Comparative Study Between Arthroscopic Versus Open Surgical Discopexy for Treatment of Temporomandibular Joint Anterior Disc Displacement Without Reduction (RCT)

NCT ID: NCT05938257

Last Updated: 2023-07-10

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-08-31

Study Completion Date

2025-08-31

Brief Summary

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Temporomandibular joint dysfunction (TMD) represents a common health problem. A recent systematic review and meta-analysis in 2021 concluded that the prevalence of TMD was 31% for adults and 11% for adolescence.

Many believe that TMD symptoms are related to internal derangement of the temporomandibular joint (TMJ), which is usually in the form of anterior disc displacement(ADD) and it is often associated with pain, clicking, limited range of motion, and even osteoarthritic changes.

Treatment of TMD include non-surgical and surgical modalities. Non-surgical treatment includes instructions, pharmacotherapy, occlusal splints and physiotherapy. Patients who do not respond to non-surgical therapy may require surgical interventions that include minimally invasive procedures (arthroscopy and arthrocentesis) and open surgery.

Arthroscopy of the TMJ was first introduced by Ohnishi in 1975, it involves lysis of adhesions and lavage of the superior joint space, as well as repositioning of a displaced disc.

Open TMJ surgery can be very effective at eliminating symptoms of pain, limited mouth opening and mandibular dysfunction.

Detailed Description

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Patients are assigned randomly into two groups; group (1) for arthroscopic discopexy, and group (2) for open discopexy.

History taking: personal history; name, age, gender and occupation. Patient's complaint(s); as TMJ clicking, pain, locking and limited mouth opening.

Clinical examination: for TMJ clicking and tenderness, measurement of maximum inter-incisal opening (MIO) in mm. Examination of facial symmetry, dental occlusion and dentoskeletal deformity.

Radiological evaluation: Computed Tomography (CT) scan of maxillofacial bones. Magnetic Resonance Imaging (MRI) for TMJ, to confirm anterior disc displacement without reduction.

Operative procedures: will be carried out by the same team, under general anaesthesia, nasotracheal intubation and supine position.

Group (1) for arthroscopic discopexy: using 1.9 mm diameter - 30-degree scope. The procedure is performed through three ports and a suture-passing spinal needle 18 gauge. One port for the scope, second port for manipulation and reduction of the displaced disc and third port for retrieval of the suture used for discopexy. The suture used is 2-0 polypropylene, which is tied down in the extra-capsular tissue.

Group (2) for open discopexy: through pre-auricular incision. Exposure of the temporomandibular joint capsule, incision is made through the lateral capsule into the superior joint space and the disc is repositioned. Discopexy is done using 2-0 polypropylene suture.

Follow up will be at intervals of 1, 3, 6 and 12 months after the operation for clinical assessment of pain by Visual Analogue Scale (VAS), MIO in mm, joint clicking and complications.

MRI of TMJ is performed after one month of surgery to evaluate position of the articular disc.

Conditions

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Efficacy of TMJ Arthroscopy

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

randomized controlled clinical trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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TMJ dysfunction

TMJ discopexy

Group Type EXPERIMENTAL

TMJ discopexy

Intervention Type PROCEDURE

Arthroscopic versus open TMJ discopexy

Interventions

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TMJ discopexy

Arthroscopic versus open TMJ discopexy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients with TMD in the form of anterior disc displacement without reduction
* Age: 20 - 50 years' old

Exclusion Criteria

* Secondary TMD
* TMJ ankylosis
* Structural deformity of TMJ
* Previous surgical intervention to TMJ
* Patients who are unfit for surgery
Minimum Eligible Age

20 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mohamed Gamal Thabet

OTHER

Sponsor Role lead

Responsible Party

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Mohamed Gamal Thabet

Assiut university

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Assiut university hospital

Asyut, Government, Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Mohamed G Thabet, physician

Role: CONTACT

01026674177

Facility Contacts

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Mohamed G Thabet, physician

Role: primary

01026674177

Other Identifiers

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Mohamed G Thabet

Identifier Type: -

Identifier Source: org_study_id

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