الفهرس 
INTRODUUCTIONOnly 14 pages are availabe for public view
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Abstract
Temporomandibular disorders (TMDs) are relatively common conditions and internal derangement is the most common among them. Clinically, it may be accompanied by pain, limitation of mouth opening, clicking, and locking. Different methods have been proposed to treat this entity, beginning with conservative approaches ending with surgery. Nowadays, arthroscopy and arthrocentesis have eliminated the use of many of the more complex surgical procedures. Despite such advancements, there is lack of prospective, randomized, clinical studies to support the use of either both. In doing the necessary studies, and comparing the results, it will be important to develop standardized patient selection criteria and treatment options to be used by all investigators.
The present study compared between arthrocentesis and operative arthroscopy in the management of patients with internal derangement of temporomandibular joint who had stage II and III Wilkes. It compared between the 2 groups as regards the mandibular movements, pain score according to visual analogue scale, presence or absence of clicking and operative time.
Both arthrocentesis and operative arthroscopy are safe, effective and feasible procedure in the management of TMJ internal derangement, taking in consideration that operative arthroscopy is feasible only in the presence of both well experienced surgeon in the operative arthroscopy procedure and all the instruments needed for this procedure.
The operative arthroscopy is significantly better than arthrocentesis as regards the post-operative pain score after 6 months according to VAS because in addition to the lavage, coblation of any synovitis and electrocoagulation of the retrodiscal tissue was done.
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The operative arthroscopy is a significantly better than arthrocentesis concerning the post-operative mouth opening (MIO) after 6 months because added to the lavage, lateral pterygoid myotomy and electrocoagulation of the retrodiscal tissue was done.
The operative arthroscopy is significantly longer procedure than the arthrocentesis procedure in the hand of highly experienced surgeons as it needs time for triangulation and any operative procedure inside the joint. It might take double or triple the time with unexperienced surgeons as it needs a long and high learning curve.
Although Arthrocentesis and arthroscopy are not without complications as damage to the facial and auriculotemporal nerves, perforation of the external auditory canal and tympanic membrane, the incidence of the complications is rare as no complication was encountered in both procedures in this study.
Arthrocentesis is a blind method, while arthroscopy reveals a direct and realistic picture of intra-articular pathology and gives us the possibility of applying different medicaments and doing operative procedure inside the joint.
Although the operative arthroscopy could yield better therapeutic results, arthrocentesis is simple, inexpensive and effective and as it uses smaller lavage needles, it is considered less traumatic and easier to manipulate.
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6.2 Recommendations
1. Operative arthroscopy necessitates the availability of:
a. Well trained and well experienced surgeon in the operative arthroscopy.
b. 30° lens in order to be able of doing the triangulation technique and insertion of the second cannula. The zero-degree lens should only be used in the arthroscopic lysis and lavage procedures.
c. Coblator or laser to provide energy inside the joint needed for myotomy of lateral pterygoid and electrocoagulation of the retrodiscal tissue. Monopolar diathermy should be avoided as it generates more heat inside the joint which can adversely affect the chondrocyte and its proteoglycan synthesis, and with time, the fumes generated during its use can affect the lens.
2. In the presence of well experienced surgeon and all the instruments needed for arthroscopy, operative arthroscopy is better to be done in order to get better therapeutic results.
3. Operative arthroscopy should be done in joints that require additional diagnosis as it reveals a direct and realistic picture of the intra-articular pathology.
4. In the absence of experienced surgeon and instruments needed for arthroscopy, arthrocentesis can be done as it is simple, safe and effective procedure and is usually done under general anesthesia.
5. Future prospective studies between both procedures is needed especially in Wilkes IV and V patients, to develop standardized patient selection criteria and treatment options according to every stage to be used by all the surgeons.