Journal of Cranio-Maxillofacial Surgery (2006) 34, 234–241 r 2006 European Association for Cranio-Maxillofacial Surgery doi:10.1016/j.jcms.2005.12.002, available online at http://www.sciencedirect.com Open versus arthroscopic surgery for internal derangement of the temporomandibular joint: A retrospective study comparing two centres’ results using the Jaw Pain and Function Questionnaire Gerhard UNDT 1 , Ken-Ichiro MURAKAMI 2 , Michael RASSE 3 , Rolf EWERS 1 1 Department of Cranio-Maxillofacial and Oral Surgery, (Director: Prof. Dr. Dr. Rolf Ewers), Medical University of Vienna, Austria; 2 Department of Oral and Maxillofacial Surgery, (Acting Chair: Ken-Ichiro Murakami DDS, DMsc, PhD), University of Kyoto, Japan; 3 Department of Oral and Maxillofacial Surgery, (Director: Prof. Dr.Dr. Michael Rasse), Medical University of Innsbruck, Austria SUMMARY. Objectives: Surgical procedures currently used for treating of internal derangement of the temporomandibular joint vary widely. Although different studies present favourable results following open or arthroscopic TMJ surgery, the criteria for a successful treatment outcome are not always defined identically. In a retrospective study, two groups of patients who underwent either open or arthroscopic surgery for internal derangement (stages III–V according to Wilkes’ classification) were investigated using the so-called JPF- Questionnaire. Patients and methods: The Kyoto collective (group 1) consisted of 28 patients, 2 men and 26 women, who underwent arthroscopic surgery. At the time of surgery, age ranged from 13 to 77 years (mean 32.8 y). The postoperative follow-up period ranged from 4 years and 4 months to 5 years and 9 months. Twelve of the 28 patients were classified as stage III, 10 as stage IV and 6 were classified as stage V (according to Wilkes) at the time of surgery. The Vienna collective (group 2) also consisted of 28 patients, 2 men and 26 women, who underwent open meniscoplasty or discectomy. At the time of surgery age ranged from 17 to 55 years (mean 31.6 years). The postoperative follow-up ranged from 5 to 6 years and 9 months. Fourteen of the 28 patients were classified as stage III, 11 as stage IV and 3 were classified as stage V (according to Wilkes) at the time of surgery. The results of the JPF-Questionnaire of the two groups were compared by Wilcoxon 2-sample tests. The Japanese version was applied, while in Austria the German version of this questionnaire was applied. Results: At a level of significance a ¼ 0.05 no significant difference was found when comparing the subgroups (Wilkes stages III, IV and V) or both groups of patients 5 years after temporomandibular joint surgery. Conclusion: There cannot be any clear indication for only one of the treatment modalities as similar results were noted following open or arthroscopic temporomandibular joint surgery. Nevertheless, arthroscopic surgery is a minimally invasive procedure resulting in a shorter or no time of hospitalization when compared with open surgery and therefore is preferred by many surgeons nowadays. r 2006 European Association for Cranio-Maxillofacial Surgery Keywords: temporomandibular joint dysfunction syndrome; surgery; arthroscopy INTRODUCTION Today there are various surgical procedures avai- lable for the treatment of internal derangement— a term which summarizes disc displacement with or without reduction, perforation of the articular disc or of the retrodiscal tissue and various degen- erative changes of the disc and/or the articula- ting surfaces. Surgical reduction of the displaced articular disc was reported as early as 1887 by Annandale (1887). In 1979, McCarty and Farrar introduced a technique of disc repositioning by excision of retrodiscal tissue and intraarticular suturing (McCarty and Farrar, 1979). This method and its variations (Hall, 1984; Dolwick and Sanders, 1985) have become the standard procedures for open disc reduction worldwide. Advanced stages of the disease require such procedures as disc repair (Dolwick and Sanders, 1985), discectomy (Lanz, 1909), or discectomy and replacement, e.g., by auricular cartilage (Witsenburg and Freihofer, 1984). The technique of arthroscopy of the TMJ was developed in Japan in the early seventies (Ohnishi, 1975). With the refinement of equipment and surgical skills, TMJ arthroscopy has been established as a diagnostic tool and a surgical method as well (Murakami et al., 1986; Sanders, 1986). In the early nineties, techniques for the arthroscopic management of disc displacement by use of lasers, electric diathermy or intra-articular suturing have been described (Ohnishi, 1991; McCain et al., 1992a; Koslin and Martin, 1993). Advanced arthroscopic surgical procedures were designed for the management of severe degenerative changes of joint surfaces (Quinn, 1994). ARTICLE IN PRESS 234