Contemporary Treatment Algorithm for Temporomandibular Joint Disease: A Retrospective Clinical Review
Connor J. Peck, BS, Alvaro Reategui, BA, Navid Pourtaheri, MD, PhD, Ludmila Chandler, BS, Maham Ahmad, BA, Omar Allam, MD, Joseph Lopez, MD, MBA, Derek Steinbacher, MD, DMD
Yale University School of Medicine, New Haven, CT
Surgical management of temporomandibular joint disease (TMD) is becoming increasingly common in plastic surgery practice. Still, there remains little consensus as to best approaches for TMD management. We therefore aimed to retrospectively review the surgical treatment of TMD at our institution, assess outcomes, and describe a contemporary treatment algorithm to maximize long-term outcomes for TMD management.
Methods: A retrospective chart review was performed on patients undergoing treatment for TMD by the senior author (DS) with a minimum of 12 months follow-up. Procedures performed, clinic notes, and radiology findings were reviewed and documented. Patients were categorized accordingly and the algorithm was derived. Patients were then called by a study investigator and asked about to rank several pre- and post-operative symptoms (1=least severe, 10=most severe): pain, muscle soreness, headaches, dental grinding/clenching, clicking/popping, trismus, difficulty eating/chewing, and asymmetry. Both paired and unpaired t-tests and chi-squared analyses were used to compare outcomes pre- and post-operatively, and between the non-invasive and invasive surgical groups.
Results: There were 62 patients included in our analysis, the majority of which were female (77.8%) with a mean age at time of surgery of 35.1 years. The most common presenting symptoms among patients were difficulty chewing/eating (96.3%), followed by masticatory muscle soreness (81.5%) and clicking/popping (77.8%). The most frequently reported radiologic finding was joint narrowing (27.0%). Patients were grouped into “conservative” (53.3%) or “invasive” (46.7%) treatment tiers based on radiologic indications, with ensuing treatment protocols described. Overall, patients in both cohorts showed a significant improvement (p<0.05) in all measured symptoms following intervention, with the largest decreases in TMJ pain (-4.7, p<0.001) and eating/chewing difficulty (-2.5, p<0.001). In comparison to patients with non-invasive treatment, those who were treated invasively experienced greater improvements in pain (p=0.02). There were no other significant differences in long-term outcomes between the two groups.
Conclusion: These data support the use of both conservative and invasive measures for managing TMD symptoms, and provide a useful outline for plastic surgery trainees seeking to integrate TMD surgery into clinical practice.
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