Procedimentos cirúrgicos invasivos na articulação temporomandibular : há evidência científica?

Abstract

Temporomandibular disorders (TMDs) are considered one of the most frequent orofacial pains. They consist of a set of functional changes that affect the temporomandibular joint (TMJ), masticatory muscles and associated structures. Invasive surgical intervention in the TMJ is indicated only when all the less invasive treatments that assist in TMD therapy have already been applied without success. With this theme, a systematic review with meta-analysis was conducted in order to review the available literature on the effectiveness of invasive surgical procedures related to the TMJ articular disc, discectomies and discoplasties. Three international databases (Medline / PubMed, Scopus and Web of Science) were searched. To be included in this review, the article should report invasive surgical procedures involving articular discs for the treatment of TMD (discectomy or discoplasty), present a comparison within the same group (pre- and post-treatment), as well as comparisons between them when reporting different interventions post-surgery. Meta-analyzes were conducted only if there were studies of similar comparisons, reporting the same outcome measures. Quantitative analysis was restricted to data from the visual analog scale (VAS) and maximum incisal opening (MIO) using the Review Manager software version 5.2. In total, 1,015 articles were found, 26 were selected for reading the full text and 19 studies were included. Sixteen were included in the meta-analysis and 3 only in the qualitative analysis. Two different parameters were assessed in 16 included studies: VAS pain and MIO. VAS showed statistically significant lower values after surgical procedures in the global analysis for comparison within the groups of discectomies (p<0.00001; I2= 84%) and discoplasties (p<0.00001; I²= 48%). The comparison within groups for MIO also showed in the global analysis a significant increase in MIO after discectomy (p<0.0001, I²= 69%) and discoplasty (p<0.00001; I²= 10%). As a conclusion of the article and thesis, the results suggest that invasive surgical procedures involving the articular disc for the treatment of TMD, such as discectomy and discoplasty, were effective in decreasing pain and improving the range of mandibular movement.