Temporomandibular Joint Arthroscopy versus Arthrotomy

Although some patients with temporomandibular joint (TMJ) disorders are successfully treated by nonsurgical means or by arthrocentesis or arthroscopic surgery, there is still a group of patients who do not respond to these procedures and for whom an arthrotomy and disc surgery (discoplasty) are necessary. Arthroscopy is an important diagnostic and therapeutic modality in the treatment of TMJ disorders being an alternative to arthrotomy ( „open“ TMJ surgery) and can be very effective in eliminating symptoms as pain, mandibular dysfunction, hypomobility, acute and chronic „closed lock“ due to osteoarthritis and arthrosis with adhesive capsulitis, where nonsurgical treatment has been unsuccessful. Bony ankylosis and fibrosis are best managed by open arthrotomy procedures. It has been found that a total of 22 of the 137 arthroscopies were diagnostic only, which resulted in immediate arthrotomy, including arthroplasty, meniscectomy [1]. Arthroscopy is a technique for direct visual inspection of internal joint structures, including biopsy and other surgical procedures per‐ formed under visual control. In 1918 Takagi first described arthroscopy of the knee joint examinations using cystoscope [2]. Onishi in 1970 was the first to report arthroscopy of the human temporomandibular joint and the first results were published by him [3,4]. The progress in research and applications of TMJ arthroscopy in joint disease have led to the acceptance of small operative procedures as a safe, minimally invasive means of effectively treating a number of intra-articular and degenerative TMJ problems [5-7]. Arthroscopic surgery has been an effective treatment for TMJ disorders refractory to nonsurgical treatments [8-10]. TMJ arthroscopy has been variously reported as successful in up to 80% of cases where outcome of arthroscopic surgery to the TMJ correlates with the stage of internal derangement [11-13]. Studies have been variable in their scientific methods and some long-term outcomes studies have been completed where both quality of life and functional outcome have been assessed [14-16]. For enabling direct comparison of the clinical results following arthroscopic