Comparison of the TMJ arthroscopy discopexy techniques: A systematic review and meta-analysis

Juan Pablo López; María Paula Orjuela; David Díaz-Baez; Luis Vicente González

doi:10.1016/j.jcms.2024.04.004

Comparison of the TMJ arthroscopy discopexy techniques: A systematic review and meta-analysis

J Craniomaxillofac Surg. 2024 Apr 16:S1010-5182(24)00142-2. doi: 10.1016/j.jcms.2024.04.004. Online ahead of print.

Authors

Juan Pablo López¹, María Paula Orjuela², David Díaz-Baez³, Luis Vicente González⁴

Affiliations

¹ Oral and Maxillofacial Surgeon, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia; Universidad El Bosque, Unidad de Investigación en Epidemiología Clínica Oral UNIECLO, Bogotá DC, Colombia. Electronic address: jplopez2304@gmail.com.
² Oral and Maxillofacial Surgery Surgeon, Universidad El Bosque, Bogotá DC, Colombia.
³ Unit of Basic Oral Investigation (UIBO), Facultad de Odontología, Universidad El Bosque, Bogotá DC, Colombia.
⁴ Oral and Maxillofacial Surgeon, Hospital Universitario La Samaritana, Bogotá DC, Colombia; Department of Oral Research, School of Dentistry, Institución Universitaria de Colegios de Colombia UNICOC, Colombia.

PMID: 38631972
DOI: 10.1016/j.jcms.2024.04.004

Abstract

This article aims to analyze which of the main arthroscopic discopexy techniques has the best results and if there are differences between the techniques for both pain and maxillary intercuspid opening. A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed with no publication date restriction in PubMed, Ovid and Embase. The PICO criteria: (P) Patients: With temporomandibular internal disorders with discopexy indication. (I) Intervention: Temporomandibular joint arthroscopic discopexy. (C) Comparison: Arthroscopic discopexy among different techniques classified as non-rigid, semi-rigid and rigid. (O) Outcomes: Impact in clinical conditions such as pain and maximum mouth opening. The inclusion criteria were Patients with temporomandibular internal disorders with discopexy indication performed with different techniques classified as non-rigid, semi-rigid and rigid. The outcomes evaluated were pain and maximum mouth opening. Case series, cohort studies, quasi-experimental studies, and randomized clinical trials with at least 3 months of follow-up were included. The exclusion criteria considered were patients with related concomitant surgeries, patients with associated neoplastic disease or connective tissue disease. A total of 1515 joints where 1400 discopexies were performed including 849 females and 204 males. The most common diagnostic was Wilkes stage III in 257 joints. For pain and oral opening, the semi-rigid technique shows the best results median (MD) 4.84 (CI 2.52-7.16; p = 0.001, I2:100%), MD -2.78 (CI -4.34, -1.21; p = 0.001, I2:99%), respectively. The rigid technique has the greatest probability for complications MD 0.14 CI 95% (0.00, -0.28). Although the semi-rigid technique showed better results, there is no statistically significant difference. However, due to the heterogeneity of the studies, the results should be interpreted with caution.

Keywords: Complications; Operative arthroscopy; TMJ discopexy; Temporomandibular joint.

Publication types

Review