ROSEMONT, Illinois – Although many temporomandibular joint disorders can be well treated with nonsurgical means, surgery remains an important therapeutic option for many who suffer from this painful disorder, according to one of the first prospective multicenter comparative studies of TMJ surgical outcomes, published in the August 2005 issue of the Journal of Oral and Maxillofacial Surgery.

Four procedures-arthroscopy, condylotomy, disc repositioning and discectomy-all produced marked reductions in pain and improvements in the ability to eat solid foods in about 90 percent of patients, according to principal author H. David Hall, DMD, MD, professor and chairman emeritus of the department of oral and maxillofacial surgery at Vanderbilt University Medical Center.

In addition, all four procedures yielded virtually indistinguishable outcomes, says Dr. Hall, who conducted the study in cooperation with the University of the Pacific, San Francisco, and the Medical College of Wisconsin, Milwaukee.

"The pain relief that followed each of the four types of operations was substantial, occurred within about a month after surgery, and was statistically insignificant by procedure," states Dr. Hall.

Researchers compared baseline measurements with changes in overall degree of pain, hours of pain experienced daily, diet, and range of motion (ROM) in the jaws one month and one year after surgery.

To qualify for surgery, patients with severe TMJ pain and dysfunction underwent a magnetic resonance imaging (MRI) study to confirm the presence of an "internal derangement," a painful disruption of the relationship between the piece of cartilage essential for smooth jaw movement, known as the articular disc, and the condyle, the rounded top of the lower jaw bone. Patients had intolerable pain that persisted after standard conservative treatment with diet changes, anti-inflammatory medications and control of bruxism, or chronic tooth grinding, a common factor in the development of TMJ problems.

When asked to rate their pain one month after surgery using a visual analog scale (VAS), patients reported scores that were markedly lower than baseline levels and remained at these levels one year after surgery.

"It appears to be surgery, per se, that accounts for this early and sustained pain relief," Dr. Hall notes. "The placebo effect typically affects about 35 percent of patients, but in this study, 90 percent of patients showed improvement. In addition, only about 50 percent of patients with internal derangements improve after one year without surgery, in contrast to about 90 percent of the patients in this study at one month."

Noting that additional controlled, multicenter research is needed, Dr. Hall states, "This evidence, along with the results of a small handful of other studies, permits a surgeon to tell patients with confidence there is an excellent chance their symptom of pain will substantially improve soon after surgery."

SOURCE: American Association of Oral and Maxillofacial Surgeons

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