LAUSR

INTRODUCTION The role of lysis and lavage has shown excellent success rates in treating internal derangement of the temporomandibular joint (TMJ). This procedure has been shown to reduce pain and improve joint mobility, sometimes even in patients suffering from advanced stages of degenerative joint disease (Wilkes IV-V). There are two different approaches to lavage and arthrolysis: Arthrocentesis and TMJ Arthroscopy. OBJECTIVES To assess both approaches' efficacy in managing internal derangement of TMJ. METHODS 92 patients with clinical and radiographic documentation of internal derangement of the TMJ unresponsive to nonsurgical therapy were randomized to one of two surgical groups: Arthroscopic lysis and lavage level 1 (64 patients) and Arthrocentesis (28 patients). Radiological changes in the joint, pain (VAS), interincisal distance, lateral and protrusive movements, and clicks and sounds of the joints were recorded. Data were compared pre-surgically (T0) and in postoperative periods of 1 week (T1) and 1 (T2),3 (T3), and 6 (T4) months. RESULTS both surgical modalities achieved a similar outcome. A gradual improvement was demonstrated during the follow-up periods with no reliance on radiological changes to the joint or the TMJ diagnosis. More than that, significant differences were encountered in all parameters but protrusion between T0 and T4. VAS decreased from 7.16±2.48 to 1.75±1.98 for the arthroscopic group and from 7.53±2.69 to 1 ±1.86 for the arthrocentesis group (P-value=0.00001). CONCLUSION Both approaches of Arthrocentesis and Arthroscopic level 1 have proven to reduce pain and improve mouth opening and lateral and protrusive movements over time.