Temporomandibular Joint Discectomy in Patients With Disc Displacement: Assessment of Osteoarthritis at 10- and 30-Year Follow-Up.

Abstract

Background: Few ≥ 10-year follow-up studies of temporomandibular joint (TMJ) discectomy without replacement in patients with disc displacement (DD) analyse the relationship between the surgery and osteoarthritis (OA) exist.

Objectives: To radiologically evaluate bony joint changes and OA development 10 and 30 years after TMJ discectomy as well as 30-year clinical outcome.

Methods: Twenty-two discectomy patients at the University of Oslo, Norway, with records confirming initial TMJ diagnosis and attendance of 10-year radiological follow-up were evaluated and eligible for 30-year follow-up. Primary variables: discectomy and CT-/CBCT-diagnosed OA at follow-ups. Secondary variables: perioperative TMJ diagnoses and remodelling at follow-up. Unoperated TMJs (Unop-TMJs) in unilaterally operated patients were controls. Statistical association and correlation analyses were performed for the 10-year follow-up (significance level p < 0.05).

Results: Twenty-two patients attended the 10-year follow-up (mean follow-up 11 years) with 27 operated TMJs (Op-TMJs) and 17 Unop-TMJs. OA perioperatively was associated with DD without reduction (p = 0.001) and additional disc abnormalities (p = 0.016). Although statistically non-significant, the number of TMJs with OA had increased at 10-year follow-up (p = 0.114, Op-TMJs: 14 to 20 joints; Unop-TMJs: 2 to 5 joints). Remodelling was correlated with discectomy (p = 0.003) and to OA (p = 0.006). Nine patients attended the 30-year follow-up (mean follow-up 32 years, 11 Op-TMJs). All TMJs with OA at 30-year follow-up had OA at 10-year follow-up. Mean maximal interincisal opening was 39 mm. No DC-TMD-diagnosed arthralgia was found.

Conclusion: Osteoarthritis developed similarly between Op- and Unop-TMJs. Only remodelling, not OA, was correlated to the surgery. The clinical results were still favourable at final follow-up.