OUTCOMES OF LEVEL I TEMPOROMANDIBULAR JOINT ARTHROSCOPY IN WILKES III INTERNAL DERANGEMENT: (A CASE SERIES)

Background: Minimally invasive temporomandibular joint (TMJ) arthroscopy has been recently evolving for treatment of TMJ disorders with ineffective conservative therapy.Aim: The main objective is to report results of Arthroscopic Lysis and Lavage (ALL) in patients with TMJ internal derangement (ID) Wilkes III as regard maximal interincisal mouth opening (MIO) with documentation of disc position in magnetic resonance imaging (MRI).Patients & Methods: A single institutional case series study was conducted on ten patients with Wilkes III TMJ ID who failed conservative measures for more than six months. Measured outcomes included MIO, pain visual analog scale (VAS), lateral movement (LM) and protrusive movement (PM), clicking and disc position. All of which were recorded preoperatively. Postoperative (PO) records were at 1,3, and 6 months except for the disc position at 6-month PO only. Results: Both MIO and pain score recorded a significant difference from the 3rd month PO; from 27.00±1.41 to 30.50±2.84 mm for MIO and from 65.30±4.62 to 34.50±7.62 points for pain (P 0.011*, 0.002*, respectively). LM and PM showed significant improvement at 6-months; from 4.20±1.03 to 5.80±0.92 mm for LM and from 3.10±0.32 to 4.40±0.84 mm for PM (P 0.044*, 0.011*, respectively). 80% of patients still had clicking and 90% still had anteriorly displaced disc at the 6M PO MRI.Conclusion: ALL is an effective modality to improve MIO in Wilkes III ID patients who are refractory to conservative treatment even with persistent radiographic anterior disc displacement. Consequently, it is recommended for patients refractory to the initial conservative treatment.