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

When trauma bites back: a systematic review on direct orofacial macrotrauma and temporomandibular disorders

OBJECTIVES

Temporomandibular disorders (TMD) are musculoskeletal conditions with a multifactorial aetiology. The predictive role of direct orofacial macrotrauma in the development of TMD is considered controversial. This systematic review aims to elucidate the association between direct orofacial macrotrauma and TMD, and to identify potential factors involved in this relationship.

MATERIALS AND METHODS

A comprehensive literature search of PubMed, Embase, and Web of Science databases up to November 1, 2023, was performed in collaboration with a medical information specialist, identifying 2,047 unique studies. Of these, 139 met the inclusion criteria of this investigation.

RESULTS

Our synthesis of the literature indicates a consistent association between TMD and direct orofacial macrotrauma in adults, while this relationship appears less defined in paediatric and adolescent populations. The association shows robustness across various TMD diagnoses and trauma locations, remaining not only immediately following the direct orofacial macrotrauma but also after long time, despite other interventions. These outcomes could be due to the physical effect of the trauma, but they might be associated with the psychosocial effect of the trauma as well.

CONCLUSIONS

The evidence supports a robust, but complex, association between direct orofacial macrotrauma and TMD.

CLINICAL RELEVANCE

This finding underscores the importance of considering both physical and psychosocial sequelae of trauma in the clinical management of direct orofacial macrotrauma and TMD.

Posttraumatic hyperalgesia and associated peripheral sensitization after temporomandibular joint injury in mice

ABSTRACT

Temporomandibular disorder (TMD) is the most prevalent painful condition in the craniofacial area. Recent studies have suggested that external or intrinsic trauma to the temporomandibular joint (TMJ) is associated with the onset of painful TMD in patients. Here, we investigated the effects of TMJ trauma through forced-mouth opening (FMO) in mice to determine pain behaviors and peripheral sensitization of trigeminal nociceptors in both sexes. Forced-mouth opening increased mechanical pain as assessed by the von Frey test, with spontaneous pain-like behaviors assessed using the mouse grimace scale and anxiety-like behaviors assessed using the open-field test. Changes in pain-like behaviors were not different between male and female mice. However, in vivo GCaMP Ca2+ imaging of intact trigeminal ganglia (TG) showed modality- and sex-dependent changes. Forced-mouth opening increased spontaneous Ca2+ responses and mechanical hypersensitivity of TG neurons compared to the sham group, which was more pronounced in male mice. Forced-mouth opening also increased Ca2+ responses evoked by cold, heat, and capsaicin stimuli, which was not different between the sexes. In retrogradely labeled trigeminal TMJ afferents, FMO induced an increase in small-sized neuronal proportions with increased colocalization with calcitonin gene-related peptides and transient receptor potential vanilloid subtype 1, which was modestly sex dependent. These results suggest that TMJ injury leads to persistent posttraumatic hyperalgesia associated with peripheral sensitization of trigeminal nociceptors with distinct sex dependency.

Progress in the Study of Temporomandibular Joint Lavage in Temporomandibular Joint Disorder

With the continuous development and progress of medicine, there are many methods for the treatment of temporomandibular disorders, among which temporomandibular joint lavage is also constantly developed. In the past century, through the efforts of some scholars and clinical summary, the understanding of this disease has been deepened and broadened. At present, through continuous exploration of the treatment methods, the lavage is relatively mature, and has achieved good clinical results. In this paper, the application of temporomandibular joint lavage in the treatment of temporomandibular joint disorders, its treatment methods, treatment mechanism, the auxiliary of other drugs, indications, complications and so on were discussed.

The profile of patients with maxillofacial trauma due to interpersonal violence treated in a hospital emergency room

AIM

This study evaluated records of patients with maxillofacial trauma due to interpersonal violence (IPV) being treated in the emergency room of a level I trauma center hospital in São Paulo, Brazil.

MATERIAL AND METHODS

Data of patients with maxillofacial trauma due to IPV recorded between January 2019 and December 2019 were retrospectively examined. Personal data, days on which they experienced IPV, and the type of maxillofacial trauma sustained were extracted and statistically analyzed (p < .050).

RESULTS

During the analysis, 1034 patients with maxillofacial trauma were identified; of these patients, 292 (28.2%) who experienced trauma due to IPV were included in this study. There was a mean age of 32.6 years and the most common type of trauma was soft tissue injuries (38.7%). Mandible and nose fractures were more prevalent in males and females, respectively. Our data, when compared with other studies on maxillofacial trauma due to IPV, showed a lower prevalence and male-to-female ratio, and a higher presence of dentoalveolar trauma. Additionally, our data when compared with studies on maxillofacial trauma due to other causes showed lower mean age and male-to-female ratios, and a higher occurrence of nose fractures differing from the predominance of mandibular fractures.

CONCLUSION

Oral and maxillofacial surgeons must be able to suspect and identify cases due to IPV among their patients with trauma. With our results, although each case has its individuality, we can suggest that cases of maxillofacial trauma in young, female, and nasal fracture patients may be suspicious for IPV.

EFFICACY OF ARTHROCENTESIS FOR TREATMENT OF INTERNAL POST-TRAUMATIC TEMPOROMANDIBULAR JOINT DISORDERS

OBJECTIVE

The aim: To study the consequences of temporomandibular joint injury and efficacy of arthrocentesis for treatment of post-traumatic internal temporoman-dibular disorders.

PATIENTS AND METHODS

Materials and methods: 24 patients who experienced trauma history in the head without jaw fractures underwent CT, ultrasound and/or MRI. TMJ ar¬throcentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia by means of blockade of the peripheral branch of the auricular-temporal nerve on the background of intravenous sedation.

RESULTS

Results: The ages of the patients varied between 18 and 44 years, and mean was 32,58 years. The causes of trauma were diverse, as traffic accident - 3 (12,5%), assault 12 (50%), hit by materials 3 (12, 5%), and fall-down 6 (25%). According to clinical and radiological signs after traumatic temporomandibular disorders, patients were divided into two groups according to Wilkes classification (1989): 13 patients with stage II (early-middle) and 11 - with stage III (middle).The control ultrasound and MRI carried out 3-6 months after arthrocentesis showed no signs of hemarthrosis in 84.61% of patients with intra-articular disorders of the second degree, and in 72.72% of patients with internal disorders of the third degree, the position and function of the articular disc was restored.

CONCLUSION

Conclusions: Arthrocentesis with TMJ lavage is a minimally invasive surgical manipulation that has proven itself in temporomandibular disorders of traumatic origin, in particular after fractures of the articular process of the mandible.

Follow-up evaluation of temporomandibular joints using magnetic resonance imaging after mandibular trauma: Case series analysis of young adult males

BACKGROUND/AIMS

A relationship between mandibular fractures and traumatic temporomandibular joint (TMJ) conditions has been suggested in many studies. Although magnetic resonance imaging (MRI) is the best option for a TMJ evaluation, few studies have evaluated the TMJ condition after a mandibular fracture using MRI follow-up. The aim of this study was to evaluate the TMJ for post-traumatic conditions following a mandibular fracture using follow-up MRI.

MATERIALS AND METHODS

Fourteen TMJs of seven young adult males (aged 19-21 years) with mandibular fractures were analyzed by MRI, and 12 TMJs of six patients were evaluated by follow-up MRI after the trauma. Regarding the intensity of MRI, the pathologic condition of TMJ was classified into acute joint inflammation, marrow edema, and joint space widening.

RESULTS

Thirteen joints (92.9%) showed pathologic conditions, including 11 with acute joint inflammation (84.6%), 10 with joint space widening (76.9%), and six with marrow edema (46.2%). Five out of 12 evaluated joints were injected with dexamethasone. Among these, four joints healed within one week, and one healed within one month. Among the seven untreated TMJs, four and one joint healed within one week and one month, respectively, but two joints of one patient did not improve until one month. Although that patient received arthrocentesis, the right joint showed osteoarthritis six months after the trauma.

CONCLUSIONS

Most TMJs were acutely damaged due to mandibular trauma and healed within one week to one month. A follow-up examination could be considered at one month after the injury to confirm the possibility of traumatic TMJ disorder, such as osteoarthritis.