Clinical assessment of intra-articular fentanyl injection following arthrocentesis for management of temporomandibular joint internal derangement

Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used

INTRODUCTION

Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains.

MATERIAL AND METHODS

The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis.

RESULTS

The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas.

DISCUSSION

Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis.

CONCLUSIONS

The most promising substances appear to be bone marrow and adipose tissue.

Do intra-articular injections of analgesics improve outcomes after temporomandibular joint arthrocentesis?: A systematic review and meta-analysis

OBJECTIVES

Intra-articular analgesics are increasingly being used after temporomandibular joint (TMJ) arthrocentesis but without clear evidence on its efficacy. The aim of this study was to review the role of intra-articular analgesic injected after TMJ arthrocentesis in improving post-operative outcomes.

METHODS

PubMed, Embase, Scopus, BioMed Central, CENTRAL and Google Scholar databases were searched from inception up to 15th April 2020. Randomised controlled trials (RCTs) on adult patients with temporomandibular joint disorders (TMDs) comparing any intra-articular analgesic with control after arthrocentesis were included. Risk of bias was assessed by Cochrane Collaboration's Risk of Bias-2 tool.

RESULTS

Nine RCTs were included. Four studies used non-steroidal anti-inflammatory drugs (NSAIDs) and five used opioids after arthrocentesis. Descriptive analysis of NSAID studies indicated that intra-articular NSAIDs may not improve pain and maximal mouth opening (MMO) after TMJ arthrocentesis. Meta-analysis indicated a statistically significant reduction of pain with the use of opioids at 1 week, 1, 3, and 6 months. Similarly, MMO was significantly improved with intra-articular opioids at 1 week, 1 and 6 months. Data were analysed from a limited number of studies with a small sample size. The quality of the included studies was low.

CONCLUSIONS

Low-quality evidence suggests that intra-articular NSAIDs may have no effect on pain and MMO after TMJ arthrocentesis. Intra-articular opioids may improve pain and MMO at short-term follow-up. Results are to be interpreted with caution considering several limitations of the review. Further high-quality trials with large sample size are needed to provide better evidence.

The use of intra-articular analgesics to improve outcomes after temporomandibular joint arthrocentesis: a review

PURPOSE

The aim of this review was to assess the efficacy of intra-articular analgesics in improving outcomes after temporomandibular joint (TMJ) arthrocentesis.

MATERIAL AND METHODS

An electronic search of PubMed, Scopus, and Google scholar databases was performed for papers in English published up to December 2017 reporting the use of intra-articular analgesics after TMJ arthrocentesis. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), comparative studies, retrospective studies, and case series were included while case reports, technical reports, animal studies, cadaveric studies, and review papers were excluded.

RESULTS

Of the six studies included in the review, three were RCTs, two were randomized comparative studies, and one was a retrospective study. Both opioids and non-steroidal anti-inflammatory drugs have been used after TMJ arthrocentesis. Morphine, tramadol, fentanyl, buprenorphine, tenoxicam, and COX-2 inhibitors are the drugs used till date. Placebo-controlled studies reported improved outcomes after TMJ arthrocentesis with morphine and fentanyl but no such results with buprenorphine and tenoxicam. Tramadol was found to be better than COX-2 inhibitor. The quality of literature was not high.

CONCLUSIONS

There is inconclusive evidence in literature on the benefits of using intra-articular analgesics after TMJ arthrocentesis. Well-designed high-quality RCTs with standard protocol studying the effects of intra-articular opioids and NSAIDS after TMJ arthrocentesis would provide stronger evidence on its use.