Arthroscopy versus arthrocentesis in the management of internal derangement of the temporomandibular joint

Abstract Introduction Temporomandibular joint (TMJ) internal derangement is a relatively common disorder affecting patients of various ages. Different methods have been suggested for treatment, beginning with conservative approaches and ending with surgical modalities. Arthrocentesis and arthroscopic lysis and lavage have been proven to be effective in enhancing the function of the joint and hence improving the quality of life. Objectives To evaluate and compare the effectiveness of arthrocentesis and arthroscopic lysis and lavage in the management of TMJ internal derangement, specifically in relation to pain reduction, range of motion, and postprocedural complications. Patients and methods A retrospective chart review of hospital patients presenting with TMJ internal derangement having been treated with either TMJ arthrocentesis or level 1 arthroscopic lysis and lavage during the January 2018–December 2023 period at a single tertiary center. This study analyzed 76 arthrocentesis patients, including 79 total joints, and 38 arthroscopy patients, including 54 total joints. Results The comparison studies revealed statistical significance in the superior performance of arthroscopic lysis and lavage in the improvement in the muscles of mastication, and TMJ pain, which is measured in visual analog scale ( P < 0.05). In contrast, arthrocentesis demonstrated greater outcomes in improving the range of motion and reducing TMJ sounds ( P < 0.05). No major complications were observed in both procedures. However, arthrocentesis showed a higher incidence of minor postprocedural complications between groups ( P < 0.5). Conclusion Arthrocentesis and arthroscopic lysis and lavage are both effective in the management of TMJ internal derangements. As the results revealed similar effectiveness, arthrocentesis may be better suited for patients with milder conditions, such as Wilkes classifications I, II, or III, and of younger age. Conversely, arthroscopic lysis and lavage may be advised for patients with more severe TMD symptoms, including Wilkes classifications IV or V, and particularly older patients. It may be beneficial to design and conduct a study directly comparing the effectiveness of arthrocentesis and arthroscopy based on the severity of the TMJ condition.