A patients' and clinicians' perception of the outcome of temporomandibular joint arthroscopy

Key Points

In brief

• A study assessing the patients' and clinicians' perception of the outcome of temporomandibular joint arthroscopy.

• Fifty per cent of patients seemed to view arthroscopy favourably.

• Many patients still felt that the jaw opening was restricted.

• The disparity between the clinical evaluation and the patients' perception of effectiveness emphasises the importance of patient feedback.

Abstract

Aim This study assessed the patients' and clinicians' perception of the outcome of temporomandibular joint arthroscopy.

Method All patients who underwent TMJ arthroscopy for both diagnostic and therapeutic purposes over a 6-year period were sent a questionnaire that asked about various symptoms attributable to the TMJ. Additionally a review of the clinical notes was performed.

Results 83 patients underwent arthroscopy to 127 temporomandibular joints. The mean follow up was 3.6 years. 55% of patients assessed their jaw function as being effective, jaw movement, pain control, and overall satisfaction were satisfactory in 37%, 57%, and 48% of cases respectively. The clinicians' assessment revealed that 45% of patients had no joint tenderness, 74% of patients were able to open to > 35 mm and 74% of patients were free of any joint noise. 66% of patients were prepared to undergo a second procedure if indicated.

Conclusion Overall, 50% of patients seemed to view arthroscopy favourably although many patients still felt that jaw opening was restricted. The outcome was not related to the position and reducibility of the disc at surgery and other variables may be responsible. The disparity between the clinical evaluation and the patients' perception of effectiveness emphasises the importance of patient feedback.

Main

The value of patient feedback in the audit of TMJ arthroscopy D. R. P. Godden and J. M. Robertson Br Dent J 2000; 188: 37–39

Comment

The treatment of temporomandibular disorders (TMD) is controversial and clinicians have widely varying views on how such conditions should be treated. The role of surgery in TMD management is equally controversial and many feel there are only a few diagnoses in which surgery has a role.

The two primary conditions addressed in this paper, namely the internal derangements of disc displacement with reduction (clicking) and disc displacement without reduction (locking) are diagnoses which fall into the fields of both conservative and surgical treatment.

The development of arthroscopy has brought another dimension into the management of these disorders. There is now an alternative to intracapsular surgery for those patients who have failed to respond to conservative treatment.

The assessment of 'success' in relation to any treatment of a TMD is difficult to quantify. What reflects successful treatment to the clinician is not always regarded in the same light by the patient.

This paper takes an interesting perspective by approaching the patients directly for their assessment of the outcome of their treatment.

In a retrospective study 100 patients were sent a questionnaire of which 83 responded. While not giving precise detail of the pre-arthroscopy signs, symptoms or treatment, the post-surgical analysis of results is interesting.

Thirty-nine patients had unilateral arthroscopy and 44 bilateral, therefore, 127 joints were arthroscoped. The difficulty frequently encountered in diagnosis is reflected by the finding at arthroscopy that 25% of the patients had 'normal or mixed findings' during bilateral treatments.

The comparison between the patient's assessment of success and the clinician's as interpreted from an analysis of the clinical records, revealed that 57% of patients regarded the procedure as a success in relation to the reduction in pain compared with 45% on clinical evaluation. Only 52%, however, felt the sign of joint noise to be improved compared with 74% clinically and only 37% assessed their range of movement in the vertical dimension to be satisfactory whereas 73% were clinically recorded as being over 35 mms. The reader is not told, however, at what stage post operatively the clinical recordings were made.

The authors point out that these results should be taken in perspective as this was a mixed group and some patients were subjected to arthroscopy for diagnostic reasons. While the overall assessment of satisfaction from the patient's point of view was only 48%, two-thirds of the sample would be prepared to undergo a further procedure should this become necessary. The authors' reference to the value of patient feedback is, therefore, confirmed.