Abstract
The aim of this study was to determine the rate of persistent pain following total
TMJ replacement and to identify potential predictive risk factors. A retrospective
review of case notes treated by a single surgeon in a tertiary unit was performed.
For each patient a number of variables were recorded including visual analogue pain
scores (0 to 10) and opioid usage pre surgery and at 12 months or last follow up beyond
12 months. Persistent pain scores of 5 to 7 were regarded as moderate and 8 to 10
as severe. The mean pain score at last follow-up was significantly lower than preoperatively
(2.1 vs. 6.3, p < 0.001) with a mean follow-up time of 40.1 months (range 12–44).
16.4% of the patients reported moderate to severe pain and 13.7% were still on regular
opioids at the last follow-up. Therefore 15 patients (20.5%) suffered from chronic
postoperative pain after TMJ replacement surgery. Patients reporting severe preoperative
pain scores (p = 0.04), regular opioid use (p = 0.001) or multiple previous open TMJ
surgeries (p = 0.03) were more likely to suffer from chronic persistent pain and these
should be regarded as predictive risk factors. The identification of these factors
allows for better risk stratification of patients, informed consent and the agreement
of expected outcomes. Patients with true articular disease and a single failed surgery
should be considered for early total TMJ replacement to minimise multifactorial persistent
pain.
Keywords
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Article Info
Publication History
Published online: November 22, 2021
Accepted:
November 16,
2021
Identification
Copyright
© 2021 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
