GP4b - Does Temporomandibular Joint Arthroscopy Improve Patient Quality of Life?

Abstract: Temporomandibular joint disease (TMD) is a global diagnosis for pathological conditions affecting the temporomandibular joint (TMJ) and surrounding masticatory muscles affecting approximately 20% of the general population with a yearly incidence of developing TMD at 4% per year.¹ The generic health status (EQ-5D-5L) of orofacial pain/TMD as assessed by quality-adjusted life years (QALYs) reports 17.54 years in perfect health after the age of 25, having an overall health effect similar to that of arthritis and depression.² Despite the widespread effect on overall quality of life (QoL), TMD research, particularly those affecting the outcome of treatment, has grossly assessed predominantly visual analogue scale of pain (VAS) and maximum mouth opening (MIO) for outcomes. Despite both of these being objective measurements, they do not assess patient-reported outcomes and thus may show a different outcome regarding the overall effects of TMJ arthroscopy. The OHIP-TMD 22 survey is the only validated survey to assess quality of life after treatment for TMD and can be compared at different time points, thus is an ideal tool to assess changes over an extended period after arthroscopic surgery. The American Association of Oral and Maxillofacial Surgery success after temporomandibular joint arthroscopy is noted as a VAS ≤3 and MIO ≥35 mm, however, the success in most of the literature is poorly defined and often does not follow these criteria. Our goal with this study is to assess the patient-reported outcome of quality of life after temporomandibular joint arthroscopy, while also comparing the subcategories within the data collected.

This prospective study has a cohort of 205 patients who received temporomandibular joint arthroscopy between January 1, 2023, to October 1, 2024. These patients had all failed 6 months or greater of conservative treatment prior to proceeding with arthroscopy as inclusion criteria and must be the age of the majority to be able to consent to participation in the study. Patients completed the OHIP-TMD 22 survey before their procedure in the pre-operative area, and then again at the 2, 6, and 12-month time points after their surgery. Results of the OHIP-TMD 22 can be added to get an overall score for the survey, with the maximum score being 110 signifying the worst possible QoL outcome, while these scores can then be compared at each time point to assess overall changes in QoL.

Preliminary data was assessed using a paired t-test to compare the preoperative results with the median scores from the three postoperative time points. The overall data from all 22 questions and the 7 subcategories of OHIP-TMD 22 were compared.

Data from the initial 88 patients treated shows a statistically significant improvement in quality of life as reported by a P value of < .0005 for all the time points and subcategories after temporomandibular joint arthroscopy. There was noted to be a non-statistically significant decline in the overall QoL postoperatively with the peak results at 2 months post-surgery, while those at 6- and 12-months post arthroscopy showed a decline. All data, however, was statistically significant with a P-value of < .0005. Temporomandibular joint arthroscopy has thus shown to be an effective method of improving the overall quality of life for those affected by TMD who fail conservative treatment.

1. Maixner, W et al (2011). Orofacial pain prospective evaluation and risk assessment study--the OPPERA study. The journal of pain, 12(11 Suppl), T4–11.e112
2. Durham, J et al (2021). DEEP Study: Modeling Outcomes and Costs of Persistent Orofacial Pain. JDR clinical and translational research, 8(1), 23800844211063870
Figure 1. Patient Study Demographics Figure 2. OHIP-Additive Results of Surveys. Summary of the median values for all surveys for the first 88 patients to complete 1-year postoperative time point. * A lower score indicates an improved QOL measure. Figure 3. Paired t-test comparing preoperative and postoperative survey results.