Discectomy is the oldest and most commonly performed operation for the painful temporomandibular joint with internal derangement. It is the one operation for which there are the longest follow-up study, with Eriksson, Silver, and Tolvanen et al reporting good results in patients about 30 years after discectomy. About 80 % to 90 % of patients clinically experience relief from pain and dysfunction after discectomy, and interestingly, the results may improve with time. However such as Myrhaug found headache and Poswillo supposed pain and limitation of movement as postoperative complications, even though this operation had the longest follow-up term, several aspects of discectomy remain unclear. The controversies to discectomy for TMJ with pain and dysfunction have laid emphasis only upon clinical results, and then the histomorphological study was planned to evaluate the morphologic change of TMJ after discectomy.
To clarify the nature of the change through an observation on the morphologic changes of articular cartilage and subchondral bone of the condyle resulting from experimental unilateral discectomy in rabbit, the author excised the left articular discs of 12 male rabbits(control 4 rabbits), weighing about 3kg, and at 1, 3, 6, 9 weeks following surgery, harvested both(left surgical site and right nonsurgical site) TMJ. The specimens were examined with light microscope after H-E and MT stain and the obtained results were as follows.
1. Histopathological features showed thickening of articular zone and active proliferation of fibrocartilaginous zone associated with slight proliferative zone in surgical site than control group. Also replacement of chondrocytes in calcified cartilaginous zone into bone cells was observed.
2. There were thinning of thickness of each zone of articular cartilage except calcified cartilaginous zone was observed in nonsurgical site.
3. In MT stain of condylar trabeculae, there was increased calcification in nonsurgical site than control and surgical site and the degree of calcification was similar in surgical site and control group.
4. In both site of experimental group no features of degenerative changes were observed.
From the above results, it is presumed that the morphologic changes of surgical site discectomy are compensatory remodeling process characterized by an hyperplastic reaction of the articular zone and fibrocartilaginous zone to filling the void created by removing the disc, and the bone changes are secondary to changes in the cartilage. Increased degree of calcification seen in condylar trabeculae of nonsurgical site results from the excessive use of condyle of that site.
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