Clinical factors affecting the outcome of arthrocentesis and hydraulic distension of the temporomandibular joint

A clinical-based protocol of diagnosis of temporomandibular joint open lock and treatment with arthrocentesis

PURPOSE

Arthrocentesis of the temporomandibular joint (TMJ) is a minimally invasive surgical procedure that provides good clinical results such as the improvement of jaw movements. It also helps to balance the synovial liquid viscosity and relieve TMJ pain by the washout of inflammatory components from the upper compartment. The purpose of this study is to report a case series of patients submitted to a clinical-based protocol of diagnosis of TMJ joint open lock and treatment with arthrocentesis.

MATERIAL AND METHODS

Patients suffering from a recurrent unilateral open lock of the TMJ were submitted to one arthrocentesis of the affected TMJ and all of them reported that the open lock was caused by daily stomatognathic activities. To decide the arthrocentesis as the initial treatment of these patients, the authors followed a rational protocol of diagnosis.

RESULTS

Ten patients were included in the present study. No complications occurred during arthrocentesis. Immediately, 1 week, 1 month, and 6 months after arthrocentesis, patients did not suffer from open lock or disc click anymore. They also reported no more pain because it was strictly related to the disc click.

CONCLUSIONS

All patients of the present study improved from the open lock and disc click of the affected TMJ for 6 months after arthrocentesis. The clinical-based protocol of diagnosis of TMJ open lock reported in the present study, followed by the treatment with arthrocentesis is a reasonable, low-cost, and safe method to treat patients with the acute open lock.

Early responses to 3 mm resilient stabilization appliance therapy for sub-acute and chronic temporomandibular disorder pain predict 12-months follow-up outcomes

Objective: To estimate whether outcomes at 12-month follow-up may be predicted by an intermediate and early response to a 3 mm resilient splint therapy for unilateral arthralgia and myofascial pain assessed at 3- and 6-month follow-ups. Methods: Data obtained from one retrospective cohort study consisting of 78 patients suffering from chronic and sub-acute unilateral arthralgia and myofascial pain who were managed with 3 mm resilient splint therapy were subjected to analysis. Results: Baseline visual analog scale (VAS) intensity, gender as well as changes in the intensity of VAS pain at 3- and 6-month follow-ups predicted unilateral arthralgia and myofascial pain group membership (p < .001). The function classified 83.3% of the cross-validated and 87.2% of original grouped cases correctly. Discussion: The proposed model may be used to timely identify patients who are at risk of developing prolonged non-responsive unilateral arthralgia and myofascial pain chronicity.

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.

Is Repeated Arthrocentesis Beneficial in the Treatment of Temporomandibular Disorders: A Retrospective Study

PURPOSE

Arthrocentesis is an effective, simple, and minimally invasive treatment in patients with temporomandibular joint (TMJ) closed lock (CL). The aim of this study was to compare the effectiveness of 1- versus 2-session arthrocentesis procedures in the management of TMJ CL.

MATERIALS AND METHODS

A retrospective cohort study was conducted using the files of patients with TMJ CL according to diagnostic criteria for temporomandibular disorders. Patients who underwent 1- or 2-session arthrocentesis were included in the study. The decision of whether to undergo 1- or 2-session arthrocentesis was made by the patients: Those who accepted a second arthrocentesis procedure were assigned to group 1 (repeated arthrocentesis group), and those who did not accept, to group 2 (arthrocentesis group). The primary predictor variable was treatment method. TMJ pain (scored on a visual analog scale) and maximum mouth opening (MMO) were selected as the outcome variables. To evaluate the clinical outcomes of 1- or 2-session arthrocentesis, MMO and pain score (on a visual analog scale) before treatment and at 1, 3, and 6 months' follow-up were analyzed. Descriptive, comparative, correlation, and multivariate analyses were conducted.

RESULTS

A total of 30 patients (25 female and 5 male patients) with TMJ disc displacement without reduction were enrolled in the study. Each group consisted of 15 patients. Statistically significant decreases in pain scores and increases in MMO values were observed in both treatment groups at 3 and 6 months (P < .05). At 6 months, MMO values were significantly higher and pain levels were significantly lower in patients who received 2 arthrocentesis procedures.

CONCLUSIONS

Repeated arthrocentesis is more successful at reducing pain and improving MMO than a single intervention in the treatment of TMJ CL.

Clinical factors affecting the outcome of arthocentesis

Objectives

This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement.

Materials and Methods

Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (≤25 years, >25 and ≤40 years, >40 and ≤60 years), VAS pain level (≤5, >5 and ≤7, >7 and ≤10), and ROM (<25 and ≥25 mm). Odds ratios (ORs) were used to describe the proportional benefit of each variable the on successful outcome of arthrocentesis. For the OR to be clinically relevant or even clinically noticeable, we assumed that the OR would need to be larger than 2.

Results

Mean preoperative pain score was 6.49±1.560 and at 6 months postoperative was 0.46±1.147 with an average decrease of pain score 6 (P<0.001). The mean preoperactive maximum mouth opening was 26.14±4.969 mm and mean maximum mouth opening at 6-month inerval was 38.92±3.392 mm. The mean increase in the mouth opening was a mean difference of 12.78 mm (P<0.001). Logistic regression showed that the maximum benefit occurred in patients aged <25 years (OR, 12.01; P=0.012), a VAS pain level of >7 (OR, 11.25; P=0.039), and a maximum vertical opening of <25 mm (OR, 7.70; P=0.038).

Conclusion

Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatment.

Evaluation of success criteria for temporomandibular joint arthrocentesis

Objectives

The aim of this study was to use four sets of success criteria to evaluate the outcomes of arthrocentesis treatment with hyaluronic acid injection in patients with internal derangement (ID) of the temporomandibular joint (TMJ).

Materials and Methods

The study included 40 patients diagnosed with unilateral Wilkes stage III TMJ dysfunction. Clinical parameters, including maximum mouth opening (MMO) and pain during function, were evaluated preoperatively, 6 months, and 1 year after TMJ arthrocentesis. Outcomes were assessed and compared using four sets of success criteria from the following: the American Association of Oral and Maxillofacial Surgeons (AAOMS; MMO ≥35 mm and visual analogue scale [VAS] score ≤3), Murakami et al.'s criteria (MMO >38 mm and VAS score <2), Emshoff and Rudisch criteria (MMO ≥35 mm and >50% pain reduction), and patient self-reports (self-evaluation of treatment as successful or unsuccessful).

Results

Significant improvements in MMO and pain reduction during function were observed between the preoperative period and 6 months and 1 year postoperatively (P<0.01). The success rates of treatment determined using AAOMS (52.5%), Emshoff and Rudisch criteria (57.5%), and self-reported patient criteria (40.0%) were similar. Application of the Murakami et al. criteria reported the lowest success rate (12.5%).

Conclusion

The AAOMS and Emshoff and Rudisch criteria are consistent with patient expectations and can be used to assess treatment efficacy.

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.

The Efficiency of Anterior Repositioning Splints in the Management of Pain Related to Temporomandibular Joint Disc Displacement with Reduction

Background and Objective

Intra-articular temporomandibular disorders are often related to pain in the area of the temporomandibular joint, ear, and temple. The aim of the study was to investigate the efficiency of anterior repositioning splints in decreasing pain related to temporomandibular joint disc displacement with reduction.

Methods

The research material consisted of 112 patients, aged 24 to 45 years, of both genders, who reported for treatment at the Consulting Room of Temporomandibular Joint Dysfunctions at the Jagiellonian University in Cracow between 2014 and 2016 due to pain in the area of the temporomandibular joint(s) and noise(s) of temporomandibular joint(s) present during jaw movements with comorbid contracture of masticatory muscles. Subjects were examined according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol and, after diagnosis of painful disc displacement with reduction and masticatory muscle contracture, they were assigned randomly to either the study or control groups (56 patients in each). In the study group, we used an anterior repositioning splint on the full lower arch for about 20 hours usage over a 4-month period. In the control group, a noninvasive therapy was applied using a biostimulation laser over 12 sessions performed every second day on the area of both temporomandibular joints with mouth open and while performing muscle self-exercises with a dominant protrusive position of the mandible. Pain intensity was evaluated using the Verbal Numerical Rating Scale (VNRS) immediately before the treatment and then after 4 and 16 weeks. The obtained data were analyzed using the Mann–Whitney U test (p ≤ 0.005).

Results

The VNRS values reported during the final examination for the study group were significantly lower than for the control group (p=0.0004).

Conclusions

The anterior repositioning splint is an efficient tool in decreasing pain related to disc displacement with reduction. This trial is registered with Clinicaltrials.gov NCT03057262.

The impact of arthrocentesis with and without hyaluronic acid injection in the prognosis and synovial fluid myeloperoxidase levels of patients with painful symptomatic internal derangement of temporomandibular joint: a randomised controlled clinical trial

We aimed to assess the relationship between myeloperoxidase (MPO) and internal derangement (ID) of temporomandibular joint (TMJ) and effects of arthrocentesis procedure, either alone or in combination with hyaluronic acid (HA) injection on the prognosis of ID of TMJ. A prospective randomised controlled trial has been conducted through patients, who underwent arthrocentesis for the treatment of ID of TMJ, were randomly divided into two groups. Group SS (n = 10) and Group HA (n = 14) patients were assigned 0·9% NaCl solution and sodium hyaluronate intra-articularly, respectively. Synovial fluid samples were assayed for MPO at the time of arthrocentesis and pain visual analogue scale (VAS) and maximum mouth opening (MMO) scores were recorded at pre- and post-operative periods as well as first-week, first-month and third-month intervals. There was a statistically significant decrease in MPO levels between the first to second arthrocenteses only in Group 2 (P = 0·001). Both VAS scores and MMO measurements decreased in the course of time following arthrocentesis and do not differ between the patients administered HA or SS. Similarly MPO levels do not change significantly between the two groups at either first or second arthrocenteses. In HA group, MPO levels significantly decreased from first to second sessions. In HA group, MPO levels decreased significantly only in patients with clinical success. Arthrocentesis procedure improves both pain VAS and MMO scores in the course of time, but these parameters do not differ between patients receiving either HA or SS. HA significantly reduces levels of MPO in synovial fluid, but SS does not. HA appears to alleviate inflammation inside the TMJ in patients with TMJ-ID.

Sodium hyaluronate: an effective adjunct in temporomandibular joint arthrocentesis

BACKGROUND

Internal derangement of the temporomandibular joint (TMJ) is one of the most common forms of temporomandibular disorders. The minimally invasive treatments such as arthrocentesis as well as arthroscopic lysis and lavage are often used as a first-line surgical treatment or in conjunction with nonsurgical modalities with low morbidity and high efficacy. Sodium hyaluronate (SH) has been proposed as an alternative therapeutic agent with similar therapeutic effects.

OBJECTIVE

A prospective study was carried out for evaluation of efficacy of TMJ arthrocentesis with and without injection of SH in management of internal derangements.

MATERIAL AND METHODS

A total of 30 patients suffering from internal derangement of TMJ were selected for this study. Patients were randomly divided into the following two groups: group 1-arthrocentesis-only group and group 2-arthrocentesis + SH group. Each group constituted 15 patients.

RESULTS

Six-month postoperative mean mouth opening (MMO) increase was 13.61 ± 1.64 and 15.53 ± 3.01 mm in group 1 and group 2, respectively. At 6 months, there was marked improvement in masticatory efficiency with mean increase of 5.07 ± 0.13 in group 1 and 6.40 ± 0.04 in group 2. Mean pain reduction was 5.27 ± 0.67 and 6.48 ± 0.44 in group 1 and group 2, respectively.

CONCLUSION

Although our series comprised a limited number of cases and a short follow-up period, initial results suggested that arthrocentesis with SH injection seemed to be superior to art.

[Arthrocentesis of the temporomandibular joint and intra-articular injections : An update]

INTRODUCTION

Arthocentesis of the temporomandibular joint combined with intra-articular washout and, more recently, intra-articular injection of pharmacological agents has been developed from the 1990s and is nowadays extensively in use for the treatment of temporomandibular dysfunctions (TMDs). The goal of our work was to answer 3 questions: 1. Is intra-articular washout effective for the treatment of TMDs ? 2. What kind of pharmacological agents may nowadays be injected in addition to washout and are these injections useful ? 3. What is the place of these treatments in the treatment strategies of TMDs ?

MATERIAL AND METHODS

A bibliographic research has been carried out in the PubMed database using following keywords arthrocentesis, temporomandibular joint. The 27 articles published between 1991 and 2016, indicating patient's inclusion criterions and objectively evaluating the clinical results (mouth opening, intra-articular noises, pain) were selected. Pharmacological agents were noticed when used.

RESULTS

1. All authors concluded to the efficacy of intra-articular washout. No prognostic factor for arthrocentesis efficacy could be identified. 2. Main pharmacological agents used were steroids, hyaluronic acid, morphine-based drugs and platelet rich plasma. Superiority of ith-injection protocols failed to win unanimous support. All authors who compared with- and without-injection protocols concluded to the superiority of with-injection protocols, whatever the agent.

DISCUSSION

Numerous studies have proven the efficacy of intra-articular washout for the treatment of TMDs resistant to noninvasive treatments. The advantage of any kind of pharmacological agent is not clear. Mechanisms of action are not all elucidated. No pharmacological agent showed any superiority over another. Study methodologies are often defective: imprecise inclusion criterions, short follow-up, confounding variables not taken into account, few comparison between pharmacological agents.

Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1

PURPOSE

Arthrocentesis has been used for the management of patients with temporomandibular joint (TMJ) pain, with good success. The additional use of hyaluronic acid (HA) or corticosteroid (CS) remains controversial. The purpose of this study was to compare HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis.

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 the instillation of HA, CS, or LR. Patients were evaluated clinically at 1 and 3 months. The primary outcome variable was pain at 1 month (by visual analog scale). Secondary outcome variables were pain at 3 months and analgesic consumption. 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 the final analysis. The mean age of patients in the HA, CS, and LR groups was 39.6, 44.3, and 51.8 years, respectively (P = .02). There was no difference among groups in time to follow-up at 1 month (P = .11). The mean decrease in pain in the CS group was 19% for right-side procedures (P = .12) and 36% for left-side procedures (P = .02). The mean decrease in pain in the HA group was 31% for right-side procedures (P = .01) and 34% for left-side procedures (P = .01). The mean decrease in pain in the LR group was 43% for right-side procedures (P < .01) and 37% for left-side procedures (P < .01). There was no difference in pain decrease among groups (P = .55). There was no difference in the use of narcotic (P = .52) or nonsteroidal anti-inflammatory drugs (P = .71) among groups.

CONCLUSION

Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in decreasing TMJ pain.

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.

Arthrocentesis and temporomandibular joint disorders: clinical and radiological results of a prospective study

Purpose. We evaluated the efficacy of arthrocentesis in the treatment of temporomandibular joint (TMJ) disorders. Material and Methods. In this prospective clinical case series, 30 consecutive patients with TMJ disorders underwent arthrocentesis using saline and sodium hyaluronate injections. Outcome measures were TMJ pain, maximum mouth opening (MMO), joint noises, and anatomical changes in the TMJ architecture. Patients were evaluated using cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) at the beginning of treatment and 60 days after the last arthrocentesis. Pretreatment and posttreatment clinical parameters were compared using paired and unpaired t-tests, and McNemar's test was used to evaluate CBCT and MRI changes (P < 0.05). Results. At 1-year follow-up examinations, visual analogue scale scores indicated that pain was reduced significantly and mean postoperative MMO was increased significantly. CBCT findings showed no significant change, and MRI showed only slight reductions in inflammatory signs. Conclusions. Within the limitations of this study, we can conclude that arthrocentesis is a simple, minimally invasive procedure with a relatively low risk of complications and significant clinical benefits in patients with TMJ disorders. This trial is registered with NCT01903512.

Piroxicam and laser phototherapy in the treatment of TMJ arthralgia: a double-blind randomised controlled trial

This study aimed to evaluate the efficacy of piroxicam associated with low-level laser therapy compared with single therapies in 32 patients presenting temporomandibular joint arthralgia in a random and double-blind research design. The sample, divided into laser + piroxicam, laser + placebo piroxicam and placebo laser + piroxicam groups, was submitted to the treatment with infrared laser (830 nm, 100 mW, 28 s, 100 J cm(-2) ) at 10 temporomandibular joint and muscle points on each side during four sessions concomitant to take one capsule a day of piroxicam 20 mg during 10 days. The treatment was evaluated throughout four sessions and 30 days follow-up through visual analogue scale (VAS), maximum mouth opening and joint and muscle (temporal and masseter) pain on palpation. The results showed that all the study groups had a significant improvement in the VAS scores (P < 0·05), and there were no significant group differences. Piroxicam was effective in the reduction of joint and muscle pain on palpation (P < 0·05) and showed the lowest temporal pain (P = 0·02) at the 30-day follow-up. The combination of low-level laser therapy and piroxicam was not more effective than single therapies in the treatment of temporomandibular joint arthralgia. The use of piroxicam was more effective in the following 30 days.

Arthrocentesis for the treatment of internal derangement of the temporomandibular joint

OBJECTIVE

The study aims to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of the temporomandibular joint (TMJ).

STUDY DESIGN

Thirty patients with TMJ internal derangement underwent arthrocentesis using saline. Pain using visual analog scale, maximum mouth opening, joint noises and mandible deviation were documented pre-operatively and post-operatively. Patients were followed for 1 year. Statistical analysis of pain was done by Wilcoxon signed Rank's test and dysfunction by students paired t test.

RESULTS

The mean pre-operative pain was 4.8 ± 2.65 and post-operatively at 1 year was 0.27 ± 0.45 with an average decrease of 4.72 (P = 0.000). The mean maximal mouth opening pre-operatively was 29.8 ± 2.35 mm and post-operatively 41.9 ± 2.48 mm at 1 year. The mean increase in the mouth opening was 12.1 ± 3.0 mm (P = 0.000).

CONCLUSION

Arthrocentesis is simple, minimally invasive procedure with less risk of complications and significant benefits in patients with TMJ internal derangement.

Temporomandibular joint pain and synovial fluid analysis: a review of the literature

The pathophysiology of temporomandibular joint pain is not well understood. A significant amount of research has been conducted to evaluate synovial fluid in these patients and in healthy controls. Qualitative and quantitative analyses of the synovial fluid have shown a significant difference between these groups. A multitude of inflammatory mediators and degradation products have been identified. The concentration of these products has been shown to correlate with several clinical parameters including pain, chronicity, severity of degenerative change, and response to treatment. A common inflammatory pathway would appear to be involved in most patients. At the present time, synovial fluid analysis does not have the sensitivity or specificity to allow specific diagnoses and targeted treatment. Continued research with the specific aim of establishing more appropriate therapeutic modalities based on the biochemical pathways is warranted.

Arthrocentesis versus nonsurgical methods in the treatment of temporomandibular disc displacement without reduction

OBJECTIVE

The aim was to compare the short- and medium-term results of arthrocentesis and conventional treatment (splint, heat, and exercise) in patients with early temporomandibular joint (TMJ) disc displacement without reduction (DDw/oR).

STUDY DESIGN

One hundred twenty consecutive patients (104 female, 16 male), who had been followed by a multidisciplinary TMJ unit with the diagnosis of DDw/oR were enrolled in this single-blind prospective study. Patients either underwent arthrocentesis or they were given a combination of splint, hot pack, and home exercise program. Visual analog scale (VAS) was used for pain assessment. Maximal mouth opening (MMO), lateral movement, and protrusion were measured. Repeat measurements were performed on the first, third, and sixth months following treatments.

RESULTS

Arthrocentesis group consisted of 54 individuals (51 female, 3 male), and the conventional treatment group consisted of 56 individuals (49 female, 7 male). The mean age values of the groups were 33.4 years (range 15-63 years) and 34.8 years (range 17-61 years), respectively. Baseline VAS and MMO values of the arthrocentesis and conventional treatment groups were similar (P > .05). Regarding VAS and MMO, lateral movement, and protrusion, the intragroup analyses showed a statistically significant reduction in both groups compared with baseline values (all P < .01). Regarding VAS values, the difference values between each evaluation and the baseline measurement were significantly higher in the arthrocentesis group, except for the first-month difference. Regarding MMO, lateral movements, and protrusion, the differences between the baseline values and each evaluation thereafter were statistically similar between the 2 groups (P > .05).

CONCLUSION

We conclude that early treatment either with conservative methods or with arthrocentesis is beneficial in DDw/oR. However, arthrocentesis seems to be superior regarding pain management. Therefore, arthrocentesis may be indicated in patients where painful complaints overwhelm despite other conservative treatments.

Resection of the disc and suspension of the lateral wall with the temporal fascia in advanced internal derangement of the temporomandibular joint

The abnormal relation between the disc, the condyle, and the temporal bone indicates internal derangement of the temporomandibular joint. The primary symptoms and findings are: limited and painful opening of the jaw, preauricular pain, and clicking sounds or crepitus. We operated on 11 patients admitting for advanced temporomandibular dysfunction. The abnormally stretched disc was tightened by resection of a wedge of tissue from the posterior of the disc and suturing of the edges. A pedicled flap of temporal fascia was turned on to the joint and its surroundings to mimic a lateral joint capsule. All patients were satisfied with the results as they had less pain and improved mouth opening. The procedures provided satisfactory symptomatic relief and supportive findings.

Somatosensory function following painful repetitive electrical stimulation of the human temporomandibular joint and skin

Temporomandibular disorders (TMD) are common pain problems in the population with uncertain pathophysiology and mechanisms. The aim of this experimental study was to: (1) Establish an experimental pain model using electrical stimuli to describe characteristics of nociception from the human temporomandibular joint (TMJ) and overlying skin. (2) Test the hypothesis that there would be sex-related differences in TMJ sensitivity. Forty-three healthy subjects (24 men and 19 women) participated. Using two unipolar needle electrodes into the skin (above the TMJ) in one session or into the TMJ in the other session, sensory detection threshold (SDT), pain detection threshold (PDT), and summation threshold (SumT) were measured, before and after repetitive electrical stimulation. Painful repetitive electrical stimulation was applied for 20 min with individually adjustment of the intensity of the stimuli to keep the pain rating around five on a 0-10 cm visual analogue scale (VAS). Sensitivity to tactile and pin-prick stimuli were assessed at 11 sites around the TMJ using two von Frey nylon filaments (5.16 and 84.96 g), as well as pressure pain threshold (PPT) and pressure pain tolerance (PPTOL) before the stimulation, after 20 min of stimulation and finally 15 min after the end of stimulation. Numerical rating scale (NRS) from 0 to 100 was used to rate the intensity of applied von Frey filaments. SDT, PDT, and SumT were higher in the TMJ than in the skin. These three measures increased after painful repetitive stimulation for 20 min (de-sensitization). In contrast to this effect, a hypersensitivity to pin-prick stimuli was detected around the TMJ area on the stimulated side after 20 min of electrical stimulation in the TMJ, but not in the skin. A bilateral hyposensitivity to tactile stimuli was detected after skin and TMJ stimulation. PPT and PPTOL did not show a significant change over time. Except for lower TMJ PPTOLs in women than men there were no significant sex-related differences in mechanical or electrical measures. The present findings indicate differences in the elicitation of hypersensitivity following repetitive electrical stimulation of skin and deep tissues. The mechanisms underlying these findings are not clear but differences in the induction of long-term potentiation and depression is a possibility. From a clinical point of view, the lack of sex differences in most of the used measures indicates that the higher prevalence of women than men amongst patients with persistent TMJ pain problems not entirely can be ascribed to a higher sensitivity of the TMJ. Further studies will examine the somatosensory sensitivity of patients with TMJ pain problems.