。根据以下纳入标准将患者纳入研究：1）关节源性和/或肌源性颞下颌关节紊乱病（TMD）；2）迪米特鲁利斯分类为1-4级；3）保守治疗至少3个月无任何改善；4）有以下TMD治疗方法之一的适应症：注射肉毒杆菌毒素；关节穿刺术；关节镜检查，以及无异体材料的开放性手术；5）年龄≥16岁。通过电话向所有患者发放一份包含11个问题的独立满意度调查问卷，其中包括6个采用10分李克特量表的问题和5个是或否的问题。主要结果是对治疗临床结果的总体满意度，次要结果是对以下方面的具体满意度：1）疼痛减轻；2）开口度；3）咀嚼能力；4）术后恢复；5）期望达成情况；6）治疗选择；7）向朋友推荐治疗；8）是否需要再次干预。焦虑和抑郁也作为变量纳入。使用描述性统计、非参数克鲁斯卡尔 - 沃利斯检验和斯皮尔曼等级相关系数检验对数据进行分析。共纳入120例患者（平均年龄41.20±17.78岁），其中109名女性（90%）和11名男性（10%）。所有患者的总体临床满意度为8.24±2.23（均值±标准差），97例患者（80.8%）表示会再次接受该治疗。接受TMJ关节穿刺术和关节镜检查的患者总体临床满意度较高（分别为9.09±0.971和9.03±1.13，p = 0.021），其次是开放性手术（8.38±1.84）。作者观察到三个具有统计学意义的相关性：1）总体临床满意度与患者期望（r = 0.803；p < 0.0001）；2）总体临床满意度与治疗后疼痛（r = -0.299；p = 0.003）；以及（3）抑郁的存在与进一步TMJ治疗的需求（r = 0.186；p = 0.043）。在该研究的局限性范围内，似乎应从一开始就关注患者期望，并且抑郁症诊断伴随TMD必须提醒临床团队和患者可能需要额外治疗。
