Complications of Diagnostic TMJ Arthroscopy: An Institutional Study

Sudden sensorineural hearing loss and vertigo following temporomandibular joint arthroscopy: a case report and literature review

Temporomandibular joint (TMJ) arthroscopy is a commonly performed procedure for the management of various TMJ disorders. While generally considered safe, it can occasionally lead to unexpected complications. This article presents a notable case of sudden sensorineural hearing loss and vertigo following TMJ arthroscopy, a rare but significant occurrence that warrants attention in clinical practice. By detailing this case, the aim is to highlight the clinical presentation, diagnostic challenges, and management strategies associated with these uncommon complications associated with TMJ arthroscopy.

Complications of temporomandibular joint arthroscopy. A critical appraisal of the literature

To search for the best available scientific evidence in relation to the reported overall and selective complication rates for arthroscopic surgery in patients presenting with internal derangement (ID) of the temporomandibular joint (TMJ). A comprehensive electronic search was conducted without data or language restrictions up to August 2023. Inclusion criteria were the following: study in humans, randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies and series of clinical cases. The proposed PICOS question was: "In clinical trials and retrospective clinical series of patients treated by arthroscopy, which were the overall and selective complication rates?" Exclusion criteria were animal studies, review papers, technical reports, and in vitro studies. The Cochrane Collaboration Tool was used to assess the risk of bias of the included studies in terms of their quality. The Strength of Recommendation Taxonomy (SORT) classification was used to determine the level of evidence of the selected studies. A total of 498 studies were identified. Of these, 16 studies fulfilled the inclusion criteria and were selected for qualitative assessment. Temporary 5th nerve deficit, ranging from 0.15% to 2.38%, was reported to occur in most larger series, comprising 7394 operated joints. Temporary 7th nerve paresis was reported to occur in 0.21%-0.7% in the largest series, comprising 6866 operated joints. Partial hearing loss was reported in 6 studies, ranging from 0.21% to 2.2% in 5845 operated joints. Edema of surrounding soft tissues, including parapharyngeal, soft palate and/or preauricular edema was reported in 8 studies, with complication rates ranging from 2% to 17.9% in 2274 operated joints. Laceration of the EAC was reported in 8 studies involving 2665 operated joints, with complication rates ranging from 0.3% to 6%. A total of 872 complicated events among 11,304 operated joints were reported, accounting for an overall complication rate of 7.71%. Complications from arthroscopic procedures have been inconsistently reported, but there are a small number of retrospective studies with well-reported complications rates. As overall complication rate accounts for less than 8% of the cases, arthroscopy seems to be a highly safe procedure for the treatment of internal derangement (ID) of the TMJ. Due to the absence of studies with high evidence, information for patients about complications should be based on clinical series of cases.

Complications of arthroscopic lysis and lavage in internal derangement of the temporomandibular joint - A single institutional experience with review of literature

PURPOSE

To evaluate the complications of arthroscopic lysis and lavage with joint sweep (ALL) procedure in the management of disc derangement of the temporomandibular joint.

METHODS

Patients with internal derangement of the TMJ who were treated by ALL in a tertiary institution from July 2018 to December 2021 were studied retrospectively.

RESULTS

The study included 39 patients (males, n = 14; females, n = 25) and 50 joints. The complications observed in the study were classified into intra and post operative complications. Post operative complications such as pain (16%), swelling (6%), reduced mouth opening (22%) and neurological complications were the most commonly observed ones. Rare complications such as ipsilateral palatal swelling (6%), parapharyngeal swelling (4%), and post operative malocclusion (2%) were also observed.

CONCLUSION

Although the complications of ALL are entirely unavoidable, their incidence can be reduced by strict adherence to standard techniques. Three-dimensional awareness and orientation of the dangerous angles and depth around the TMJ region is mandatory to reduce the complications.

Use of the Temporalis Myofascial Flap in Internal Derangement of the Temporomandibular Joint - An Evaluative Study

Introduction

Internal derangement is an abnormal relationship between the articular disc and the mandibular condyle. The most common cause is trauma. Various classifications have been given for internal derangement. Initial management is done conservatively and if the disease is progressed, surgery is the option. Various surgical methods and interpositional materials following discectomy have been given in the literature.

Materials and Methods

Over the past 15 years, we selected a group of 30 patients, Wilkes Class IV and V where conservative therapy had failed and were candidates for surgery. The patients had their disc repositioned, the damaged part of the disc was excised and disc was reinforced using the temporalis myofascial flap (TMF). In cases where the disc was non-salvageable, discectomy was done and TMF was placed between condyle and glenoid fossa, sutured with Prolene. The follow-up period was 3 years.

Results

Of the 30 patients, there were 9 male and 21 female. Range of mouth opening was 3.3-3.8 cm with improvements in 1 year. The jaw relations gradually improved and were restored after 3 weeks. Patients were totally pain free in 6 months.

Discussion

For the cases where surgery is the line of treatment, we strongly suggest disc repositioning and reinforcement with TMF as the flap is bulky, locally available and easy to harvest and causes no deformity at the donor site.

Surgical complications related to temporomandibular joint arthroscopy: a prospective analysis of 39 single-portal versus 43 double-portal procedures

Temporomandibular joint (TMJ) arthroscopy is a minimally invasive surgical procedure proposed for diverse TMJ intra-articular disorders. A prospective study was designed with the aim of investigating intraoperative and postoperative surgical complications for single and double-portal TMJ arthroscopy. All interventions were performed by one surgeon with the same surgical protocol. A total of 55 patients were enrolled, resulting in 82 TMJ arthroscopies (28 unilateral and 27 bilateral). A total of 39 single portal (47.57%) and 43 double-portal (52.43%) arthroscopies were performed. No severe and irreversible complications were observed. Most complications were resolved after 4 weeks. Double-portal was associated with more complications (n=23) compared with single-portal TMJ arthroscopy (n=14), with a statistically significant difference found between single and double-portal TMJ arthroscopy in two intraoperative complications: intra-articular bleeding (P=0.044) and oedema of the preauricular area (P=0.042). This study confirms the safety of TMJ arthroscopy for single and double-portal procedures, with the authors suggesting a multicentre study, in an effort to minimize any possible bias.

Complications of temporomandibular joint arthrocentesis

Arthrocentesis is a frequently performed and accepted minimally invasive and predictable procedure in the treatment of temporomandibular joint disorders. This review aimed to evaluate arthrocentesis complications. The literature search has included PubMed, Google Scholar, and EMBASE databases by using terms "((TMJ OR TEMPOROMANDIBULAR JOINT OR TMD OR TEMPOROMANDIBULAR DISORDER) AND ARTHROCENTESIS) AND COMPLICATION". Publications up to 2019 were examined. Seven studies involving arthrocentesis complications were included. Although arthrocentesis is considered as a cost-effective and safe procedure, complications may be seen due to its proximity to important anatomical structures. Most of these complications are short-lived and can easily be managed in the outpatient clinic; however, some severe complications have rarely been reported in the literature. The practitioners who perform this procedure should be aware of these possible complications and be able to manage them in the clinic.