Intraoperative complications in temporomandibular joint arthroscopy: A retrospective observational analysis of 899 arthroscopies

Minimally invasive therapies in temporomandibular joint surgery is field of interest. Recently, a network meta-analysis of clinical trials was published to some conclusion, which advocates the use of minimally invasive therapies for the early management of degenerative disorders that can improve clinical variables. The procedures include arthrocentesis and arthroscopy with or without the application of intra-articular substances (Al-Moraissi et al., 2020).

However in 1992, McCain et al. describe the reposition of the articular disc by arthroscopy in a data collection with 11 patients, giving great diagnostic and operative versatility to this type of surgical technique (McCain et al., 1992) Currently, different authors have performed the discopexy with arthroscopy. Pain reduction, an increase of mandibular interincisal opening, and reductions in joint noise are some of the clinical variables improved with advanced arthroscopy (Loureiro-Sato and Tralli, 2020). Similar to this, a study published in 2016 demonstrated that arthroscopy with resorbable pins is a useful procedure improving clinical parameters and mandibular function with a decrease of pain and an increasing evolution in the mandibular interincisal opening in a short and long follow-up (Martín-Granizo and Millón-Cruz, 2016; Millon-Cruz and Martin-Granizo lopez 2020).

Arthroscopy, like other procedures, requires training to prevent complications. Greene et al., described the anatomical considerations to be taken into account during arthroscopic surgery. The facial nerve, the neurovascular complex of the superficial temporal vessels, and the auriculotemporal nerve may be close to the puncture sites. Additionally, the thin-thickness roof of the glenoid fossa and the proximity of the external auditory canal to the temporomandibular joint also make it a risk zone for perforations (Greene et al., 1989). This may explain why the complications described for arthroscopic surgery are directly related to the anatomy surrounding the puncture areas (McCain, 1988). Currently this surgical technique has had a significant increase in its use. For this reason, it is important to have a thorough understanding of the complications that can occur and how to address them. However there is little knowledge about intraoperative complications.

This retrospective cross-sectional, observational analytical study aims to describe the main intraoperative complications of arthroscopy in patients with Wilkes stages II, III, and IV.

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