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Torres-Gaya J, Boscà-Ramón A, Marqués-Mateo M, Valverde-Navarro A, García-San Segundo MM, Puche-Torres M. Temporomandibular joint arthrocentesis guided by ultrasonography: An anatomical study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:e27-e31. [PMID: 33706027 DOI: 10.1016/j.jormas.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
The temporomandibular joint (TMJ) arthrocentesis is a common procedure in maxillofacial surgery departments for the treatment of TMJ dysfunction. The use of ultrasonography in this area is rare, and in the vast majority of cases only as a diagnostic, and non-therapeutic use. Through this study we propose the equipment and ultrasound parameters necessary to obtain detailed and practical images when using ultrasonography as a therapeutic guide in arthrocentesis of TMJ. In addition, we provide data regarding the placement and working angulations of both the ultrasound probe and the needle that are ideal for facilitating image-guided puncture. It is a simple technique, with a relatively short learning curve, and that can provide considerable intraoperative help to the surgeon.
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Affiliation(s)
- J Torres-Gaya
- Oral and Maxillofacial Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain.
| | - A Boscà-Ramón
- Department of Radiology, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain.
| | - M Marqués-Mateo
- Oral and Maxillofacial Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain; Surgery Department, Faculty of Medicine and Dentistry, Universitat de Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain.
| | - A Valverde-Navarro
- Anatomy and Human Embryology Department, Universitat de Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain.
| | - M M García-San Segundo
- Oral and Maxillofacial Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain.
| | - M Puche-Torres
- Surgery Department, Faculty of Medicine and Dentistry, Universitat de Valencia, Av. de Blasco Ibáñez, 15, 46010 Valencia, Spain; Oral and Maxillofacial Department, Hospital Clínico Universitario de Valencia, Fundación de Investigación Hospital Clínico (INCLIVA), Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain.
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Palma LF, de Godoy Froes G, Pereira A, Tateno RY, Campos L, de Moraes LOC. Puncture points related to the tragal-lateral canthus line in conventional temporomandibular joint arthrocentesis: are they accurate? A cadaver study. Oral Maxillofac Surg 2020; 25:247-251. [PMID: 32978694 DOI: 10.1007/s10006-020-00911-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the technical success of conventional TMJ arthrocentesis in cadavers, using the tragal-lateral canthus line as an anatomical reference for the puncture points. METHODS Ten formalin-treated and 8 fresh cadavers were submitted to the arthrocentesis. A point located 10 mm anteriorly and 2 mm inferiorly to the beginning of the tragal-lateral canthus line (A) and another point 20 mm anteriorly and 10 mm inferiorly (B) were demarked on the cadavers' skin. Following, 1 mL of methylene blue solution was injected through the needle at point A, and then another needle was placed at point B. Saline solution was injected through the first needle, identifying a free flow of bluish solution. RESULTS Concerning the formalin-treated cadavers, TMJ arthrocentesis was not successfully performed in any case (0%). In the fresh cadavers, the procedure was properly conducted bilaterally in only one case (12.5%) and unilaterally in 3 cases (37.5%), 2 on the left side (25.0%) and one on the right (12.5%). CONCLUSION The traditional points related to the tragal-lateral canthus line seemed not to be accurate references for the insertion of the needles in conventional TMJ arthrocentesis when 1 mL of solution is used initially and the maximum mouth opening is not achieved.
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Affiliation(s)
- Luiz Felipe Palma
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, SP, Brazil. .,MSc Dentistry Program, Ibirapuera University, São Paulo, SP, Brazil.
| | - Gabriela de Godoy Froes
- School of Dentistry, Centro Universitário das Faculdades Metropolitanas Unidas, São Paulo, SP, Brazil
| | - Alyne Pereira
- School of Dentistry, Centro Universitário das Faculdades Metropolitanas Unidas, São Paulo, SP, Brazil
| | - Ricardo Yudi Tateno
- Department of Post-Graduation in Implantology, School of Dentistry, University of Santo Amaro, São Paulo, SP, Brazil
| | - Luana Campos
- Department of Post-Graduation in Implantology, School of Dentistry, University of Santo Amaro, São Paulo, SP, Brazil
| | - Luís Otávio Carvalho de Moraes
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, SP, Brazil
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Ultrasonography-guided arthrocentesis versus conventional arthrocentesis in treating internal derangement of temporomandibular joint: a systematic review. Clin Oral Investig 2020; 24:3771-3780. [PMID: 32594307 DOI: 10.1007/s00784-020-03408-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This systematic review assessed the clinical question: 'Does ultrasonography (USG)-guided arthrocentesis provide better outcomes than conventional arthrocentesis in patients with temporomandibular disorder (TMD)?' MATERIALS AND METHODS The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial search was performed on electronic databases-including Medline, PubMed, and Cochrane Library-followed by manual and reference searches until the date September 27, 2019. The articles selected were evaluated for study and patient characteristics, arthrocentesis procedure details, and treatment outcomes (post-operative pain, maximum mouth opening (MMO), procedure time, and attempts of needle positioning). Risk of bias was assessed with the Cochrane Consumers and Communication Review Group's data extraction template and Critical Appraisal Skills Programme (CASP). RESULTS Out of the 325 initially identified articles, four studies with 144 patients were included in the final qualitative analysis. No significant differences were found in pain reduction and improved MMO between sample groups receiving conventional arthrocentesis and USG-guided arthrocentesis. Needle positioning attempts and procedural times were conflicting between the two groups. CONCLUSIONS This systematic review found that the outcomes of USG-guided arthrocentesis were not superior to conventional arthrocentesis. Conflicting data was found in the attempts of needle positioning and procedural time. Standardized treatment protocols and data from well-designed USG-guided arthrocentesis randomized clinical trials were lacking. CLINICAL RELEVANCE Arthrocentesis with or without USG guidance are both effective for treating patients with TMD to reduce pain and to improve MMO. USG-guided arthrocentesis was not found to be superior to conventional arthrocentesis.
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Şentürk MF, Gülşen U. Re: Comparison of clinical outcomes of treatment of dysfunction of the temporomandibular joint between conventional and ultrasound-guided arthrocentesis. Br J Oral Maxillofac Surg 2019; 57:388-389. [PMID: 30910413 DOI: 10.1016/j.bjoms.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Affiliation(s)
- M F Şentürk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey.
| | - U Gülşen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bulent Ecevit University, Zonguldak, Turkey
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Folle FS, Poluha RL, Setogutti ET, Grossmann E. Double puncture versus single puncture arthrocentesis for the management of unilateral temporomandibular joint disc displacement without reduction: A randomized controlled trial. J Craniomaxillofac Surg 2018; 46:2003-2007. [DOI: 10.1016/j.jcms.2018.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/16/2018] [Accepted: 10/18/2018] [Indexed: 11/26/2022] Open
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Intraoperative comparison of single- and double-puncture techniques in temporomandibular joint arthrocentesis. Int J Oral Maxillofac Surg 2018; 47:1060-1064. [DOI: 10.1016/j.ijom.2018.03.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/27/2018] [Accepted: 03/29/2018] [Indexed: 11/20/2022]
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Grossmann E, Poluha RL, Iwaki LCV, Iwaki Filho L. Arthrocentesis with different irrigation volumes in patients with disc displacement without reduction: One-year follow-up. Cranio 2018; 38:122-127. [PMID: 30048223 DOI: 10.1080/08869634.2018.1491930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: This study evaluated the clinical efficacy of arthrocentesis when varying the irrigation volume in patients with disc displacement without reduction (DDWOR). Methods: Thirty DDWOR patients were equally divided into two groups: G1 (50 mL) and G2 (200 mL). Information was compared for pain, the maximum interincisal distance (MID), protrusion, and right and left laterality. Results: Arthrocentesis was able to reduce the pain and increase the MID, protrusion, and both laterality values significantly one year after the procedure (p < 0.001) in both groups. However, comparisons between the groups revealed no significant difference (p > 0.05). Furthermore, changes in volume did not affect the arthrocentesis results (p = 0.626, odds ratio = 1.625; 95% confidence interval = 0.230-11.461). Conclusion: Arthrocentesis techniques using 50- and 200-mL irrigation volumes were both effective, with no significant differences between techniques observed after one year of follow-up.
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Affiliation(s)
- Eduardo Grossmann
- Department of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Liogi Iwaki Filho
- Department of Dentistry, State University of Maringá, Maringá, Brazil
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Bas B, Kazan D, Kutuk N, Gurbanov V. The Effect of Exercise on Range of Movement and Pain After Temporomandibular Joint Arthrocentesis. J Oral Maxillofac Surg 2018; 76:1181-1186. [PMID: 29406255 DOI: 10.1016/j.joms.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/16/2017] [Accepted: 01/02/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Arthrocentesis is an effective treatment modality for temporomandibular disorders, especially in patients who have pain and limited mouth opening. Surgeons generally suggest physical exercises after arthrocentesis and arthroscopy procedures; however, there has been no study in the literature evaluating the effects of exercise on clinical outcomes. This study investigated whether physical exercises after arthrocentesis would result in early improvements in clinical symptoms in patients with temporomandibular joint disc displacement without reduction (TMJ DDw/oR). MATERIALS AND METHODS The study group was composed of 27 patients with TMJ DDw/oR. Patients who needed arthrocentesis after failed conservative nonsurgical treatment were enrolled in the study. Group 1 was composed of 14 patients who were not started on a physiotherapy program after the arthrocentesis procedure. Group 2 was composed of 13 patients who were started on a self-administered physiotherapy program immediately after the arthrocentesis procedure. Physiotherapy included a 6-week exercise program. Patients were followed for 3 months. Range of maximal mouth opening (MMO) and joint pain as measured by the visual analog scale (VAS) were examined to determine clinical efficacy before and after treatment. RESULTS In groups 1 and 2, mouth opening increased and pain scores decreased at 1-week and 1- and 3-month follow-ups (P < .05). No relevant relation was found between the 2 groups according to MMO for all time points and VAS scores at 1 week. A relevant relation was found between the 2 groups according to VAS scores at 1 and 3 months. CONCLUSION Physical exercise after arthrocentesis has no effect on range of mouth opening but does decrease pain.
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Affiliation(s)
- Burcu Bas
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Dilara Kazan
- Research Assistant, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey.
| | - Nukhet Kutuk
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem University, Istanbul, Turkey
| | - Vugar Gurbanov
- Research Assistant, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
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