"Modified arthroscopic disc repositioning and suturing technique for the treatment of TMJ anterior disc displacement without reduction: A technical note"

Abstract

Anterior disc displacement without reduction (ADDwoR) is one of the most common types temporomandibular disorders (TMD), which is often characterized by joint pain, abnormal joint sounds, and limited mouth opening. Disc repositioning has been described as an effective method to reduce joint pain and improve range of motion. Yang's arthroscopic disc repositioning and suturing surgery has been reported to be the most stable technique with 95%-98% of success rate. However, the main challenges of this procedure are as follows: (1) it is relatively complex and requires a pair of customized grippers (lasso-type and hook-type); (2) it needs a self-designed surgical suture, which is hardened at the end of the suture. The aim of the study was to introduce the modification to the technique and report on the efficacy of the treatment. A total of 25 patients (36 joints) with anterior disc displacement without reduction were included. The visual analogue scale (VAS) scores (0-10) decreased to 0.48 ± 0.92 at 3 months postoperatively (P < 0.0001). Patients with limited mouth opening preoperatively detected a significant improvement in maximum inter-incisal opening (MIO) of 37.59 ± 4.33 mm (P < 0.0001). MRI showed the discs were repositioned in all 25 patients, giving a success rate of 100%. This study reports a modification to Yang's technique which enables extracorporeal suture threading, without excessive limitations on the suture materials, and allowing for the completion of all suturing procedures using one single instrument. Limitations should be noted such as the small sample size and short follow-up period, and further investigation will be carried out in the future.

Keywords: Anterior disc displacement without reduction; Arthroscopy; Disc repositioning; Modification; Temporomandibular joint.