Functional Surgery of the Temporomandibular Joint With Conscious Sedation for “Closed Lock” Using Eminectomy as a Treatment: A Case Series

Purpose The purpose of this case series study was to evaluate the advantages and disadvantages of using local anesthesia and conscious sedation (CS) rather than general anesthesia (GA) for performing functional surgery on patients suffering from temporomandibular joint (TMJ) closed lock, using the eminectomy procedure. Performing this procedure using CS allows functional assessment of the TMJ meniscus at the time of surgery. The objectives of this study were to determine if this surgery is possible under CS, to determine the benefits of being able to see the meniscus in action, and to investigate the patients' acceptability for this form of anesthesia. Patients and Methods Twenty-two patients who underwent this eminectomy procedure under either CS or GA on a day-case basis participated in this retrospective case series study. All the recruited patients had this procedure carried out after a course of nonsurgical conservative treatment that had failed to relieve the symptoms associated with their TMJ disorder—“closed lock.” Results Objective results obtained were as follows: preoperative and postoperative mouth opening; preoperative investigations; preoperative treatments. Subjective results obtained were as follows: preoperative and postoperative pain; noises; clicks; hearing and deviation on opening; patient rating of operation success. Paired t testing showed a significant change in mouth opening for both groups. The mean mouth opening change in the CS group (n = 9) was 10.6 mm ( P = .014) and in the GA group (n = 13) was 13.7 mm ( P < .001). An unpaired t test showed there is no statistical difference between these groups ( P = .467). The subjective data recorded showed comparable outcomes and acceptance for the 2 techniques in terms of pain and operation success. Conclusions The use of local anesthesia and CS is an alternative to GA for performing TMJ procedures in appropriately selected patients. The advantage of direct visualization of the meniscus and its movements in the nonasleep patient requires further evaluation.