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Minimally invasive surgical treatment for temporomandibular joint in patients with various rheumatic diseases

https://doi.org/10.14412/1996-7012-2017-4-12-17

Abstract

Temporomandibular joint (TMJ) involvement occurs in patients with different rheumatic diseases (RDs). Pain, limitation of mouth opening can lead to significant problems in both oral hygiene and when eating. Conservative treatments for TMJ lesions are not always effective. Objective: to evaluate the efficiency of minimally invasive surgical interventions (TMJ arthrocentesis and arthroscopy) in patients with RDs. Patients and methods. The investigation enrolled 64 patients with different RDs (43 with rheumatoid arthritis, 11 with psoriatic arthritis, 8 with systemic lupus erythematosus, and 2 with ankylosing spondylitis) who were divided into three groups in relation to the severity of TMJ involvement in accordance with the Wilkes classification. All the patients underwent TMJ magnetic resonance imaging at baseline and 6 months after treatment. Also at baseline, 14 days, and 1, 6, and 12 months after surgery, the investigators assessed TMJ pain intensity by visual analogue scale and the parameters of mandibular movements. Patients with Wilkes stages IV and V TMJ involvement underwent arthroscopic intervention into the TMJ and those with III stage received TMJ arthrocentesis with arthrolavage. Results and discussion. After surgical treatment, all the groups were noted to have a significant decrease in TMJ pain intensity compared with the baseline level; moreover, the severity of TMJ pain most significantly decreased on day 7 after surgery. Later on, positive changes remained within subsequent follow-up months. There were data similar in the higher degree of mouth opening. The results of surgical treatment in patients with Wilkes stage V TMJ involvement were worse than in those with stages III and IV. Conclusion. Minimally invasive TMJ surgery in patients with RDs is effective and associated with the low frequency of postoperative complications and exacerbations of RDs. The efficiency of minimally invasive TMJ surgery is higher in patients with the early and middle stages of TMJ involvement according to the Wilkes classification. Further investigations are needed to assess the long-term results of minimally invasive TMJ surgery in patients with RDs.

 

About the Authors

A. Yu. Drobyshev
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow
Russian Federation


I. D. Zaslavsky
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow
Russian Federation


T. V. Dubinina
V.A. Nasonova Research Institute of Rheumatology, Moscow
Russian Federation


A. N. Kuznetsov
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow
Russian Federation


D. V. Shipika
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow
Russian Federation


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Review

For citations:


Drobyshev AY, Zaslavsky ID, Dubinina TV, Kuznetsov AN, Shipika DV. Minimally invasive surgical treatment for temporomandibular joint in patients with various rheumatic diseases. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2017;11(4):12-17. (In Russ.) https://doi.org/10.14412/1996-7012-2017-4-12-17

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ISSN 1996-7012 (Print)
ISSN 2310-158X (Online)