| 1340 Systematic review of arthroscopic treatment of temporomandibular joint disorder | ||
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R.W. MONTINI1, C. HAYES1, A. ANTCZAK-BOUCKOMS2, and J. LAU3, 1Harvard University, Boston, MA, USA, 2University of Connecticut, Farmington, USA, 3New England Medical Center, Boston, MA, USA Introduction: Arthroscopy is a frequent treatment modality for patients with temporomandicular joint disorder (TMD) that do not respond to conventional therapies. Despite many reports on this procedure, it has been difficult to draw conclusions about its usefulness. Purpose: The purpose of this systematic review is to summarize the current state of knowledge about the clinical utility of arthroscopy in treatment of TMD. Methods: A Medline search of the English literature from 1966 through July 2000 identified 4,594 citations. Papers that met our inclusion criteria were retrieved, critically appraised, and their results summarized. Results: Thirty-two arthroscopic papers were included in this study. There was only 1 randomized controlled trial of 21 patients that compared arthroscopic treatment followed by physical therapy with physical therapy or no treatment. There was no difference between the treatments in the evaluations of pain, movement restriction, function impairment, interference with daily life situations, and well-being. The other 31 studies were case series with a total of 4,561 patients (study size range from 12 to 3,146). There was large variation in the inclusion criteria including pain, reduced range of motion, closed lock, jaw dysfunction and changes in diet that persist for greater than three months in the presence of conventional therapies. The most common arthroscopic procedure was lysis and lavage but included disc suturing, anterolateral capsular release, and cauterization repositioning. Self-reported pain and maximum incisal opening were the two most commonly measured outcomes. About 80% of the patients report improvement in pain and functional symptoms. Conclusion: TMD patients who are unresponsive to conventional therapies may experience some improvement in symptoms following arthroscopic treatment. However, the lack of uniform definitions of the diagnosis and outcomes among the studies made it difficult to know which patients truly benefit from this intervention. Future studies should pay attention to methodological quality issues.(supported by NIDCR #RO1DE11646)
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| Seq #128 - Treatment and Outcomes 3:45 PM-5:00 PM, Thursday, 7 March 2002 San Diego Convention Center Exhibit Hall C | ||
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