ANESTHESIA/TMJ DISORDERS/FACIAL PAIN

Is Temporomandibular Joint
Arthroscopy Effective in Managing
Pediatric Temporomandibular Joint
Disorders in the Short- and
Long- Term?
Daniel D. Choi, DDS, MD,* Katherine Vandenberg, MD,y Drew Smith, MS,z
Clayton Davis, DDS, MD, MSc, FRCD(C),x and Joseph P. McCain, DMD, FACSk
Purpose: Although temporomandibular joint (TMJ) arthroscopy outcomes have been well documented in
the adult population, conclusive data are lacking for pediatric patients with TMJ disorders. The aim of the pre-
sent study was to evaluate the early and late outcomes of TMJ arthroscopy in the pediatric population.
Patients and Methods: We performed a retrospective analysis to evaluate the short- (1-month) and
long-term (1-year) improvements in the visual analog scale (VAS) scores for pain after pediatric TMJ arthros-
copy from 2008 to 2016. The arthroscopic interventions varied according to the diagnostic findings and
Wilkes classification. The primary outcome variable was the magnitude of VAS score for pain (0, no pain;
100, worst pain) at 1 year postoperatively. The secondary outcome variables were the short-term for the
VAS score for pain and the short- and long-term outcomes for perceived jaw dysfunction (0, normal jaw
function; 100, complete jaw dysfunction), mouth opening, joint loading (contralateral joint pain when
biting on the canine), joint noise, and muscle pain. Univariate, bivariate, and multivariate statistical ana-
lyses were performed with the significance level set at P < .05.
Results: A total of 23 patients (37 joints), with a mean age of 14.1 years (range, 12.8 to 16.7 years) had
undergone TMJ arthroscopic surgery with short- and long-term postoperative follow-up data available. The
VAS scores for pain showed average improvements of 26% in the short-term (P < .0001) and 25% in the
long-term (P < .0008). Perceived jaw dysfunction showed an average improvement of 23.8% in the
short-term (P < .0001) and 19.2% in the long-term (P < .0008). The average mouth opening had improved
by 5.4 mm in the short-term (P < .0016) and 8.2 mm in the long-term (P < .0001). Controlling for stage and
diagnosis, the patients with Wilkes III showed the most benefit with statistically significant improvements
in pain, jaw dysfunction, maximum interincisal opening, and joint loading pain.
Conclusions: TMJ arthroscopy could be an effective and minimally invasive form of surgical intervention
for treating Wilkes II, III, and IV TMJ disorders in the pediatric population.
Ó 2019 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg -:1-8, 2019

*Assistant Professor, Department of Oral and Maxillofacial
Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
yResident, Division of Otolaryngology, Department of Surgery,
University of New Mexico School of Medicine, Albuquerque, NM.
zMedical Student, Herbert Wertheim College of Medicine, Florida
International University, Miami, FL.
xAssociate Professor, Faculty of Medicine and Dentistry,
University of Alberta, Edmonton, AB, Canada.
kProgram Director, Endoscopic OMS Fellowship, and Director,
TMJ Surgery, Massachusetts General Hospital, Boston, MA.
Previously presented as a poster abstract at the American Associa-
tion of Oral and Maxillofacial Surgeons 2016 national meeting; and
the findings were previously presented at the Joint European Society
of Temporomandibular Joint Surgeons/American Society of Tempo-
romandibular Joint Surgeons in 2017.
Conflict of Interest Disclosures: None of the authors have any
relevant financial relationship(s) with a commercial interest.
Address correspondence and reprint requests to Dr Choi: Depart-
ment of Oral and Maxillofacial Surgery, Thomas Jefferson University
Hospital, 909 Walnut St, 3rd Fl, Philadelphia, PA 19107; e-mail:
DanielDChoi@gmail.com
Received September 19 2018
Accepted July 23 2019
Ó 2019 American Association of Oral and Maxillofacial Surgeons
0278-2391/19/30896-1
https://doi.org/10.1016/j.joms.2019.07.011

1
2 TMJ ARTHROSCOPY FOR PEDIATRIC TMJ DISORDERS
Diseases of the temporomandibular joint (TMJ) can
result in significant pain and limitations in jaw func-
tion for the patient. Minimally invasive surgical
arthroscopy is an approach that has been used for
more than 40 years to ameliorate pain and restore
function.1,2 Positive TMJ arthroscopy outcomes have
been well documented in the adult population.1,3-5
However, conclusive data regarding TMJ arthroscopy
have been lacking for pediatric patients.
The pediatric pathologic entities of the TMJ ranges
from articular disc disorders, inflammatory diseases
of the synovium, and benign and malignant pathologic
lesions of the joint. Arthroscopy might play a role in
the early identification and treatment of disorders of
the TMJ articular disc and synovium.
Articular disc displacement of the TMJ will
commonly be anteriorly or medially displaced and
can progress to locking disorders and cartilage degen-
eration. Disc displacement can be treated with
nonsteroidal anti-inflammatory drugs (NSAIDs), repo-
sitioning appliances, and arthroscopic interventions.6
Other factors that can contribute to the accelerated
deterioration of the joint include inflammatory
arthritis, macrotrauma and microtrauma, septic
arthritis, and crystal-induced arthritis.
As the disease process progresses, it can lead to
decreased joint motility, abnormalities in mandibular
growth, facial asymmetry and fibrous, and bony ankylo-
ses, which necessitate surgical interventions.7-9 Facial
asymmetries and dental malocclusions can be treated
with orthognathic procedures once the patient has
reached maturity. TMJ ankyloses will usually require
surgical excision of the ankylosed mass and
autogenous or alloplastic TMJ reconstruction.7
Although arthroscopy has not been well studied in
pediatric TMJ disorders, the practice has been
reviewed thoroughly as treatment of other orthope-
dic joint disorders. At present, arthroscopy is indi-
cated for the surgical treatment of the pediatric
shoulder, elbow, wrist, hip, knee, and ankle.10 The
outcomes have been overwhelmingly positive. A
study of pediatric elbow arthroscopy showed that
85% of patients had good or excellent outcomes,
with 90% of the children returning to sports without
limitations. Postoperatively, no complications
occurred, with no patient experiencing nerve injury,
infection, or loss of range of motion.11 A similar study
of pediatric shoulders showed that arthroscopic
Bankart repair is an effective treatment of shoulder
instability that significantly limits the recurrence of
shoulder dislocations.12
With the findings from these studies, we hypothe-
sized that TMJ arthroscopy in the pediatric population
would be a safe and effective procedure. If the hypoth-
esis were supported, it could lead to the early diag-
nosis and treatment of the underlying disease
process, improve mouth opening, and amelio-
rate pain.
Patients and Methods
STUDY DESIGN AND SAMPLE
To address the research purpose, we designed and
implemented a retrospective cohort study. The study
population included all patients who had presented
for evaluation and management of TMJ pain or
dysfunction to the senior author (J.P.M.) at Baptist Hos-
pital of Miami from 2008 to 2016.
To be included in the study sample, the patients
were required to be 16 years old or younger and to
have arthralgia or limitations in mouth opening or
jaw function secondary to the TMJ confirmed by the
radiographic and clinical findings. The exclusion crite-
rion was the absence of data on the short- (1-month)
and long-term (1-year) outcomes.
All the patients had received initial conservative
medical management, which had included soft diet,
NSAIDs, muscle relaxants, and a night guard appliance
worn for 4 to 6 weeks. After conservative management
had failed, further evaluation was performed with
diagnostic imaging, including magnetic resonance im-
aging (MRI) studies and serology. Serology included
testing for potential inflammatory contributors to joint
disease, including antinuclear antibody, rheumatoid
factor, cyclic citrullinated peptide, and human leuko-
cyte antigen B27.
DATA COLLECTION
The recorded data included demographic data
(eg, age, gender, joint side, unilateral vs bilateral),
MRI findings, serologic results, Wilkes classification,
the procedure performed, and need for additional sur-
gery. Clinical data were recorded for subjective pain
(visual analog scale [VAS]), perceived jaw dysfunction,
maximal interincisal opening (MIO), muscle pain
(ie, tenderness to palpation along the masseter or tem-
poralis muscle), and joint loading pain (ie, joint pain
when the patient bit on a tongue blade with the
contralateral canine).
The arthroscopic interventions varied from level 1
(diagnostic), level 2 (operative) to level 3 (disc recon-
struction) according to the diagnostic findings and
Wilkes classification. The histopathologic, serologic,
and arthroscopic findings contributed to the final dif-
ferentiation between inflammatory and noninflamma-
tory joint disease.
The patients were identified by searching the medi-
cal records using the Current Procedural Terminology
codes and patient age at surgery. The health sciences
institutional review board (IRB) of Florida Interna-
tional University approved the present study (approval
CHOI ET AL
date, January 10, 2018; IRB protocol approval no.
IRB-18-0019).
PRIMARY PREDICTOR VARIABLE
The primary predictor variable was the time
measured at 1 month and 1 year postoperatively.
PRIMARY OUTCOME VARIABLE
The primary outcome variable was the change in
pain at the 1-year postoperative follow-up
examination.
SECONDARY OUTCOME VARIABLES
The secondary outcome variables were the change
in pain at 1 month, changes in perceived jaw dysfunc-
tion at 1 month and 1 year postoperatively, and
changes in the MIO at 1 month and 1 year post-
operatively.
PAIN, PERCEIVED JAW DYSFUNCTION, AND MIO
Pain and perceived jaw dysfunction were recorded
using a VAS. Both measurements were site-specific.
Pain was measured using a scale of 0 to 100 (0, no
pain; 100, worst pain). Perceived jaw dysfunction
was also measured using a scale of 0 to 100 (0,
normal jaw function; 100, complete jaw dysfunction)
according to the patient’s perceived ability or
inability to eat, chew, talk, yawn, and open their
mouth comfortably. The MIO was measured by
observing the jaw opening and measuring the dis-
tance between the incisal edges with a ruler in
millimeters.
FOLLOW-UP PROTOCOL
All patients were seen for follow-up examinations at
1 month and 1 year postoperatively. The clinical mea-
surements, subjective VAS score for pain, and
perceived jaw dysfunction were recorded by the se-
nior author (J.P.M.), who had also performed the initial
procedure.
STATISTICAL ANALYSIS
Data were collected in Excel, and data analysis was
performed using Excel (Microsoft, Redmond, WA)
and SPSS (IBM Corp, Armonk, NY). t Tests were per-
formed to determine the statistical significance, with
the P value set at .05. The changes in pain, perceived
jaw dysfunction, and MIO were compared with the
preoperative values using analysis of variance
(ANOVA), t tests, and Pearson’s correlation. One-
way ANOVA was used to compare the changes in
pain, jaw dysfunction, and MIO among the different
Wilkes classifications. Multiple linear regression anal-
ysis was used to compare the changes in pain, jaw
3
dysfunction, and MIO after adjusting for the other
preoperative variables. Statistical significance was
set at P < .05.
Results
A total of 23 patients (37 joints) with a mean age of
14.1 years (range, 12 to 16 years) had undergone TMJ
arthroscopic surgery with 1-month and 1-year postop-
erative follow-up data available. Of the 23 patients, 22
(96%) were girls. Of the 37 joints, 32 were classified as
noninflammatory internal derangement (Wilkes II,
n = 12; Wilkes III, n = 16; Wilkes IV, n = 4) and 5 as in-
flammatory.
In the overall group, the VAS score for pain showed
an average improvement of 26% in the short-term
(P < .0001) and 25% in the long-term (P < .0008).
The perceived jaw dysfunction also showed significant
improvements with an average improvement of 23.8%
in the short-term (P < .0001) and 19.2% in the long-
term (P < .0008). The average mouth opening had
improved by 5.4 mm in the short-term (P < .0016)
and 8.2 mm in the long-term (P < .0001).
Of the 16 joints with preoperative muscle pain, the
pain had resolved after 1 year in 10 joints (62%). Of the
13 joints with preoperative joint loading pain, the pain
had resolved after 1 year in 10 joints (77%). Of the 25
joints with joint noise, 14 (56%) had experienced res-
olution of joint noise. At 1 year postoperatively, the im-
provements in all the studied variables (ie, pain,
perceived jaw function, MIO, muscle pain, joint
loading, joint noise) showed statistically significant dif-
ferences (P < .05; Table 1).
When comparing the magnitude of the changes in
pain, perceived jaw dysfunction, and MIO with the
preoperative values, no association was found with
the level of involvement (unilateral vs bilateral),
gender, age at surgery, laterality (right vs left), or in-
flammatory status. However, the magnitude of pain re-
lief at 1 month and 1 year showed an association with
the amount of preoperative pain (P < .001) and
perceived jaw dysfunction preoperatively (P < .001).
The presence of preoperative muscle pain showed a
significant association with the magnitude of pain
reduction at 1 year (P = .03) and jaw function at
1 year (P = .03); Table 2).
After adjusting for covariates, the level of preopera-
tive pain was associated with the improvement in pain
in the short-term (P = .001) but not in the long-term.
The amount of preoperative jaw function was associ-
ated with significant pain relief in the long-term
(P = .018). Preoperative jaw function was associated
with improvements in function in the short-
(P < .001) and long- (P < .001) term. In contrast,
pain was only associated with the long-term outcomes
(Table 3).
4 TMJ ARTHROSCOPY FOR PEDIATRIC TMJ DISORDERS
Table 1. OVERALL OUTCOMES
Variable Mean Preoperative Value
VAS score for pain 42.2
Jaw dysfunction 41.6
MIO (mm) 33.5
Joint muscle pain 16
Joint loading pain 13
Joint noise 25
Abbreviations: MIO, maximum interincisal opening; VAS, visual analog scale.
* Statistically significant (P < .05, paired t test).
Choi et al. TMJ Arthroscopy for Pediatric TMJ Disorders. J Oral Maxillofac Surg 2019.
When controlling for Wilkes classification in the
noninflammatory disease group, we found a noted dif-
ference between Wilkes II and IV. Patients with Wilkes
III had the best outcomes with statistically significant
differences in pain reduction, improved function,
and improved MIO in the short- and long-term out-
comes (Table 4). Those found to have inflammatory
arthritis did not show any improvements of statistical
significance.
No complications were encountered with any of
the patients. Repeat arthroscopic procedures were
performed for 4 patients (6 joints). All 6 joints had
undergone initial lysis and lavage and subsequently
required definitive disc reconstruction. Three pa-
tients (4 joints) were diagnostically Wilkes II and 1
patient was diagnostically Wilkes III bilaterally. All
these patients performed well after their disc recon-
struction procedure.
Discussion
The purpose of the present study was to evaluate
the short- and long-term changes in pain for TMJ
arthroscopy in the pediatric population. These results
suggest it is a safe and effective procedure for reducing
pain in the short- and long- term. The perceived jaw
dysfunction had also improved in the short- and
long-term in the overall group.
Those patients with a diagnosis of an inflammatory
disease process performed poorly compared with
those with noninflammatory disease (Wilkes classifica-
tion II, III, or IV). Among those with noninflammatory
internal derangement, those with Wilkes III experi-
enced the best outcomes in the short- and long- term
for pain, function, and improvement in the MIO.
Those with Wilkes II did well from a functional aspect
in the short-term but not in the long-term. Three of
these patients had undergone initial lysis and lavage
but had ultimately required a repeat arthroscopic pro-
cedure for definitive disc repositioning.
Mean Postoperative Value
1 Month P Value 1 Year P Value
16.2 <.0001* 17.2 <.0001*
17.8 <.0001* 22.4 .0008*
38.9 <.0016* 41.7 <.0001*
11 .13 6 .0008*
1 .0002* 3 .0008*
6 <.0001* 11 .0001*
Current pediatric TMJ disorders are treated by med-
ical management, splint therapy, intra-articular steroid
injections, arthrocentesis, and arthroscopic and open
joint procedures. Surgical management should focus
on improving function, ameliorating pain and avoiding
any long-term sequelae and growth disturbances.
Intra-articular steroid injections can help decrease
inflammation of the synovium but have shown to be
associated with heterotopic bone formation.13 Arthro-
centesis can provide benefits by flushing inflammatory
mediators but can also miss the diagnosis and be less
effective for advanced degenerative joint disease.
Open joint procedures can lead to unwanted signifi-
cant growth disturbances. Arthroscopy offers an alter-
native to achieve many of these goals with potentially
less morbidity.
No complications were encountered in this popula-
tion; however, careful attention should be given
regarding the pediatric TMJ. Great care should be
taken to not cause unwanted iatrogenic injury of the
cartilage and articular disc, which can progress to
the state of osteoarthritis or halt the normal develop-
ment of the joint. As the patient grows, the puncture
technique will vary because the anatomic location of
the glenoid fossa and articular eminence will shift
with the patient’s age. The articular eminence grows
inferiorly and undergoes multiple vertical growth
phases at 1 to 6 months old, 5 to 6 years old, and 9
to 12 years old. This is believed to coincide with the
eruption of primary dentition, first permanent molar,
and second permanent molar. The distance from the
glenoid fossa to the external auditory canal will remain
minimally changed after the age of 2 years.14,15 The
initial puncture in the superolateral aspect of the
joint should be entered by locating the most concave
portion of the glenoid fossa, which should remain
unchanged after the age of 2 years. The second
puncture will be dictated by the most anterolateral
portion of the joint, which will shift inferiorly with
the eminence as the patient grows.
 CHOI ET AL
Table 2. SHORT- AND LONG-TERM OUTCOMES VERSUS TREATMENT GROUPS

Change in Pain Scores Change in Function Scores

Variable n At 1 mo P Value* At 1 yr P Value At 1 mo P Value At 1 yr P Value

Joints 37 25.9  4.2 NA 24.9  4.2 NA 23.8  4.3 NA 19.2  5.2 NA

Gender .61y .57y .25y .04y
Male 1 (2 joints) 35  2.1 1.5  1.5 4.5  2.5 2.5  2.5
Female 22 (35 joints) 25.4  4.3 25.4  4.3 22.6  4.4 21.7  5.1
Age (yr) .39z .19z .34z .12z
Mean  SD 14.1  1.2 0.046 0.15 0.07 0.20
Range 12.8-16.7
Laterality .33y .43y .89y .97y
Unilateral 9 33.8  8.9 31.3  1.2 25.0  11 18.8  16.3
Bilateral 28 23.8  4.8 23.1  4.3 23.4  4.7 19.3  5.2
Side .83y .87y .98y .72y
Right 19 26.8  6.5 24.2  5.4 23.7  6.1 17.4  7.0
Left 18 25.0  5.4 25.6  6.5 23.9  6.3 21.1  8.0
Disease type .58y .52y .59y .26y
Noninflammatory 32 26.9  4.4 25.9  4.2 25.0  4.8 21.6  5.9
Inflammatory arthritis 5 20.0  4.2 18.0  10.7 23.8  4.3 4.0  5.1
Preoperatively
Pain 0.786x <.001y 0.729x <.001y 0.556x < .001y 0.449x .003y
Perceived jaw dysfunction 0.634x <.001y 0.738x <.001y 0.771x < .001y 0.739x <.001y
MIO 0.101 .28z 0.041 .41 0.025 .44z 0.137 .21z
Muscle pain .10y .03y .32y .07y
Yes 16 33.8  4.0 35.0  6.5 28.8  6.5 30.0  7.1
No 21 20.0  6.5 17.1  4.9 20.0  5.8 11.0  7.0
Joint loading pain .17y .06y .24y .13y
Yes 13 33.8  5.8 35.4  6.1 30.8  6.8 30.0  8.6
No 24 21.7  5.5 19.2  5.2 20.0  5.5 13.3  6.4
Joint noise .88y .07y .07y .045y
jj
Yes 25 26.4  4.7 30.0  4.7 29.2  5.3 26.4  6.5
No 12 25.0  8.8 14.2  7.6 4.2  7.4 +7.8  2.7

Abbreviations: MIO, maximal interincisal opening; NA, not applicable; SD, standard deviation.
* Between groups.
y P value computed using analysis of variance.
z Pearson correlation computed using analysis of variance.
x Correlation significant at P = .01.
k Correlation significant at P = .05.
Choi et al. TMJ Arthroscopy for Pediatric TMJ Disorders. J Oral Maxillofac Surg 2019.

5
6 TMJ ARTHROSCOPY FOR PEDIATRIC TMJ DISORDERS

Table 3. SHORT- AND LONG-TERM OUTCOMES ADJUSTED FOR COVARIATES

Dependent Variable Source DF Mean Square F Value P Value

Pain at 1 mo
Preoperative pain 1 37.43 13.86 .001*
Preoperative jaw dysfunction 1 2.15 0.796 .380
Pain 1 yr
Preoperative pain 1 7.48 2.89 .101
Preoperative jaw dysfunction 1 16.53 6.38 .018*
Muscle pain 1 5.14 1.98 .17
Function 1 mo
Preoperative pain 1 2.2 0.76 .39
Preoperative jaw dysfunction 1 60.4 21.03 <.001*
Function 1 yr
Preoperative pain 1 27.68 10.07 .004*
Preoperative jaw dysfunction 1 130.29 47.42 <.001*
Preoperative muscle pain 1 4.95 1.8 .191
Gender 1 47.39 17.25 <.001*
MIO at 1 mo
Preoperative MIO 1466.1 60.28 <.001*
Preoperative jaw dysfunction 21.4 0.88 .35
MIO at 1 yr
Preoperative MIO 716.1 19.6 <.001*
Preoperative jaw dysfunction 32.06 0.877 .357
Preoperative muscle pain 0.29 0.008 .93
Abbreviations: DF, degrees of freedom; MIO, maximal interincisal opening.
* Correlation significant at P = .05.
Choi et al. TMJ Arthroscopy for Pediatric TMJ Disorders. J Oral Maxillofac Surg 2019.

The TMJ is especially susceptible to resorption in
the growing patient. In the fetal period, condylar chon-
drogenesis and endochondral ossification occur,
which lead to the initial formation of the mandibular
condyle. The condylar cartilage remains relatively
thin, because endochondral ossification occurs faster
than chondrogenesis.16 Ingervall et al17 investigated
22 cadavers using microradiography and reported
that complete cortication of the condyle did not occur
until age 20. Lei et al16 studied 1438 cone-beam
computed tomography scans of patients aged 10 to
30 years and reported subchondral cortical bone for-
mation began at adolescence (age 13 to 14 for boys
and age 12 to 13 for girls) and did not complete corti-
cation until 22 years of age for men and 21 years of age
for women. Potentially sustained or repetitive over-
loading of an immature condyle with a chronically dis-
placed disc can lead to adverse changes and
dysfunctional remodeling.16 Other factors such as sy-
novial hyperplasia, increased estrogen receptors, and
increased cytokines can also play a role in progressive
condylar resorption.18
Most patients did well with initial lysis and lavage;
however, several patients had required a secondary
definitive discopexy after the initial lysis and lavage.
Hall19 had initially speculated in 1995 that disc
displacement can contribute to condylar degeneration
and facial asymmetry. Recent studies have investigated
the role of the disc and demonstrated progressive ante-
rior displacement and shortening of the disc in
conjunction with shortening of the condylar height
in those with untreated disc displacement.20 In juve-
nile patients younger than 20 years old, anterior disc
displacement without reduction was associated with
decreases in condylar height, which was attributed
to either condylar resorption or halted condylar
growth.21 In juvenile unilateral anterior disc displace-
ment (age younger than 20 years), Xie et al22 reported
significant differences in the ipsilateral condylar
height and progressive mandibular asymmetry during
a 12-month follow-up period. Thus, the finding that
disc displacement can lead to condylar resorption ap-
pears well supported; however, it remains to be deter-
mined whether disc repositioning surgery can prevent
progressive resorption of the condyle.
In our small sample size, the outcomes for the pe-
diatric patients with a diagnosis of inflammatory joint
disease were not as good as those for the patients
with noninflammatory disease. However, value still
exists in obtaining an early diagnosis, which could
lead to a subsequent referral to rheumatology. The
future advantages of arthroscopy could include target
CHOI ET AL 7

specific delivery of medication and obtaining histo-

Value

.187
P
pathologic findings to determine whether systemic
medications should play a role in managing the dis-

5.8  2.3

+10.7  1.8

+11.8  6.9
ease process.
MIO at The limitations of the present study included its
1 yr

(<.001)
retrospective nature, small sample size, and lack of a

(.03)

(.18)
control group. Without a control group, the potential
exists that this patient population could have shown
Value

improvement with continued medical management.

.492
P

Future studies should compare the outcomes of ar-

throcentesis, arthroscopy, and continued medical
+4.2  2.6

+8.1  2.6

+2.5  6.8 management to assess for any differences in the thera-

MIO at
1 mo

(.008)

peutic outcomes. With longer term data, future studies

(.12)

(.73)
should also assess whether any negative or positive
sequelae result from arthroscopy when assessing
Value

normal craniofacial growth and progressive osteoar-

.218
P

thritis in the TMJ.

In conclusion, the results from the present study
45.0  5.0 (.003)
12.5  11.4 (.29)

22.5  7.6 (.01)

have shown that pediatric TMJ arthroscopy could be

Function at

a safe and effective method for managing pain and

jaw dysfunction in TMJ disorders of the pediatric
1 yr

population.
Table 4. PAIN AND JAW DYSFUNCTION OUTCOMES STRATIFIED BY WILKES CLASSIFICATION

References
Value

.726
P

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