Anchored disc phenomenon with a normally positioned disc in the temporomandibular joint: Characteristics and behaviour

Effect of duloxetine in temporomandibular joint disorders: A comparison with arthrocentesis

Purpose

This study was conducted to compare the efficacy of temporomandibular joint (TMJ) arthrocentesis, duloxetine therapy alone, and duloxetine in combination with TMJ arthrocentesis in the treatment of painful TMJ.

Materials and Methods

Thirty patients with TMJ pain were included in the study who were divided into three groups with ten patients in each group. Group A included patients having only TMJ arthrocentesis; in Group B, only duloxetine therapy (30 mg) was given twice a day orally for 3 months; and in Group C, a combination of TMJ arthrocentesis with duloxetine therapy (30 mg) was given twice a day orally for 3 months. Patients were followed at regular interval of the 1^st day, 5^th day, 7^th day, 4^th week, 6^th week, and 12^th week and assessed in terms of pain, maximum mouth opening (mm), clicking, Hospital Anxiety and Depression Rating Scale and estimation of interleukin-6 (IL-6). The data collected were compiled and statistically analyzed.

Results

The pain was found to be significantly lower in Group C than other groups at weeks 4, 6, and 12. In Group C, mouth opening increased significantly than Groups A and B on subsequent follow-ups. On biochemical analysis of IL-6 levels in lavage fluid, a significant decrease was observed in levels of IL-6 in lavage fluid in Groups A and C postoperatively.

Conclusion

The present study states that pain was observed to be much less after arthrocentesis along with duloxetine therapy. This combination therapy leads to much better and faster outcome, but still, long-term follow-ups with larger number of patients are required.

Is the Anchored Disc Phenomenon a Truly Distinct Entity? A Systematic Review

PURPOSE

This review aimed to examine whether the anchored disc phenomenon (ADP) is truly a distinct entity, independent of the closed-lock condition attributed to nonreducible disc displacement.

MATERIALS AND METHODS

Clinical and/or diagnostic imaging studies addressing the anchored disc or ADP were considered. Articles eligible for inclusion were written in English; were conducted in humans; showed, in their titles or abstracts, any of the keywords used in the search method; included some type of disc imaging system; and related disc mobility to disc position. Of 18 potentially relevant articles, 10 were included.

RESULTS

Of the studies, 9 used magnetic resonance imaging and 1 used double-contrast cone-beam computed tomography. In 1,691 joints, 270 discs (16%) were shown to be anchored in a normal (41%) or displaced (59%) position. Of 149 displaced anchored discs, 52 were reducible and 97 were nonreducible. Intra-articular adherences, synovitis, and adhesions were common arthroscopic findings in patients with the ADP.

CONCLUSIONS

The temporomandibular joint anchored disc shown by disc imaging systems is worthy of inclusion in the existing categories of temporomandibular joint internal derangement. Classification of the ADP as a distinct entity still awaits a consensual definition of the problem, validation of the underlying hypothesis, and clarification of the natural history of the phenomenon.

TMJ Arthrocentesis Alone and in Combination with Duloxetine in Temporomandibular Joint Pain

Purpose

The purpose of the study was to compare the efficacy of arthrocentesis alone and arthrocentesis with duloxetine in patients with TMJ pain.

Materials and methods

This study comprised of 20 patients. Patients with TMJ pain as confirmed by RDC/TMD and with pain duration of at least 3 months were included in the study. Patients were randomly divided into two groups, group A in which patients were treated with arthrocentesis alone and group B in which patients were treated with arthrocentesis followed by duloxetine 30 mg twice daily for 12-week therapy. Patients were followed up at regular interval at day 1, day 5, day 7, week 4, week 6 and week 12. Outcome assessment of pain, swelling, maximal mouth opening, painful/pain-free lateral or protrusive jaw movement was done. Hospital anxiety and depression (HAD) scale was used to assess pre- and post-treatment anxiety and depression. Radiologic assessment was done based on OPG and CBCT. Biochemical assessment of IL-6 in lavage fluid between groups A and B was done pre-operatively and postoperatively.

Results

There was significant reduction of pain in both groups, but reduction of pain was more in group B than in group A at week 4, week 6 and week 12. Mouth opening was significantly higher in group B than in group A patients. Reduced painful lateral and protrusive movements were seen in group B than in group A patients. There was no significant difference in hospital anxiety and depression scale among the groups at pre-operative and at 4th week post-operative. Though a significant reduction of IL-6 levels was seen post-operatively, there was no significant difference between the two groups.

Conclusion

Arthrocentesis is an effective procedure for relieving symptoms in patients with temporomandibular disorders. In this study, combination of duloxetine with arthrocentesis gave much better outcome than arthrocentesis alone. Further studies with large sample size required to evaluate the effect of arthrocentesis plain or in combination with duloxetine in providing permanent relief to the patient.

Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short Term for Improving Function and Quality of Life After Arthrocentesis? Part 2

PURPOSE

Although arthrocentesis has been used for the management of patients with temporomandibular joint pain, the benefit of hyaluronic acid (HA) or corticosteroid (CS) remains uncertain. The purpose of this study was to assess the efficacy of HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis for changes in quality of life (QoL), jaw function (Jaw Function Limitation Scale [JFLS] score), and maximum incisal opening (MIO).

MATERIALS AND METHODS

This was a prospective multicenter double-blinded randomized clinical trial. Consecutive patients presenting to the oral and maxillofacial departments at Emory University, the University of Pennsylvania, the University of California-Los Angeles, the University of Cincinnati, and the Oregon Health Sciences University were enrolled in the study. Patients were randomized to HA, CS, or LR. All patients underwent arthrocentesis and then instillation of HA, CS, or LR. All patients were evaluated clinically at 1 and 3 months. The outcome variables were QoL, JFLS score, and MIO. Univariate, bivariate, and multivariate statistics were computed, with a P value less than .05 considered significant.

RESULTS

One hundred two patients were enrolled in the study. Four were lost to follow-up, leaving 98 patients for analysis of data at 1 month. An additional 51 were lost to follow-up at 3 months, leaving 51 patients for data analysis at this time point. There was no difference among groups for QoL Mental Health Composite score at 1 month (P = .70) or 3 months (P = .69). There was no difference among groups for JFLS score at 1 month (P = .71) or 3 months (P = .98). There was no difference among groups for MIO at 1 month (P = .47) or 3 months (P = .31). All groups showed within-group improvements in JFLS score and MIO at 1 and 3 months.

CONCLUSION

Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in improving jaw function and MIO at 1 and 3 months. QoL is not improved with arthrocentesis alone or in combination with CS or HA.

Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of 'locking duration'

Temporomandibular joint (TMJ) 'closed lock' (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be 'acute' or 'chronic' depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid-August 2013 were conducted for English-language studies of any design investigating the effects of non-surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor-quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high-quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by 'unlock' mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.

Temporomandibular joint arthrocentesis. Review of the literature

The treatment of the temporomandibular joint (TMJ) is still controversial. TMJ arthrocentesis represents a form of minimally invasive surgical treatment in patients suffering from internal derangement of the TMJ, especially closed lock. It consists of washing the joint with the possibility of depositing a drug or other therapeutic substance. Resolution of symptoms is due to the removal of chemical inflammatory mediators and changes in intra-articular pressure. Numerous clinical studies regarding this technique have been published. The goal of this paper is to review all clinical articles that have been published with regard to the critique of this technique. 19 articles with different designs fulfilling selection guidelines were chosen. A series of clinical and procedure variables were analyzed. Although the mean of improvement was higher that 80%, further research is needed to determine more homogeneous indications for TMJ athrocentesis.