The Role of TMJ Arthroscopy in Cases of Blunt Facial Trauma Without Evidence of Mandibular Fractures

Objectives: Direct trauma to the face is a known cause for Temporomandibular Disorders (TMD). We retrospectively present TMD patients who needed level I and II TMJ arthroscopy after enduring a blunt facial trauma.

Patients and Methods: From January 2015 to December 2018, forty-two patients underwent level I and II TMJ arthroscopy by a single surgeon. Indications were internal derangement, osteoarthritis and inflammatory diseases, after failing of a 3 month long conservative treatment.

Results: 6 patients had a history of blunt facial trauma prior to TMD symptoms without evidence of any mandibular fracture. There were 4 men and 2 women with age ranged from 20 to 68 (mean 45 years). 4 patients were involved in motor-vehicle accidents and 2 were hit by a blunt object at work. The mean time interval from injury to a professional TMJ specialist examination was 18 months.

MRI of the involved joints revealed disc displacement without reduction with thickened retro-discal tissue. In two cases disc perforation and deformation were demonstrated and in two other cases subchondral cysts were shown.

Arthroscopic findings included inflamed thickened synovium and disc deformation.

Conclusion: Facial blunt trauma in the absence of mandibular fractures is usually underestimated. 14.3% of our study population developed TMD symptoms that required level I and II TMJ arthroscopy after failing of conservative treatment. The intra-articular injuries included synovitis and disc derangement and perforation. Synovitis is known to play an important role in inducing TMJ pain by changing the synovial fluid composition that can cause restrictions of the condylar movements. Therefore, in patients who sustained a blunt facial trauma, we suggest a self-physiotherapy regimen and close follow-up meetings. In cases where there is no improvement, TMJ arthroscopy is recommended. Although our study included a small number of patients, this entity of TMD after blunt trauma cannot be underestimated.