UNASSIGNED: This systematic review aims to describe the clinical outcomes after TMJ arthroscopy followed by intra articular infiltration with different substances.
UNASSIGNED: A literature search was carried out, the variables were Arthroscopy with different substances, pain and maximal mouth opening. The inclusion criteria were articles that reported infiltration of different substances after arthroscopy. Case series, observational studies, and randomized clinical trials were included. Exclusion criteria were studies that included arthrocentesis, animal studies, connective tissue disease, patients with previous surgeries.
UNASSIGNED: Of the 5 studies finally included, the population studied were 346 subjects, of which 315 were female. The mean age was 34.7 (16-77). Regarding diagnoses, Wilkes III and Wilkes IV were taken into account. The most commonly used substance was sodium hyaluronate/hyaluronic acid in 4 of the 5 studies.
UNASSIGNED: Multiple substances have been infiltrated within the temporomandibular joint, with sodium hyaluronate/hyaluronic acid being the most studied. However, the benefit of substances like ATM artroscopia adyuvantes has not been clearly established. It is recommended in future studies that the substances and results be evaluated in the same way to obtain more homogeneous studies.

Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open surgery and alloplastic replacement. The majority of patients treated in primary care and managed initially in secondary care have myofascial pain and can be managed conservatively with rest, topical NSAIDs, muscle massage, and a bite orthosis. Those who fail to improve and have articular related pain with limitation of function should initially undergo arthroscopic investigation and arthrocentesis, which is effective at resolving symptoms in 80% of patients. Arthroscopy provides the best diagnostic aid should there be a failure to improve and should enable the surgeon to appropriately plan open surgery. Historically, surgical intervention was based on a \'one size fits all\' philosophy with the surgeon carrying out a procedure which they are used to doing regardless of the pathology. Prior to arthroscopy this carried an \'80% chance of getting 80% better\' regardless of approach. Prior arthroscopy reduced success rates to 50%-60% and a better success rate is needed. Basing surgical intervention on the pathology encountered is a sensible approach to joint management, with the surgeon performing surgery on the articular surfaces or disc as indicated. Having used this approach over the last 15 years the author has achieved success rates of 80% in the longer term and this philosophy, rationale, and technique will be discussed along with analysis of more recent publications in the field.

Several studies have considered Botulinum Neurotoxin Type A injections effective in treating temporomandibular joint disorder (TMD) symptoms. A double-blind, randomized, controlled clinical trial investigated the benefit of complementary incobotulinumtoxinA (inco-BoNT/A) injections in the masticatory muscles of patients submitted to bilateral temporomandibular joint (TMJ) arthroscopy.
Fifteen patients with TMD and an indication for bilateral TMJ arthroscopy were randomized into inco-BoNT/A (Xeomin, 100 U) or placebo groups (saline solution). Injections were carried out five days before TMJ arthroscopy. The primary outcome variable was a Visual Analogue Scale for TMJ arthralgia, and secondary outcomes were the myalgia degree, maximum mouth opening, and joint clicks. All outcome variables were assessed preoperatively (T0) and postoperatively (T1-week 5; T2-6-month follow-up).
At T1, the outcomes in the inco-BoNT/A group were improved, but not significantly more than in the placebo group. At T2, significant improvements in the TMJ arthralgia and myalgia scores were observed in the inco-BoNT/A group compared to the placebo. A higher number of postoperative reinterventions with further TMJ treatments were observed in the placebo group compared to inco-BoNT/A (63% vs. 14%).
In patients submitted to TMJ arthroscopy, statistically significant long-term differences were observed between the placebo and inco-BoNT/A groups.

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.

The anterior displacement of the articular disc is the most frequent cause of pathological alterations in the TMJ. Although it is an extremely common pathology, there is no certainty about the aetiopathogenesis of this disease. The main aim of the present report is to describe new anatomical findings that could help clarifying the aetiopathogenesis of this disease and determine a typology of treatment based on the cause of the disease. All the operative records of patients who underwent arthroscopic osteoplasty of the medial TMJ wall in our centre from January 2021 to September 2021 were reviewed and analysed to identify specific anatomical features observed in every procedure. Fifty-two joints were included for analysis in this study. Twenty-two joints were classified as Wilkes stages II-III and 30 as Wilkes stages IV-V. The most common complication observed in our sample was the dysaesthesias found in the temporal and preauricular regions. Other complications observed were frontal branch paresis (n = 2), intraoperative bleeding (n = 1), and postoperative malocclusion (n = 1). The compression of the superior head of pterygoid lateral muscle (SPLM) on the medial bony wall and the consequent muscle atrophy could be key for the aetiology of the anterior TMJ disc displacement. Therapeutic actions on the osseous and muscular component in this anatomical area could improve the outcomes of patients affected by TMJ internal derangement. A meticulous dissection of the fascia of the superior fascicle of the lateral pterygoid muscle allows a remodelling of the bone surfaces with minimal complications.

Temporomandibular joint (TMJ) surgical arthroscopy has become a usual operation to treat different pathologies such as internal derangements and degenerative joint diseases and osteoarthritis. Although many instruments such as palpators, forceps, scissors, scrapers, scalpels, and motorized terminals are needed to perform different arthroscopic surgical procedures, it is of paramount importance to have devices that allow the surgeon to cut and coagulate tissues safely. Coblation (cold ablation) is a process that using a radiofrequency electrical energy passing through saline solution and produces plasma that can be applied precisely to tissues to break molecular bonds within cells. This surgical technique has become the best surgical option to perform different arthroscopic surgical techniques. Coblation of synovitis areas, lysis of adhesions, disc mobilization techniques with the anterior release (capsulotomy or myotomy), and posterior coagulation of the retro discal tissues are the most common procedures performed. Disc perforations, bone chondromalacia, synovial chondromatosis (SC), and joint hypermobility can also be treated using coblation technologies.

This study aims to describe intraoperative complications in temporomandibular joint arthroscopy in patients with Wilkes stage II, III y IV. An analytic observational retrospective study. Inclusion criteria were patients who had no improvement with conservative treatment diagnosed as Wilkes II stage to Wilkes stage IV, and no previous TMJ surgery. Exclusion criteria were disc perforation observed by arthroscopy. Data collected from 458 patients (899 arthroscopies). Of this population, 772 (85.8%) arthroscopies correspond to women, and 127 men (14.1%). Of the sample evaluated, 368 (40.9%) were arthroscopic without discopexy, and 531 (59%) were arthroscopic with discopexy using resorbable pins. In total, 330 complications (36.7%) were found, of which 293 (32.5%) were implicated with iatrogenic damage to the anatomy, and 36 (4%) were associated with some instrument failure. Of this total number of complications, 191 (51.9%) of 386 corresponded to the arthroscopy without discopexy group and 138 (25.9%) of 531 corresponded to the arthroscopy with discopexy group. These study data suggest that the main complications were irrigation fluid extravasation (p = 0.000), and intra-articular bleeding (p = 0.001) followed by pin problems (p = 0.001) in cases of arthroscopies with discopexy. Within the limitations of the study it seems that the learning curve has an important influence on the occurrence of complications. At the beginning of the learning curve, complications are more related to anatomy. Afterwards, the rate of complications decreases but they are more related to the instruments used in advanced techniques. Therefore, proper training and a wide learning curve can reduce the risk of complications and if any occur, more timely management could be given.

To evaluate the complications of arthroscopic lysis and lavage with joint sweep (ALL) procedure in the management of disc derangement of the temporomandibular joint.
Patients with internal derangement of the TMJ who were treated by ALL in a tertiary institution from July 2018 to December 2021 were studied retrospectively.
The study included 39 patients (males, n = 14; females, n = 25) and 50 joints. The complications observed in the study were classified into intra and post operative complications. Post operative complications such as pain (16%), swelling (6%), reduced mouth opening (22%) and neurological complications were the most commonly observed ones. Rare complications such as ipsilateral palatal swelling (6%), parapharyngeal swelling (4%), and post operative malocclusion (2%) were also observed.
Although the complications of ALL are entirely unavoidable, their incidence can be reduced by strict adherence to standard techniques. Three-dimensional awareness and orientation of the dangerous angles and depth around the TMJ region is mandatory to reduce the complications.

Temporomandibular Joint (TMJ) arthroscopy is considered an effective and safe minimally invasive surgical approach. While the long-term outcomes of arthroscopy tend to be positive and free of secondary effects, patients occasionally complain about their hearing following the treatment. The aim of this prospective study was to investigate possible hearing changes associated with TMJ arthroscopy. Pure-tone audiograms were performed in patients two weeks before TMJ arthroscopy and repeated six weeks after intervention. A total of 15 patients (mean age of 41.73±16.36) were enrolled; 25 TMJ arthroscopies were performed (five unilateral and ten bilateral). Statistically significant differences were found between preoperative and postoperative audiograms in the frequencies 256Hz (P=0.011) and 8kHz (P=0.058, borderline). For the frequency 256Hz the difference was favourable, but not superior to 5dB. For the frequency 8kHz, in three patients the TMJ arthroscopy resulted in a decrease of 10dB. However, no clinical hearing changes or complaints were observed in the involved patients. No differences in audiograms between level 1 or 2 arthroscopy were observed. The study reinforces the safety of the TMJ arthroscopy level 1 and 2 with the reported protocol. The authors recommend larger studies to validate the results, specially for frequency 8kHz.

OBJECTIVE: The aim of this study was to determine the efficacy of arthroscopic lysis and lavage on pain in patients with unilateral Wilkes stage III derangement of the temporomandibular joint. Authors retrospectively evaluated whether the arthroscopic lysis and lavage has an impact on pain decrease in patients with moderate osteoarthritis.
METHODS: Patients with unilateral Wilkes III of temporomandibular joint were included in this study. All patients underwent arthroscopic lysis and lavage (ASC-L), assessed pain before and after the procedure (primary outcome variable), maximal interincisal opening (MIO) was recorded as secondary outcome variable. The patients also subjectively assessed whether they were satisfied with the outcome of the arthroscopy or whether their condition required further interventions. The disc position was evaluated by magnetic resonance imaging (MRI) 24 months after the arthroscopy and compared with the disc position on the MRI prior to the arthroscopy. The R Project for Statistical Computing 3.4.1 and the Gretl Pro programs were used for statistical analysis. In addition to the descriptive statistics methods, the Shapiro-Wilk normality test was used to verify data normality and the two sample t test used to test the hypotheses themselves.
RESULTS: The sample consisted of 62 patients who underwent arthroscopic lysis and lavage (ASC-L) in 2015 and 2016. It included 6 men and 56 women with an average age of 34.37. Pain and MIO were recorded during regular check-ups 1, 3, 6, 12, and 24 months. A therapeutic effect (MIO over 34 mm, VAS score 0-1) was recorded in 69% of cases 24 months after the ASC-L. Nonetheless, the work demonstrated the importance of subjective assessment, as 87% of patients perceived their condition as satisfactory after 24 months and not requiring further intervention, while 8 patients (13%) perceived it as unsatisfactory. Disc reposition 24 months following the ASC-L was recorded in only 44% of patients who assessed their condition as satisfactory. Patients with persistent disc dislocation 24 months after the arthroscopy were older, had a lower average maximal interincisal opening value before the ASC-L and a longer duration of mandibular movement restriction before the ASC-L (evaluated as a statistically significant difference).
CONCLUSIONS: In this study, the authors confirmed that ASC-L is an effective therapeutic method in patients with WIII, from both clinical and subjective perspectives. This work demonstrated that improvement in patients with Wilkes stage III is not related to disc reposition. Postoperative physiotherapy is an integral component of ASC-L and is reflected in the final results.