I would like to comment about an article by Henderson et al1 that appeared in the November 1992 issue of the Archives. The authors explained that they had 12 subjects in whom "internal derangement" (ID) of the joint was diagnosed and nine subjects for whom the diagnosis was myofascial pain disorder. They explained that those subjects with ID who were "unresponsive to nonsurgical therapy" underwent arthroscopic temporomandibular joint surgery.
All 12 patients with ID underwent surgery. It appears that a clearer statement would be to say that all those subjects with ID had surgery because none benefited from nonsurgical treatment.
I am surprised that they were able to achieve 100% diagnostic accuracy in evaluation of these difficult patients. It appears that nonsurgical treatment for patients with ID is completely useless.
The authors should, on the other hand, be complimented on their effort to quantitate these vague symptoms.
Hilding DA. Otologic Complaints. Arch Otolaryngol Head Neck Surg. 1994;120(6):675. doi:10.1001/archotol.1994.01880300089018
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