Discectomy as an effective treatment for painful temporomandibular joint internal derangement: a 5-year clinical and radiographic follow-up.

PURPOSE: The purpose of this prospective study was to compare the preoperative and 5-year postoperative status of patients after unilateral discectomy for painful internal derangement of the temporomandibular joint.

PATIENTS AND METHODS: The study was based on 64 patients. Fifty-six had disc displacement without reduction and 8 had disc displacement with reduction. The patients were examined clinically and radiographically before and 5 years after the operation according to a standardized protocol.

RESULTS: Eighty-five percent of the patients (n = 52) had good results, 6% had acceptable results, and 9% had a poor outcome. Three patients (5%) were reoperated and 5 other patients (8%) needed a contralateral operation during the 5-year follow-up. The median increase in maximum mouth opening was 11 mm (range, -8 to +35 mm) and 83% of the patients had more than 40 mm maximal mouth opening postoperatively. Seventy-five percent of the patients had crepitation at 5-year follow-up compared with 27% before the operation. Postoperatively, the majority of the joints showed radiographic evidence of osteophytes, flattening, and sclerosis. The radiographic alterations did not correlate with the patients' symptoms.

CONCLUSIONS: The results of this long-term follow-up after unilateral discectomy support the use of this operation in patients with painful internal derangement who show no improvement after prior nonsurgical treatment. The postoperative radiographic alterations should be interpreted as adaptive changes rather than progressive degenerative joint disease.