Prognostic Impact Of Disc Perforation On Condylar Remodeling TMJ Surgery

To investigate the effects of articular disc perforation (DP) on condylar remodeling following disc repositioning surgery in adults with anterior disc displacement without reduction (ADDWoR). This cohort study included 77 patients with 113 joints diagnosed with ADDWoR, enrolled from October 2022 to January 2024. The 113 joints were stratified into perforated (44 joints) and non-perforated (69 joints) groups based on intraoperative findings. Three-dimensional condylar morphology was analyzed preoperatively and 6-months postoperatively using cone-beam computed tomography (CBCT). Statistical analyses included independent t test and multivariate regression. No significant differences in condylar volume, height, or mediolateral diameter was observed between groups. The increase of the anteroposterior condylar diameter was greater in the non-perforated group [0.5644±1.092mm vs. 0.1413±0.8434mm; P < 0.05]. A significant inverse correlation existed between patient age and volume change (R2=0.117, P<0.001), with patients under 30 years exhibiting superior remodeling [53.02±114.8mm3 vs. -17.08±148.8mm3;P<0.01]. Disc Perforation (DP) did not negatively impact condylar remodeling in adult ADDWoR patients following disc repositioning surgery. Instead, age was identified as the crucial prognostic factor, with significant bone regeneration diminishing after age 30. This highlights the need for age-stratified surgical planning, advocating for prioritizing disc repositioning in younger patients and exploring adjuvant biologics, such as stem cell augmentation, in older cohorts.