Vertiginous crisis following temporomandibular joint athrocentesis: a case report

Progress in the Study of Temporomandibular Joint Lavage in Temporomandibular Joint Disorder

With the continuous development and progress of medicine, there are many methods for the treatment of temporomandibular disorders, among which temporomandibular joint lavage is also constantly developed. In the past century, through the efforts of some scholars and clinical summary, the understanding of this disease has been deepened and broadened. At present, through continuous exploration of the treatment methods, the lavage is relatively mature, and has achieved good clinical results. In this paper, the application of temporomandibular joint lavage in the treatment of temporomandibular joint disorders, its treatment methods, treatment mechanism, the auxiliary of other drugs, indications, complications and so on were discussed.

Temporomandibular Joint Disorders: Functional and Conservative Treatment

Temporomandibular joint disorders (TMDs) represent a group of conditions that cause pain and dysfunction in the joints and muscles responsible for jaw movement [...].

Oral splint therapy in patients with Menière's disease and temporomandibular disorder: a long-term, controlled study

PURPOSE

To assess the effect of oral splint therapy on audio-vestibular symptoms in patients with Menière's disease (MD) and temporomandibular disorder (TMD).

METHODS

Retrospective case-control study. Treatment group: 37 patients with MD and TMD who received gnatological treatment.

CONTROL GROUP

26 patients with MD and TMD who had never received gnatological treatment. The number of vertigo spells in 6 months (primary endpoint), pure-tone audiometry average (PTA), MD stage, functional level, Dizziness handicap Index (DHI), Tinnitus handicap Index (THI) and Aural Fullness Scale (AFS) were compared at baseline and after 24 months according to groups. Analysis of Covariance was used to determine the treatment effect.

RESULTS

Groups were comparable for demographic, clinical data, baseline PTAs and the number of vertigo spells. Analysis of covariance showed a significant effect of gnathological treatment on number of vertigo spells ([Formula: see text] = 0.258, p < 0.001), PTA ([Formula: see text] = 0.201, p < 0.001), MD stage ([Formula: see text] = 0.224, p < 0.001), functional level ([Formula: see text] = 0.424, p < 0.001), DHI ([Formula: see text] = 0.421, p < 0.001), THI ([Formula: see text] = 0.183, p < 0.001), but not for AFS ([Formula: see text] = 0.005, p = 0.582). The treatment group showed vertigo control of class A in 86.5% and class B in 13.5% of patients. In the control group, vertigo control was of class A in 19.2% of patients and class B in 11.5%, class C in 30.8%, class D in 11.5%, class E in 19.2% and class F in 7.7%. Classes of vertigo control differed significantly (X² test, p < 0.001).

CONCLUSIONS

Oral splint therapy could represent a viable treatment in patients with TMD and uncontrolled MD disease. The effects are maintained at least after 2 years.

Are YouTube Videos a Useful and Reliable Source of Information for Patients with Temporomandibular Joint Disorders?

Counseling is considered a first-line conservative therapy with respect to temporomandibular joint disorders (TMJD). Nowadays, 50 to 80% of patients acquire health information from the internet before turning to professionals. The purpose of this study has been to investigate the quality of information about TMJD that patients can obtain from YouTube. A YouTube.com search was conducted using the terms "temporomandibular joint disorder"; "limited movement of the mandible"; and "mandibular joint pain". The videos identified were assessed independently by two panels of three professional and lay reviewers with HONcode, modified DISCERN (MD) and the global quality scale (GQS). A total of 106 videos were included. The professional reviewers reported a mean HONcode score of 4.148 ± 1.314 and a mean MD score of 2.519 ± 1.267, testifying to a modest general quality of the videos. The mean GQS score was 2.987 ± 1.012 for the professional and 3.469 ± 0.891 for the lay reviewers (p < 0.001). The correlations between the ratings were significant between the reviewers within the same group but not between the two groups. The presence of animations significantly influenced the GQS score expressed by the lay reviewers (p = 0.011) but not that of the professionals (p = 0.640). The quality of the information on TMJD on YouTube is generally of poor quality. Healthcare systems and professionals should be prepared to correct misinformation and build trusting relationships with patients which are based on quality counseling. Similarly, academic institutions should produce quality content that leads patients with TMJD toward a correct diagnostic-therapeutic process.

Does arthroscopy cause more complications than arthrocentesis in patients with internal temporomandibular joint disorders? Systematic review and meta-analysis

The objective of this study was to compare, through a systematic review with a meta-analysis, the relative risks of arthroscopy and arthrocentesis in the temporomandibular joint. MEDLINE/PUBMED, EMBASE, Cochrane Library (CENTRAL), Web of Science, SCOPUS were the researched databases, as well as grey literature and manual searches. The search results showed 656 studies, but only five met the eligibility criteria. The evaluation included 194 joints (104 patients): 101 were arthroscopy and 93 arthrocentesis. Complications were observed in four patients undergoing arthroscopy (two with temporary facial paralysis and two with prolonged cervical oedema) and in three patients undergoing arthrocentesis (two with severe bradycardia and one with prolonged cervical oedema). The meta-analysis demonstrated a relative risk of 0.99 for complications after arthroscopy compared with arthrocentesis, but the results showed no statistical differences. In conclusion, this systematic review suggests that there is no increased risk of complications with arthroscopy than arthrocentesis. When complications were present, they were temporary.

Complications of temporomandibular joint arthrocentesis

Arthrocentesis is a frequently performed and accepted minimally invasive and predictable procedure in the treatment of temporomandibular joint disorders. This review aimed to evaluate arthrocentesis complications. The literature search has included PubMed, Google Scholar, and EMBASE databases by using terms "((TMJ OR TEMPOROMANDIBULAR JOINT OR TMD OR TEMPOROMANDIBULAR DISORDER) AND ARTHROCENTESIS) AND COMPLICATION". Publications up to 2019 were examined. Seven studies involving arthrocentesis complications were included. Although arthrocentesis is considered as a cost-effective and safe procedure, complications may be seen due to its proximity to important anatomical structures. Most of these complications are short-lived and can easily be managed in the outpatient clinic; however, some severe complications have rarely been reported in the literature. The practitioners who perform this procedure should be aware of these possible complications and be able to manage them in the clinic.

Success Rate in Puncture of the Temporomandibular Joint

Puncture of the temporomandibular joint (TMJ) is a minimally invasive treatment for various jaw disorders. This study used a cadaveric model to evaluate the procedure from two entrance points with respect to hit ratio and possible complications, such as extraarticular extrusion of injection fluid. Ten heads, embalmed with Thiel's method, were investigated. A straight line drawn with a colored pen connected the center of the tragus and the lateral canthus. The first portal "A" was located at a distance of 1 cm anterior and 2 mm caudal from the center of the tragus. Portal "B" was located 2 cm anterior and 1 cm caudal starting from the same reference point. Punctures "A" and "B" were performed alternately on the right and left sides. Specimens were dissected and the local distribution of the injected latex was recorded. With Approach A, four punctures (40%; 4/10) reached the TMJ, whereas with Approach B, six injections (60%; 6/10) entered the TMJ. There were no statistically significant differences between the tested puncture methods (P = 0.0317) and body sides (P = 1). With each method, for example, 35% (7/20) each, the injected latex was either periarticular or retromandibular. In a further 20% (4/20), it was located subperiosteally alongside the ramus of mandible. The latex was injected into the infratemporal fossa and the external acoustic meatus in one case each (each 5%). There was no statistically significant difference between the techniques. The adjacent anatomy has to be kept in mind during TMJ puncture as the complication rate was remarkably high, suggesting that ultrasound guided intraarticular injection could improve the hit rate. Clin. Anat., 33:683-688, 2020. © 2019 Wiley Periodicals, Inc.

An unusual complication during arthrocentesis: N. facialis paralysis, with N. lingualis and N. alveolaris inferior anesthesia

This case report aims to review complications that can occur during arthrocentesis and report an unusual complication observed in a 55-year-old man. The patient received arthrocentesis in an attempt to treat painful locking episodes of his right temporomandibular joint (TMJ). One hour after the operation, the patient experienced temporary facial paralysis in the area of the facial nerve and anesthesia of the lingual and alveolar inferior nerves. No persistent complications were detected during the postoperative follow-up. We suspected this complication occurred after anesthetic solution overflowed from a traumatic perforation in the joint capsule to the infratemporal area during the operation. To our knowledge, this complication has not been previously reported in the literature.

Clinical and intra-operative factors affecting the outcome of arthrocentesis in disc displacement without reduction: A retrospective study

BACKGROUND

Temporomandibular disorder (TMD) is a group of disease which affects the temporomandibular joint (TMJ) and supporting tissues of the musculoskeletal structures. Arthrocentesis is an effective treatment modality for TMD, especially in patients who suffer from pain and limited mouth opening.

OBJECTIVE

The aim of this study was to investigate the effects of pre-operative and intra-operative variables on the clinical outcome of arthrocentesis therapy.

METHODS

The records of 83 patients diagnosed as disc displacement (DD) without reduction according to DC/TMD, and treated with arthrocentesis were selected. Sex, age, bruxism history, pain intensity and maximum mouth opening (MMO) were recorded as pre-operative variables. Extravasation and the amount of irrigation were recorded as intra-operative variables. The success of the arthrocentesis procedure was determined as MMO <35 mm and pain intensity lower than 3, at third-month follow-up.

RESULTS

At 3-month follow-up, clinical evaluation showed a significant reduction in TMJ pain and an increase in MMO (P < 0.05). It was found that patients with an unsuccessful outcome are those who had a more restricted MMO and severe pain before the procedure. Extravasation was found to be a significant factor that affects the success of the procedure.

CONCLUSION

The success of arthrocentesis in TMJ DD without reduction is adversely affected by the severity of the pre-operative clinical symptoms. Extravasation is also a factor that has a negative effect on the success of the procedure.

Investigation of the effects of temporomandibular joint arthrocentesis on blood volume of the retinal structures

Objective

Arthrocentesis is a minimally invasive surgical procedure that is used to alleviate the symptoms of temporomandibular joint (TMJ) disorders. The aim of this study was to investigate the effect of arthrocentesis on the blood supply to the retinal structures.

Materials and Methods

Arthrocentesis was performed on 20 patients with TMJ disorders, and choroidal thickness (CT) in patients was measured to evaluate retinal blood circulation. The blood volume of the retinal structures was evaluated ipsilaterally before and after arthrocentesis, and these measurements were then compared with measurements obtained from the contralateral side.

Results

Before arthrocentesis, there were no differences in retinal blood volumes between the ipsilateral and contralateral sides (P = 0.96). When ipsilateral CT measurements taken before and after arthrocentesis were compared, retinal blood supply was found to have significantly decreased after arthrocentesis (P = 0.04). When contralateral CT measurements taken before and after arthrocentesis were compared, retinal blood supply was also found to have decreased after arthrocentesis, but not significantly (P = 0.19).

Conclusion

The solution of local anesthesia with epinephrine applied before the arthrocentesis procedure was found to reduce the blood volume of the retinal structures. To the best of our knowledge, this is the first study that has investigated the blood volume of the retinal structures following arthrocentesis.

Arthrocentesis of Temporomandibular Joint- Bridging the Gap Between Non-Surgical and Surgical Treatment

The temporomandibular joint forms one of the most fascinating and complex synovial joints in the body. Movements of the temporomandibular joint are regulated by an intricate neurological controlling mechanism, which is essential for the system to function normally and efficiently. Lack of such harmony may cause disruptive muscle behavior or structural damage to any of the components. The management of refractory pain and dysfunctions in the temporomandibular joint poses challenge both to the oral physician and maxillofacial surgeon. Arthrocentesis is a simple, minimally invasive technique that can be used instead of more invasive procedures in patients with pain that fails to respond to conventional conservative measures. This review provides a full comprehensive overview of the literature about the various technical and prognostic aspects in relation to arthrocentesis of the temporomandibular joint, and every clinician must take into account this consideration when performing this procedure in treating patients with temporomandibular disorders.

An Investigation of the Morphology of the Petrotympanic Fissure Using Cone-Beam Computed Tomography

Objectives

The purpose of the present study was: a) to examine the visibility and morphology of the petrotympanic fissure on cone-beam computed tomography images, and b) to investigate whether the petrotympanic fissure morphology is significantly affected by gender and age, or not.

Material and Methods

Using Newtom VGi (QR Verona, Italy), 106 cone-beam computed tomography examinations (212 temporomandibular joint areas) of both genders were retrospectively and randomly selected. Two observers examined the images and subsequently classified by consensus the petrotympanic fissure morphology into the following three types: type 1 - widely open; type 2 - narrow middle; type 3 - very narrow/closed.

Results

The petrotympanic fissure morphology was assessed as type 1, type 2, and type 3 in 85 (40.1%), 72 (34.0%), and 55 (25.9%) cases, respectively. No significant difference was found between left and right petrotympanic fissure morphology (Kappa = 0.37; P < 0.001). Furthermore, no significant difference was found between genders, specifically P = 0.264 and P = 0.211 for the right and left petrotympanic fissure morphology, respectively. However, the ordinal logistic regression analysis showed that males tend to have narrower petrotympanic fissures, in particular OR = 1.58 for right and OR = 1.5 for left petrotympanic fissure.

Conclusions

The current study lends support to the conclusion that an enhanced multi-planar cone-beam computed tomography yields a clear depiction of the petrotympanic fissure's morphological characteristics. We have found that the morphology is neither gender nor age-related.

Complications and post-operative sequelae of temporomandibular joint arthrocentesis

OBJECTIVE

 To evaluate intraoperative complications and postsurgical sequelae associated with arthrocentesis of the TMJ, including injection of Sodium Hyaluronate.

METHODS

This retrospective study evaluated 433 arthrocentesis procedures performed in 315 patients between January 2009 and August 2016. The authors reviewed the complications identified during the procedure and the follow-up period.

RESULTS

Temporary swelling of the periarticular tissues (95.1%) or the external auditory canal (23.5%), ipsilateral temporary open bite (68.8%), frontalis and orbicularis oculis paresis (65.1%), preauricular hematoma (0.4%), and a case of vertigo (0.2%) were the complications detected.

CONCLUSIONS

TMJ arthrocentesis remains a procedure with a minimum number of important complications. If present, complications are generally temporary, caused by the anesthetic effect or by the soft tissue edema created by the fluid extravasation created by the irrigation procedure, and can be managed on an outpatient basis.