Efficacy of Arthroscopy in

management of TMJ pain

Sunil Sidana
Peterborough District Hospital
 Arthroscopy Indications

• Unexplained TMJ pain that is non responsive to

conservative treatment
• Internal derangement associated with
hypomobility
• Diagnose : to identify problems within the joint
• Therapeutic: break up adhesions and joint
washout ( lysis and lavage)
• Biopsy of suspected lesions or disease
 Aim

• To assess the efficacy of Arthroscopy in

relieving Temporomandibular joint pain.
 Gold Standard

• Temporomandibular Joint Arthroscopy: A

6 year multicentre retrospective study of
4831 joints
Journal of Oral and Maxillofacial Surgery
Vol 50 Issue 9, September 1992
• 91.3 % had good or excellent pain
reduction
 Method of study
• Retrospective
• Period last 20 years
• Search through code V16.9
• 17 arthroscopy cases
• All had conservative treatment for 3 to 12
months.
• Follow up 3 months to 4 years after arthroscopy
• Mouth opening was inadequately recorded and
therefore not used as an outcome measure
Results
 Sex
18
16
14
12
10
8
6
4
2
0
males females
 Age
7
6
5
4
age range
3
2
1
0
10-20 yrs 21-30 yrs 31-40 yrs 41-50yrs
 Side of Pain
14

12

10

0
right left bilateral
 Efficacy
12 no
improvement
11
10
9
8
7
6
5
4 improvement
pain free
3
2
1
0
 Second Procedures
3.5
eminectomy
3
second
2.5 arthroscopy arthroplasty

2
tmj
1.5 replacement

0.5

0
 Conclusion

• Only 35% of patients found improvement or relief of pain

after arthroscopy.

• Arthroscopy was ineffective in relieving temporomandibular

joint pain in this small selected sample.
Recommendations for Change

• Measure mouth opening in mm on all TMJ

patients
• Clinicians should check codes of
procedures
• Audit a. arthrocentesis and b. eminectomy
to compare results with arthroscopy
• No indications to re-introduce arthroscopy
Thank you