Arthrocentesis in TMJ Internal Derangement: A Prospective Study

Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy

BACKGROUND

The management of internal derangement (ID) of the TMJ is challenging because of multiple etiologic factors and varying degrees of severity. The aim of this study was to evaluate the clinical outcomes of patients with unilateral ID treated with arthrocentesis and stabilization splint therapy during a 6-month period.

METHODS

A total of 105 patients (87 females, 18 males) with unilateral ID were included in this study. Patients were divided into unilateral anterior disc displacement with reduction (ADDwR) and unilateral anterior disc displacement without reduction (ADDwoR). Patients with ADDwoR were subdivided according to the erosive bone changes. Objective parameters on mandibular movement and subjective parameters on pain were obtained and assessed. Their clinical outcomes before and after arthrocentesis and stabilization splint therapy were compared with the chi-square, Fisher's exact test, paired t-test, or Wilcoxon singed-rank test.

RESULTS

All objective parameters of unilateral ID patients significantly increased at the 6-month follow-up. The differences in mean visual analog scale (VAS) pain scores were statistically significant in all subjective variables (p < 0.01). In joints with ADDwoR, preoperative maximal mouth opening, and maximal protrusive movement in both groups, with erosive and non-erosive changes were significantly increased after 6 months (p < 0.01). However, right and left maximal lateral movement increased after treatment in both groups but without significant differences. All VAS pain scores on jaw movement and palpation of associated muscles showed a significant decrease regardless of erosive changes.

CONCLUSIONS

The combination of arthrocentesis and subsequent stabilization splint therapy was shown to be highly effective in pain reduction and improvement of mandibular movements in both unilateral ADDwR and ADDwoR, as well as in cases with both erosive and non-erosive bony changes associated with unilateral ADDwoR.

Clinical Evaluation of Intra-Articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in the Management of Degenerative Osteoarthritis of Temporomandibular Joint

AIM: This study aims to evaluate the effectiveness of intra-articular injection of chondroitin sulfate and sodium hyaluronate in cases of temporomandibular joint (TMJ) degenerative osteoarthritis. MATERIAL AND METHODS: Thirty patients ASA I of both sexes, who were selected from outpatient clinic of Oral Surgery Department, Faculty of Dentistry – Suez Canal University, complaining of painful TMJ, presence of unilateral or bilateral TMJ pain, impairment of jaw movements, and joint sounds. Clinical examination was performed to all patients and pre-operative measurements of visual analog scale (VAS) for morning pain, pain with movement and spontaneous pain, maximum mouth opening, and presence or absence of clicking. Patients were randomly divided into two groups; (a) Study group consisted of 15 patients, they had intra-articular injection of chondroitin sulfate and sodium hyaluronate once weekly for 3 weeks and (b) control group consisted of 15 patients, they had intra-articular injection of sodium hyaluronate once weekly for 3 weeks. Post-operative measurements of VAS for previous pain types, maximum mouth opening, and clicking were obtained at 1 month, 3 months, and 6 months post-injection. RESULTS: There was a statistically significant reduction of all types of pain in the study group compared to the control group at all time intervals (p ≤ 0.05), for maximum mouth opening, there was a significant improvement in mouth opening in the study group for all time intervals (p ≤ 0.05), but for the clicking, there was not statistically significant difference between the study and control groups after 1 month, 3 months, and 6 months. The difference between groups was barely statistically significant (p = 0.05). CONCLUSION: Intra-articular injection of a combination of chondroitin sulfate and sodium hyaluronate is an effective tool in reducing pain, clicking, limited mouth opening, and other symptoms associated with degenerative TMJ diseases.

Clinical outcomes in TMD patients after arthrocentesis with lysis, lavage and viscossuplementation

Introduction

Temporomandibular disorders (TMD) affect a considerable part of the population [1]. Its most prominent symptoms are restricted joint function with limited maximum mouth opening (MMO), pain and headache, with an important impact on Quality of Life [2,3]. The aim of this study is to evaluate the effect of Arthrocentesis with Lysis, Lavage and Viscosupplementation (ALLV) with hyaluronic acid in the treatment of pain related to TMJ internal derangements.

Materials and methods

Thirty patients diagnosed with internal derangement of the temporomandibular joint through magnetic resonance imaging were submitted to ALLV, after 6 months of ineffective conservative treatment. A classic, single session, two-needle technique arthrocentesis was performed in all cases, encompassing the injection of 200–300 mL of Ringer lactate solution to the superior joint compartment for lysis and lavage, followed by intra-articular injection of 1 mL of hyaluronic acid for viscossuplementation [4,5]. Patients were prescribed a simple program of physical exercises to be repeated daily at home for one month. Evaluation was carried pre-operatively on the day of surgery and post-operatively at 1 week, 1 month, 3 months, 6 months and 12 months after the procedure. Evaluated clinical parameters included: pain (at rest and in function) – Visual Analogic Scale (VAS); maximum mouth opening (MMO) – millimetres (mm); mastication efficiency – VAS. Overall tolerability of the procedure (Likert scale: 0–4) was evaluated at 1-week post-operative time. Data was collected between September 2016 and May 2019. Statistical significance was set at p < .05. Paired t-tests were used to compare pre- and post-operative pain, MMO and mastication efficiency. Statistical procedures were performed using IBM® SPSS® Statistics – Version 24 and Microsoft® Excel for Mac – Version 16.15.

Results

Twenty-six of the selected patients were women and mean age was 38.86 ± 17.5 years old. In all cases a single side TMJ was treated − 14 left and 16 right. MRI had shown anterior disc displacement (ADD) with complete reduction on opening in 15 patients, without reduction in 9 and with partial reduction in 6. Results show an improvement in pain, both at rest and in function, MMO and mastication efficiency at a statistically significant level, up to 12 months post-operative. The procedure was considered well tolerated (mean Likert: 3.15 ± 1.13) and no adverse events were reported. Discussion and conclusions: ALLV is a safe, well tolerated and cost-effective minimally invasive procedure, which proves to reduce pain and functional impairment up to 12 months post-operative, with little or no complications [6,7].

Arthrocentesis versus glucocorticosteroid injection for internal derangement of temporomandibular joint

BACKGROUND

It is necessary to clarify that temporomandibular joint disorders (TMDs) are one of the most misdiagnosed and mistreated maladies in the medical practice. It is an umbrella term, embracing conditions which involve the temporomandibular joint (TMJ) and related muscles. One of these common irritating disorders is the internal derangement which is used specifically to describe the displacement of the TMJ disc. The treatment can vary according to the severity and chronicity into non-invasive, minimally invasive, and invasive procedures. However, permanent recovery is rarely obtained.

AIM OF THE STUDY

This study was established to compare the effectiveness of two minimally invasive procedures: arthrocentesis and glucocorticosteroid (GCS) local single joint injection in the management of internal derangement of the TMJ.

METHODS

Thirty patients aged from 18 to 42 years were included in this study with internal derangement which was confirmed clinically and with a cone beam CT scan. The patients were divided into two groups of 15 patients. Arthrocentesis was performed to one group (group A) by using Shepard's cannula and lactated Ringer's solution. Glucocorticosteroid injection was done to the other group (group B) using a 1 ml/40 mg methylprednisolone acetate vial. The study was performed in the Department of Oral and Maxillofacial Surgery, Ghazi Alhareery Hospital-Medical City, from October 2017 to September 2018.

RESULTS AND CONCLUSION

After 4 months of clinical follow-up, the results revealed that the GCS injection has minimal outcomes in the treatment of TMJ internal derangement compared to arthrocentesis. On the other hand, arthrocentesis and lavage had dedicated promising outcomes.

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.

Comparison of efficacy of sodium hyaluronate and normal saline arthrocentesis in the management of internal derangement of temporomandibular joints - A prospective study

Purpose:

The aim of the present study was to evaluate the efficacy of arthrocentesis with and without sodium hyaluronate (SH) injection in the treatment of patients with temporomandibular joint (TMJ) internal derangement.

Materials and Methods:

The study consisted of 20 patients with chief complaints of limited mouth opening, TMJ pain, and jaw deviation. Patients with disc displacement with reduction and closed lock were randomly divided into two groups. In Group 1, only arthrocentesis was performed, and in Group 2, arthrocentesis plus intra-articular injection of SH was performed. Arthrocentesis was performed under aseptic conditions using normal saline. Clinical evaluation was done for maximum mouth opening (MMO), TMJ pain, and jaw deviation before the procedure and 1 week, 2 weeks, 1 month, and 3 months following arthrocentesis.

Results:

The mean visual analog scale (VAS) score change was statistically significant in Group 1 and Group 2 for within the group analysis. There was statistically significant difference in VAS score between Group 1 and Group 2 at all time intervals postoperatively. The increase in MMO from preoperative to 3 months postoperatively was statistically significant for within the group analysis. There was a reduction in mandibular deviation in both Group 1 and Group 2, but the difference was not statistically significant. There was no statistically significant difference in deviation between the two groups.

Conclusion:

Arthrocentesis with SH is superior to arthrocentesis alone in treating patients suffering with TMJ internal derangement, who are refractory to conservative treatment.

Temporomandibular Joint Arthrocentesis: A Prospective Study and Audit of 500 Joints of Central India

Aim and Objectives:

Aim of this study was to compare prospective effectiveness of arthrocentesis of temporomandibular joint by single- and double-needle technique in central India population.

Materials and Methods:

Out of 230 patients, 500 joints were included in the study and were randomly selected into two groups: single needle and double needle. Follow-up of patients were done as 1 week, 1 and 3 months. (The statistical analysis was done using SPSS [Statistical Package for Social Sciences] Version 15.0 Statistical Analysis Software).

Results:

Both techniques were equally effective at reducing pain and increasing the maximal mouth opening. The single-needle technique was easier to perform and required a shorter operative time (P < 0.01).

Conclusion:

The results obtained indicate that single versus double arthrocentesis techniques were equally effective in reducing the pain and increasing the mouth opening and reducing the clicking sound. However, single-needle technique was easier to perform and required a shorter operative time.

Diagnostic imaging modalities and surgical anatomy of the temporomandibular joint in rabbits

The temporomandibular joint (TMJ) is a condylar synovial joint that, together with the masticatory muscles, controls mandibular movement during mastication. The rabbit is often used as a model species for studying the mechanisms of TMJ diseases, and in regenerative research. However, there are significant differences between rabbit and human TMJs that should be taken into account before using this model for experimental research. Here, we use several analytical approaches (radiography, computed tomography and magnetic resonance imaging) to enable a detailed description and analysis of the rabbit TMJ morphology. Moreover, possible surgical approaches have been introduced with a focus on available access into the rabbit TMJ cavity, which relate our findings to clinical usage.

Comparison of local and general anaesthesia for arthrocentesis of the temporomandibular joint

Arthrocentesis of the temporomandibular joint is an effective treatment for some disorders, and is usually done under local anaesthesia. We know of few studies that have compared the ease of arthrocentesis and its outcomes under local or general anaesthesia, so we studied 32 patients (n=16 in each group). Postoperative oedema and pain, maximum mouth opening, duration of arthrocentesis, and ease of operation were assessed to compare the relative effectiveness of the two types of anaesthetic. Scores for duration of arthrocentesis (p=0.003) and ease of procedure (0.004) differed significantly, while the other results were similar in the two groups. We noticed some superior outcomes when the procedure was done under general anaesthesia, but because of its limitations, selection of patients becomes more important.