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Revista Española de Cirugía Oral y Maxilofacial

versión On-line ISSN 2173-9161versión impresa ISSN 1130-0558

Rev Esp Cirug Oral y Maxilofac vol.26 no.2 Barcelona mar./abr. 2004

 

Discusión


Arthroscopy for the internal derangement of TMJ: clinical outcome from a prospective evaluation
La artroscopia en el daño interno de la ATM: resultados clínicos de un estudio prospectivo

In this prospective study, the authors show the efficacy of lysis and lavage in surgical treatment of that called temporomandibular joint dysfunction, whose evolutive onset is located in Wilkes stage I and in Wilkes V in the final stages.

In the last 15-20 years, our studies have demonstrated the efficacy of surgical treatment by arthroscopy and, specifically, performing lysis and lavage. From my point of view the prospective performance of this study is still interesting, although, as the authors admit, the sample size is limited and above all, in relationship with stages III and IV, which are the most common in the disease in which the surgical treatment is indicated.

The study design has been correctly performed, although the false positives established by the magnetic resonance in relationship with disk perforation must be stressed. Although it is not data that change the intention of the study, we feel that other magnetic resonance findings should be assessed with more security for inclusion in the Wilkes’ stages, according to imaging criteria.

It is important to stress the two reasons that we consider most frequent in the dysfunction etiology (micro- and macrotrauma). In our protocol, we should clearly include the first as microtrauma: the background of bruxism and serious occlusal disorders, and in the second, macrotrauma, the direct relationship that exists with joint traumatism.

The evolution of the surgical treatments, whenever it is within minimally invasive techniques, makes it necessary for the maxillofacial surgeons to consider the arthroscopy as a surgical technique whose management is required in joint dysfunction disease.

In additions those maxillofacial surgeons who treat joint diseases should not ever forget the concurrence of other specialists in this treatment: physiotherapists, orthodontists and prostodontists, and they must know the therapeutic possibilities performed by these specialists.

J.L. Gil Díez Usandizaga
Jefe de Sección
Servicio de Cirugía Oral y Maxilofacial
Hospital de la Princesa, Madrid, España

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