Dermal Grafts in TMJ Discectomy: Clinical Outcomes and Limitations

The use of dermal interpositional grafts following temporomandibular joint (TMJ) discectomy has been proposed as a method to improve joint function, reduce pain, and prevent degenerative changes after disc removal. However, current clinical evidence suggests that dermal graft placement offers limited advantages over discectomy alone.

Understanding the true benefits and limitations of dermal grafting is essential when selecting appropriate surgical management for patients with advanced internal derangement of the TMJ.

Effect of Dermal Grafts on Joint Structure

One of the theoretical goals of dermal graft placement after discectomy is to act as a disc substitute. In practice, however, dermal grafts do not remodel into a biconcave structure similar to the native articular disc. As a result, they fail to restore normal load distribution within the joint.

Additionally, dermal grafts do not prevent progressive condylar erosion following disc removal. Regressive condylar remodeling has been observed at similar rates in patients treated with discectomy alone and those treated with discectomy plus dermal grafting.

Intraarticular Adhesion Formation

Another proposed benefit of interpositional grafting is prevention of intraarticular adhesions. Clinical studies have not demonstrated a protective effect of dermal grafts in this regard. Adhesion formation remains a potential complication following discectomy, regardless of whether dermal tissue is interposed.

Impact on Pain and Function

Evidence indicates that dermal grafting does not significantly improve pain outcomes when compared with discectomy alone. Similarly, range of mandibular motion shows no clinically meaningful difference between the two approaches.

These findings suggest that dermal graft placement does not alter the underlying biomechanical or inflammatory processes responsible for pain and functional limitation in advanced TMJ disease.

Effect on Joint Sounds

The most consistent benefit associated with dermal interpositional grafting appears to be a reduction in postoperative joint noise. In one clinical series, 33 of 35 operated joints demonstrated no clinical evidence of joint sounds, including crepitus, at an average follow-up of two years after discectomy with dermal graft placement.

While this reduction in joint noise may improve patient perception of surgical success, it has not been correlated with improved pain relief, function, or joint preservation.

Clinical Implications

Current evidence supports the conclusion that dermal graft placement following TMJ discectomy does not provide superior outcomes with respect to pain relief, mandibular range of motion, prevention of condylar remodeling, or adhesion formation. Its primary benefit appears limited to a reduction in audible joint sounds.

Given the additional surgical time and donor site morbidity associated with dermal graft harvest, its routine use following discectomy should be carefully considered and individualized based on patient-specific goals.

Board and Exam Pearls

• Dermal grafts do not assume a biconcave disc shape

• Dermal grafting does not prevent condylar erosion

• No improvement in pain or range of motion compared to discectomy alone

• Joint sounds may decrease, but functional outcomes are unchanged

• Dermal grafts do not prevent intraarticular adhesions

Conclusion

While dermal interpositional grafts may reduce postoperative joint noise following TMJ discectomy, available evidence does not support their routine use for improving pain, function, or joint preservation. Discectomy alone remains an effective surgical option for appropriately selected patients with advanced internal derangement.