A clinical and histopathological study of osteoarthrosis of the temporomandibular joint

Objectives— The aims of this study were (i) to objectively assess the histopathological features in TMJ condylar head specimens and to correlate the findings with clinical information obtained from pathology request forms and hospital notes. (ii) to analyse the pre- and postoperative investigation and management of patients with TMJ-OA. Design— A retrospective histological analysis of 136 specimens using a semi-quantitative scoring system. Subjects— 132 patients with TMJ-OA in Trent Hospital Region (mean age 34; range 14–71) provided 136 condylar heads. Main outcome measures—11 histological parameters were assessed. The global scores obtained were compared with the clinical data. Results— There was no clear correlation between histology and pre- and postoperative clinical data. 95% of patients were treated for at least 6 months before surgery and 94% o had pain before surgery. Postoperatively, the success rate was 58% (35% painfree and 23% o still in pain but better than before surgery). Non-surgical treatments were not used routinely after surgery. Only 62% of the patients were followed up for at least one year after surgery. 61% of the patients were reported to have macroscopic degenerative changes at surgery whilst all had microscopic OA. Conclusion— The mean age of patients presenting with TMJ-OA is younger (M=31/F=34) than in some studies while there is still a female preponderance for the disease. Tomograms and arthrograms appear to have a higher specificity than orthopantomograms for diagnosing gross degenerative change. There appears to be a need for a standardised management protocol.