الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Internal derangement i
s the most prevalent type of temporomandibular disorders
(TMDs), which are very frequent disorders . F our main factors included in the etiology;
trauma, emotional stress, parafunctional habits, and atypical occlusal conditions Pain, clicking and clinical dysfunction entailing limitation of mouth opening and locking are the
most common presentation. MRI is the imaging modality of choice . it should be
included with the patient complain and clinical examination for proper diagnosis.
Conservative measu res are the first line of treatment with reported 90% success rate while
open surgery is the last option for end stage irreversible cases.
Recently,
minimally invasive procedures ( MIP s) have become the 1 st alternative in
refractory cases with reported 80% success rate. TMJ arthroscopy is the best modality and
comprises three levels; level I: ALL, level II: OA, and level III: discopexy. Reviewing the
literature revealed a lac k of RCT comparing them. Consequently, this study aimed to compare
between the thre e levels as regarding pain, clicking, MIO, lateral and protrusive movements
as a primary outcome, while disc position in MRI and operative time represented the
secondary outcome.
All three levels of arthroscopy have attained
a significant improvement con cerning
pain and all functional movements including MIO, lateral, and protrusive movements with no
significant difference between them except for MIO where level II showed a better
significance than level I at the 3 rd and 6 th month PO FU. Additionally, lev el II had the earliest
decrease of pain (VAS) score from the 1 st month PO FU.
Level III discopexy is significantly better than the other two levels as regards the
clicking improvement a nd the disc position in the 6 M PO MRI. Thus, it has proved to be the
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most stable fixation to maintain the disc in position and resolve clicking.ost stable fixation to maintain the disc in position and resolve clicking. Additionally, it had a Additionally, it had a significantly significantly longer operative time which can be explained by the more surgical steps that has longer operative time which can be explained by the more surgical steps that has been done. been done.
Being a minimally invasive, the incidence of compli
Being a minimally invasive, the incidence of complications is very low in literature cations is very low in literature and even in the present study where only and even in the present study where only one patient of one patient of level level II II had temporary had temporary cheek cheek numbnessnumbness.. LLevel III discopexyevel III discopexy patients presented withpatients presented with immediateimmediate PO dental malocclusion, PO dental malocclusion, yet yet all all of them regained of them regained theirtheir normal occlusion normal occlusion dduringuring the followthe follow--up period.up period.
6.2
6.2 RecommendationsRecommendations
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1.. In contrast to the old concepts of exhaustion of conservative measures, arthroscopy is In contrast to the old concepts of exhaustion of conservative measures, arthroscopy is highly recommended to be implemented as soon as the patient does not show an highly recommended to be implemented as soon as the patient does not show an improvement to the initial medical treatmenimprovement to the initial medical treatment.t.
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2.. Whatever the selected Whatever the selected arthroscopic arthroscopic technique, arthroscopy should be considered the technique, arthroscopy should be considered the first first alternative measure for refractory patients as all levels showed comparable results alternative measure for refractory patients as all levels showed comparable results regardingregarding the better postoperative clinical outcome of pain and functional movemthe better postoperative clinical outcome of pain and functional movements.ents.
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3.. Level II (Level II (OAOA)) procedures require an arthroscopy set with complementary procedures require an arthroscopy set with complementary equipmentequipment such as coblatorsuch as coblator..
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4.. Level IIILevel III arthroscopic rigid fixation (ARF) with resorbable pins is intricate and arthroscopic rigid fixation (ARF) with resorbable pins is intricate and demanding, necessitating demanding, necessitating customcustom--made instruments for pin discopexymade instruments for pin discopexy, , eextensive xtensive surgical experiencesurgical experience and the and the affordability of the pin priceaffordability of the pin price..
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5.. FutureFuture studies with a longstudies with a long--term FU are term FU are recommendedrecommended especially after the pin has especially after the pin has resorbed (resorbed (1818--2626 months PO), as this can help level III discopexy patients months PO), as this can help level III discopexy patients to to achieve a achieve a wider range of functwider range of functional movementsional movements..