Open versus arthroscopic surgery for the management of internal derangement of the temporomandibular joint: a meta-analysis of the literature

The objective of this study was to assess the clinical outcomes of the following three surgical methods for the management of internal derangement (ID) of the temporomandibular joint (TMJ): arthroscopic lysis and lavage (ALL), arthroscopic surgery (AS), and open surgery (OS). A systematic and electronic search of several databases with specific key words was performed from their inception through November 2014. Clinical human studies, including randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies, with the aim of comparing the three surgical methods for the management of ID of the TMJ were included. Seven publications were identified: three RCTs, two CCTs, and two retrospective studies. A significant difference was found between OS and AS in pain reduction (P = 0.05), but no significant difference with regard to maximal inter-incisal opening (MIO > 35 mm), mandibular function impairment, and clinical findings (clicking, joint tenderness, and crepitation) (P = 0.52, P = 0.34, and P = 0.19, respectively). The results of the meta-analysis showed that the use of OS is superior to AS in pain reduction, with comparable MIO, jaw function, and clinical findings. In addition, the results of the present study showed that ALL provides greater improvement in MIO and comparable pain reduction when compared to AS.