Relationship between intra-articular adhesions and disc position in temporomandibular joints: Magnetic resonance and arthroscopic findings and clinical results

Objective: The objective of this study was to evaluate the relationship between intra-articular adhesions (IA) and disc position on magnetic resonance imaging (MRI) and direct arthroscopic vision, and to compare the presence of IA and clinical symptoms in patients diagnosed with internal derangements (ID) of temporomandibular joint (TMJ), along with their clinical outcomes. Methods: A total of 67 patients (134 TMJs) were included in the study. All patients were refractory to previous conservative treatment, and MRI was performed before surgery in all cases. The incidence of IA was evaluated in relation to disc displacement, type of displacement (with or without reduction), and stage of ID according to the Wilkes-Bronstein classification. Patients were divided into an adhesion and non-adhesion group. The association between the two groups with respect to preoperative clinical parameters (maximal interincisal opening, locking duration, joint pain, patient age) and postoperative parameters at 6 and 12 months was evaluated. Results: The incidence of IA was 44% and the most common location was the anterior recess of the joint. IA were found in 58.3% of the joints with disc displacement without reduction, and in 28.9% of those with disc displacement with reduction (p < 0.05). In joints with well-positioned discs, adhesions were found in 15% of the cases. Patient age and locking duration were significantly higher in the adhesions group (p < 0.05). In relation to clinical outcome, there was no clinically relevant difference between groups at 6 and 12 months. Conclusions: In TMJ with disc displacement without reduction, the presence of IA was significantly higher than in joints with well-positioned discs or displacement with reduction, which leads to the hypothesis that disc hypomobility is an important factor in the genesis of adhesions. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.