Efficacy of Sodium Hyaluronate for Temporomandibular Joint Disorder by Single-Puncture Arthrocentesis

Efficacy of Arthrocentesis with and Without Sodium Hyaluronate Injection for Temporomandibular Joint Disorders: A Comparative Study

Aim

To evaluate the efficacy of arthrocentesis with and without sodium hyaluronate injection for internal derangement of temporomandibular joint.

Materials and Methods

Patients with clinically and radiographically confirmed cases of temporomandibular joint disorders were enrolled for this study. 20 patients were randomly allocated into two groups for arthrocentesis of TMJ with 10 patients in each group. In group 1, patients were treated with TMJ arthrocentesis followed by sodium hyaluronate injection, and in group 2, patients were treated with arthrocentesis alone. All the patients were treated under local anaesthesia. The patients were followed up at 1st week, 2nd week, 4th week and 12th week post operatively for maximum mouth opening, lateral mandibular movements, pain at rest and on mastication and the subjective efficacy of the treatment.

Results

By the end of twelfth week follow up, the mean mouth opening showed significant improvement in group 1, the right and left lateral movements showed better results in group 1 than in group 2, pain at rest and pain on mastication were mild in both the groups with subjective efficacy good in group 1 and moderate in group 2.

Conclusion

This study suggested that TMJ arthrocentesis with sodium hyaluronate injection had better clinical outcome compared to TMJ arthrocentesis alone for TMJ disorders.

Current Clinical Research Directions on Temporomandibular Joint Intra-Articular Injections: A Mapping Review

This mapping review aims to identify and discuss current research directions on intracavitary temporomandibular joints (TMJs) injections. The inclusion criteria allowed studies published in the last full six years, based on patients diagnosed with temporomandibular joint disorders (TMDs), treated by TMJ intra-articular injections. Medical databases covered by the Association for Computing Machinery, Bielefeld Academic Search Engine, PubMed, and Elsevier Scopus engines were searched. The results were visualized with tables, charts, and diagrams. Of the 2712 records identified following the selection process, 152 reports were qualified for review. From January 2017, viscosupplementation with hyaluronic acid (HA) was the best-documented injectable administered into TMJ cavities. However, a significant growing trend was observed in the number of primary studies on centrifuged blood preparations administrations that surpassed the previously leading HA from 2021.

State of the Art in Temporomandibular Joint Arthrocentesis-A Systematic Review

Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the temporomandibular joint has become a widely approved method for non-invasive treatment, bridging the gap between conservative and surgical approaches. Regardless of technique, treatment is based upon joint lavage and lysis of the inflammatory fibrous tissue adhesions, which, in turn, improves joint mobility and reduces pain and closed lock. Recently, approaches for intra-articular injections have been proposed as adjuvant or replacement therapy. The aim of this study was to assess the most efficient technique of arthrocentesis. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, a reference list search and a manual search, was performed. Relevant articles were selected after three search rounds for final review. The studies pulled for the analysis presented information about the relevant predictors, including the technique of arthrocentesis (single- or two-needle method), fluid used for lavage (Ringer lactate or saline), volume of the fluid, application of the injectable, number of interventions, pain (VAS) and mouth opening scores (MMO) and follow-up. All cohorts showed improvement in mouth opening, but significant pain reduction was observed only in cohorts treated either by arthrocentesis alone or arthrocentesis followed by intra-articular injectables. Intra-articular injectables used alone failed to reduce pain post-operatively when compared to other cohorts. We concluded that both double-needle and single-puncture arthrocentesis techniques are equally efficient. Application of the adjuvant injectable did not improve the outcomes of arthrocentesis performed alone. The volume of the fluid used for joint lavage and its chemical composition were not significant in clinical outcomes. However, due to the lack of homogeneity in the study settings, a meta-analysis could not be applied and a systematic review was conducted. We still, however, state that there is a knowledge gap in the current literature regarding the use of injectables alone, as well as a longitudinal follow-up, which provides information about treatment efficiency. More high-quality and randomized controlled trials are required to shed light on this subject.

The Influence of Surface Modification with Biopolymers on the Structure of Melt-Blown and Spun-Bonded Poly(lactic acid) Nonwovens

The article presents the continuation of the research on modification of fibrous carriers based on poly(lactic acid) using the electrophoretic deposition (EPD) method by the two types of biocompatible polymers-sodium hyaluronate and sodium alginate. Such modified nonwovens, differing in the structural parameters due to different manufacturing methods, could be potentially used in different biomedical applications. The results of the analysis indicate that the EPD process significantly changes the structural characteristics of the carrier in terms of thickness and porosity, which not always can be beneficial in terms of the final application. The varying structure of both carriers significantly influences the mode of deposition of the layer, the efficiency of the deposition process as well as the structural characteristics of the carrier after deposition. Microtomographic and SEM studies were employed to analyze the structure of deposits, and FTIR analysis allowed for confirmation of the occurrence of the polymer layers and its chemical structure.

Use of the Temporalis Myofascial Flap in Internal Derangement of the Temporomandibular Joint - An Evaluative Study

Introduction

Internal derangement is an abnormal relationship between the articular disc and the mandibular condyle. The most common cause is trauma. Various classifications have been given for internal derangement. Initial management is done conservatively and if the disease is progressed, surgery is the option. Various surgical methods and interpositional materials following discectomy have been given in the literature.

Materials and Methods

Over the past 15 years, we selected a group of 30 patients, Wilkes Class IV and V where conservative therapy had failed and were candidates for surgery. The patients had their disc repositioned, the damaged part of the disc was excised and disc was reinforced using the temporalis myofascial flap (TMF). In cases where the disc was non-salvageable, discectomy was done and TMF was placed between condyle and glenoid fossa, sutured with Prolene. The follow-up period was 3 years.

Results

Of the 30 patients, there were 9 male and 21 female. Range of mouth opening was 3.3-3.8 cm with improvements in 1 year. The jaw relations gradually improved and were restored after 3 weeks. Patients were totally pain free in 6 months.

Discussion

For the cases where surgery is the line of treatment, we strongly suggest disc repositioning and reinforcement with TMF as the flap is bulky, locally available and easy to harvest and causes no deformity at the donor site.

Efficacy of arthrocentesis and lavage for treatment of post-traumatic arthritis in temporomandibular joints

Objectives

Joint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that arise after trauma are defined as post-traumatic arthritis (PTA). Although PTA is well recognized in knee and elbow joints, PTA in the temporomandibular joint (TMJ) has not been clearly defined. Interestingly, patients experiencing head and neck trauma without direct jaw fracture have displayed TMJ disease symptoms; however, definitive diagnosis and treatment options are not available. This study will analyze clinical aspects of PTA in TMJ and their treatment outcomes after joint arthrocentesis and lavage.

Materials and Methods

Twenty patients with history of trauma to the head and neck especially without jaw fracture were retrospectively studied. Those patients developed TMJ disease symptoms and were diagnosed by computed tomography or magnetic resonance imaging. To decrease TMJ discomfort, arthrocentesis and lavage with or without conservative therapy were applied, and efficacy was evaluated by amount of mouth opening and pain scale. Statistical differences between pre- and post-treatment values were evaluated by Wilcoxon signed-rank test.

Results

Patient age varied widely between 20 and 80 years, and causes of trauma were diverse. Duration of disease onset was measured as 508 posttrauma days, and 85% of the patients sought clinic visit within 2 years after trauma. In addition, 85% of the patients showed TMJ disc derangement without reduction, and osteoarthritis was accompanied at the traumatized side or at both sides in 40% of the patients. After arthrocentesis or lavage, maximal mouth opening was significantly increased (28-44 mm on average, P<0.001) and pain scale was dramatically decreased (7.8-3.5 of 10, P<0.001); however, concomitant conservative therapy showed no difference in treatment outcome.

Conclusion

The results of this study clarify the disease identity of PTA in TMJ and suggest early diagnosis and treatment options to manage PTA in TMJ.