Our Summary

This research paper looked at complications that occurred during a specific type of jaw surgery (known as temporomandibular joint arthroscopy) in patients with certain stages of a jaw disorder (Wilkes stage II to IV). The study excluded patients who had already had this surgery or whose jaw disc was perforated.

The data was collected from 458 patients who underwent this surgery (some patients had the surgery more than once, resulting in 899 total surgeries). Most of the patients were women (85.8%).

There were two types of surgery: one where the jaw disc was left as is (40.9% of surgeries), and another where the disc was pinned in place with absorbable pins (59% of surgeries).

Complications occurred in 36.7% of surgeries. Most of these (32.5%) were due to damage caused by the surgeon (iatrogenic damage), while 4% were due to issues with the surgical tools.

The study found that complications were more common in surgeries without disc pinning (51.9% of these surgeries had complications) compared to surgeries with disc pinning (25.9% of these surgeries had complications).

The most common complications were fluid leaking out of the surgical area, bleeding inside the joint, and issues with the pins in surgeries that used them.

The study also suggested that the surgeon’s experience level can affect the rate and type of complications. Early in a surgeon’s career, complications are more likely to be due to damaging the patient’s anatomy. As a surgeon gains experience, the rate of complications decreases, but when they do occur, they’re more likely to be due to issues with the surgical tools.

The study concludes that thorough training and practice can reduce the risk of complications. If complications do occur, they can be managed more effectively.

FAQs

  1. What were the main complications found in temporomandibular joint arthroscopy according to the study?
  2. How does the learning curve influence the occurrence of complications in TMJ arthroscopy?
  3. How does the rate and type of complications differ between arthroscopy with and without discopexy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about arthroscopy is to ensure they follow all pre-operative instructions provided by their healthcare team, such as fasting before the procedure and avoiding certain medications. This can help reduce the risk of complications during and after the arthroscopic surgery. Additionally, patients should communicate any concerns or questions they have with their healthcare provider to ensure they are well-informed and prepared for the procedure.

Suitable For

Patients who are typically recommended for arthroscopy are those who have not responded to conservative treatments for temporomandibular joint (TMJ) disorders, specifically those diagnosed with Wilkes stage II, III, or IV. These patients may be experiencing significant pain, dysfunction, and limited range of motion in the jaw joint. Additionally, patients who have not had any previous TMJ surgery may also be candidates for arthroscopy. It is important to note that patients with disc perforation observed by arthroscopy may be excluded from this recommendation. Arthroscopy may be considered as a minimally invasive procedure to diagnose and treat TMJ disorders, particularly when conservative treatments have been unsuccessful.

Timeline

  • Before arthroscopy: The patient likely experiences symptoms of temporomandibular joint (TMJ) dysfunction, such as pain, clicking, limited jaw movement, and difficulty eating. They may have already undergone conservative treatments without improvement.

  • During arthroscopy: The patient undergoes a minimally invasive surgical procedure to examine and potentially treat the TMJ. In this study, patients with Wilkes stage II to IV TMJ dysfunction were included. The procedure may involve arthroscopy without discopexy or arthroscopy with discopexy using resorbable pins.

  • After arthroscopy: The study found that complications occurred in 36.7% of cases, with the most common being irrigation fluid extravasation, intra-articular bleeding, and pin problems. Complications were more common in the arthroscopy without discopexy group compared to the arthroscopy with discopexy group. The study suggests that proper training and a wide learning curve can reduce the risk of complications and improve management if complications do occur.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with arthroscopy for my specific condition?
  2. How experienced are you in performing arthroscopic procedures on the temporomandibular joint?
  3. What is your success rate with arthroscopic procedures for patients with Wilkes stage II, III, and IV?
  4. What is the typical recovery time and post-operative care for arthroscopy on the temporomandibular joint?
  5. Are there any alternative treatments to arthroscopy that I should consider?
  6. How will you determine if arthroscopy is the best treatment option for my condition?
  7. What should I expect during the arthroscopic procedure?
  8. How will you manage any potential complications that may arise during or after the arthroscopic procedure?
  9. How many arthroscopic procedures have you performed in the past year?
  10. Are there any specific pre-operative instructions or restrictions I should follow before undergoing arthroscopy on my temporomandibular joint?

Reference

Authors: González LV, López JP, Díaz-Báez D, Martin-Granizo López R. Journal: J Craniomaxillofac Surg. 2022 Aug;50(8):651-656. doi: 10.1016/j.jcms.2022.06.011. Epub 2022 Jul 8. PMID: 35842375