Saravanan Kokila Krishnamoorthy MD, Presenter: Nothing to Disclose

Quentin N. Anderson MD, Abstract Co-Author: Nothing to Disclose

Eric Schiffman DDS, Abstract Co-Author: Nothing to Disclose

John Look DDS, Abstract Co-Author: Nothing to Disclose

Mansur Ahmad PhD, Abstract Co-Author: Nothing to Disclose

Long term imaging results of TMJ surgical intervention for closed lock condition (anterior disk displacement without reduction) are not clear. A randomized clinical trial was conducted for a period of five years to determine the incidence of arthritic changes in closed lock patients. Outcome analysis focused on statistical difference between surgically treated patients (arthroplasty, disc reduction, or excision) and non-surgical clinical management.

After a closed lock diagnosis was confirmed by MRI in 106 patients, they were randomly assigned to Group A) medical management (n = 29); Group B) comprehensive non-surgical treatment (n = 25); Group C) arthroscopic surgery (n = 26); or Group D) disc repair/plication or discectomy surgery (n = 26). Arthrosis was assesses by tomography at baseline, 2 years and 5 years, with all image interpretations performed by a single board-certified radiologist. Tomograms have been completed at the 5-year follow-up for 95 subjects.

For 88.4% of the subjects (84 of 95), no frank arthrosis was observed up to the five-year follow-up. For the 11.6 % of subjects progressing to arthrosis (11 of 95), the treatment group distributions were: Group A- 7.7% (2 of 26); Group B- 4.6% (1 of 22); Group C- 16.7% (4 of 24); Group D- 17.4% (4 of 23). There was no statistical between-group difference in these proportions (p = 0.167, Nonzero Correlation, PROC FREQ, SAS Institute). Adjustment for gender, age, baseline somatization and baseline depression did not change this finding of no treatment group difference (p > 0.2, PROC LOGISTIC, SAS Institute).

The results of this prospective study show that TMJ closed lock progressed to arthrosis within five years for 11.6% of subjects, and the incidence of arthrosis at five years did not differ statistically between surgical and non-surgical treatments. This study was supported by NIH Grant #R29DEO8668, R01DE1342 and P30-DEO9737.

Determine the incidence of arthritic changes in closed lock patients and determine if surgical management alters the incidence of arthosis.

Krishnamoorthy, S, Anderson, Q, Schiffman, E, Look, J, Ahmad, M, Five Year Randomized Clinical Trial on TMJ Progressive Arthrosis: Effects of Surgical and Non-Surgical Treatment.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4434664.html