Temporomandibular Joint (TMJ) Disorders Following Anterior Temporal Lobectomy in Patients with Medically Intractable Temporal Lobe Epilepsy: A Retrospective Study

Objective: Patients with medically intractable temporal lobe epilepsy who had temporal lobectomy surgery (TLS) have reported postoperative TMJ related discomfort. The literature does not include these as typical 'complications', hence, the purpose of this pilot study was to determine if TMJ related pain/discomfort after surgery has increased in TLS patients. Method: A 21-item questionnaire with an open-ended comment section (TMJQ) was mailed to 201 patients who had TLS (between 1997-2001) at the Cleveland Clinic Foundation. The TMJQ included items recommended by the American Academy of Orofacial pain for TMD screening. Patients responded using a Likert-like scale (0 none- 3 severe)regarding specific problems: prior to surgery (PreA), 1-month post-op (PostB), and presently- at least 1 year after surgery (PostC). Responses to the 21 items were combined to produce summary scores for all pre-surgical(PreASum) and both sets of post-surgical items (PostBSum and PostCSum). Results: Fourty-two patients (22 males, 20 females) responded. Their average age at the time of surgery was 38.3±11.1 years. Paired t-test analyses indicated that there was a significant (p<0.05) increase in TMJ related problems between PreASum (5.1±5.9) and the post-surgical scores (PostBSum: 13.0±13.2; PostCSum: 9.0±12.0). The 1 year postop scores were significantly lower than the 1 month postop scores. There was no difference in postop pain between gender. The questionnaire item that were significantly related to TMJ problems were those associated with opening/closing and chewing. Conclusion: This pilot study found that temporal lobectomy surgery patients had TMJ related problems 1 month posteoperative, and the problems persisted 1 year after surgery. Further prospective studies are needed to further define the scope of this problem.