Meta-analysis of surgical treatments for temporomandibular articular disorders

Purpose: Temporomandibular joint articular disorders may cause severe pain and dysfunction. We addressed the following questions. Can any surgical procedures effectively treat these disorders? If so, which procedures are most effective? Materials and Methods: We performed meta-analyses of surgical trial results to determine whether certain surgical procedures are effective in specific patient groups. To compensate for the lack of parallel control groups in published studies and for the improvement that has been observed in untreated patients, we used historical data from nonsurgical trials to derive 3 estimates of historical control group improvement (0%, 37.5%, and 75%). To our knowledge, this is the first meta-analytic evaluation of surgical treatments for temporomandibular joint disorders. Results: Among patients refractory to nonsurgical therapies, surgical arthrocentesis and arthroscopy were effective for patients with disc displacement without reduction at all assumed control group improvement rates. Disc repair/repositioning had a statistically significant effect at all but the highest improvement rate. In patients with disc displacement with reduction, arthroscopy and disc repair/repositioning had statistically significant effects at all but the highest assumed rate of control group improvement. There were no statistically significant differences between the effects of any treatments. Conclusions: Surgical treatments appear to provide some benefit to patients refractory to nonsurgical therapies. The most reliable evidence supports the effectiveness of arthrocentesis and arthroscopy for patients with disc displacement without reduction. Better designed trials are needed before one can accurately determine the magnitude of the benefits of surgery. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:3-10, 2003