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Heo HA, Park S, Pyo SW, Yoon HJ. Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy. Maxillofac Plast Reconstr Surg 2024; 46:24. [PMID: 38976106 DOI: 10.1186/s40902-024-00436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The management of internal derangement (ID) of the TMJ is challenging because of multiple etiologic factors and varying degrees of severity. The aim of this study was to evaluate the clinical outcomes of patients with unilateral ID treated with arthrocentesis and stabilization splint therapy during a 6-month period. METHODS A total of 105 patients (87 females, 18 males) with unilateral ID were included in this study. Patients were divided into unilateral anterior disc displacement with reduction (ADDwR) and unilateral anterior disc displacement without reduction (ADDwoR). Patients with ADDwoR were subdivided according to the erosive bone changes. Objective parameters on mandibular movement and subjective parameters on pain were obtained and assessed. Their clinical outcomes before and after arthrocentesis and stabilization splint therapy were compared with the chi-square, Fisher's exact test, paired t-test, or Wilcoxon singed-rank test. RESULTS All objective parameters of unilateral ID patients significantly increased at the 6-month follow-up. The differences in mean visual analog scale (VAS) pain scores were statistically significant in all subjective variables (p < 0.01). In joints with ADDwoR, preoperative maximal mouth opening, and maximal protrusive movement in both groups, with erosive and non-erosive changes were significantly increased after 6 months (p < 0.01). However, right and left maximal lateral movement increased after treatment in both groups but without significant differences. All VAS pain scores on jaw movement and palpation of associated muscles showed a significant decrease regardless of erosive changes. CONCLUSIONS The combination of arthrocentesis and subsequent stabilization splint therapy was shown to be highly effective in pain reduction and improvement of mandibular movements in both unilateral ADDwR and ADDwoR, as well as in cases with both erosive and non-erosive bony changes associated with unilateral ADDwoR.
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Affiliation(s)
- Hyun-A Heo
- Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suhyun Park
- Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Woon Pyo
- Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Joong Yoon
- Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Oflioğlu S, Özyurt A, Efeoğlu C. Pressure Infusor Assisted Arthrocentesis. J Oral Maxillofac Surg 2024; 82:756-760. [PMID: 38621667 DOI: 10.1016/j.joms.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
Temporomandibular joint internal disorders commonly present with limited mouth opening and pain. Treatment options range from invasive surgical procedures to minimally invasive interventions. This technical note aims to introduce a modification to the arthrocentesis technique in which a pressure infusion cuff (VBM Classic Infusor, Medizintechnik GmbH, Germany) is used for irrigation instead of syringes or peristaltic pumps. A pressure infusion cuff (bag) is an inflatable bag with a hand pump and a sphygmomanometer that allows monitorization of the pressure, and it is intended to apply pressure on intravenous fluid bags to assist with rapid infusion of fluids. This allows the operator to maintain an efficient and stable flow pressure throughout the procedure while avoiding occupational hand and wrist problems resulting from manual irrigation with syringes. Furthermore, pressure monitoring, as read on the sphygmomanometer of the cuff, facilitates the manipulation of the needles and adjustment of the pressure should the patient experience discomfort. This increases the patient's compliance, physician's comfort, and allows the collection of quantitative data in clinical studies.
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Affiliation(s)
- Salih Oflioğlu
- Resident in Oral and Maxillofacial Surgery, Dokuz Eylül University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Sağlık ve Sanat Yerleşkesi, İzmir.
| | - Anıl Özyurt
- Associate Professor, Dokuz Eylül University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Sağlık ve Sanat Yerleşkesi, İzmir
| | - Candan Efeoğlu
- Professor, Dokuz Eylül University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Sağlık ve Sanat Yerleşkesi, İzmir
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Zheng L, Gao L, Hu Y, Zhang L, Guan Y. Progress in the Study of Temporomandibular Joint Lavage in Temporomandibular Joint Disorder. J Multidiscip Healthc 2024; 17:2175-2184. [PMID: 38736540 PMCID: PMC11088858 DOI: 10.2147/jmdh.s458227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024] Open
Abstract
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.
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Affiliation(s)
- Lihan Zheng
- Savaid Stomatology School, Hangzhou Medical College, Hangzhou, Zhejiang, 310053, People’s Republic of China
| | - Lixia Gao
- Savaid Stomatology School, Hangzhou Medical College, Hangzhou, Zhejiang, 310053, People’s Republic of China
| | - Yaohui Hu
- Savaid Stomatology School, Hangzhou Medical College, Hangzhou, Zhejiang, 310053, People’s Republic of China
| | - Liqun Zhang
- Department of Periodontics, Stomatological Hospital of Lin’an District, Hangzhou, Zhejiang, 310053, People’s Republic of China
| | - Ye Guan
- Savaid Stomatology School, Hangzhou Medical College, Hangzhou, Zhejiang, 310053, People’s Republic of China
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Xu J, Ren H, Zhao S, Li Q, Li C, Bao G, Kang H. Comparative effectiveness of hyaluronic acid, platelet-rich plasma, and platelet-rich fibrin in treating temporomandibular disorders: a systematic review and network meta-analysis. Head Face Med 2023; 19:39. [PMID: 37633896 PMCID: PMC10463486 DOI: 10.1186/s13005-023-00369-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/13/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVE This study aims to compare the efficacy of intra-articular injections of hyaluronic acid (HA), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) for treating temporomandibular disorders (TMDs) and summarize their mechanisms of action. METHODS Randomized controlled trials (RCTs) published until November 13, 2021, were identified using electronic and manual searches. Each study was evaluated for the risk of bias using the Cochrane risk of bias tool. The studies found via searches were categorized by follow-up time (1, 3, or 6 months). Evidence quality was graded according to the GRADE system. RESULTS Twelve RCTs were included that involved 421 patients with TMD. The network meta-analysis showed that all treatment groups improved compared to the placebo groups in terms of pain and maximal mouth opening (MMO). For pain evaluated via the visual analog scale, PRF exhibited better analgesic effects than PRP or HA after 1 and 3 months. PRP appeared to be more effective than PRF was after 6 months but there were no statistically significant differences between the two. For MMO, the effect of PRP was superior to those of PRF and HA after 1 month. However, after 3 and 6 months, PRF provided more encouraging results in improving MMO. CONCLUSION PRP and PRF exhibited similar short-term efficacy in treating TMD, while PRF was more advantageous in terms of long-term efficacy. Therefore, PRF was recommended for treating TMD.
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Affiliation(s)
- Jingjing Xu
- Key Laboratory of Stomatology of State Ethnic Affairs Commission, Northwest Minzu University, Lanzhou, 730030, China
- Department of Temporomandibular Joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Hui Ren
- Department of Temporomandibular Joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Shuwei Zhao
- Department of Temporomandibular Joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Qian Li
- Department of Temporomandibular Joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Ce Li
- Department of Temporomandibular Joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China
| | - Guangjie Bao
- Key Laboratory of Stomatology of State Ethnic Affairs Commission, Northwest Minzu University, Lanzhou, 730030, China.
| | - Hong Kang
- Department of Temporomandibular Joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China.
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Pohranychna K, Ohonovskyi R, Rybert Y, Minko L, Hlova O. EFFICACY OF ARTHROCENTESIS FOR TREATMENT OF INTERNAL POST-TRAUMATIC TEMPOROMANDIBULAR JOINT DISORDERS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:155-160. [PMID: 36883504 DOI: 10.36740/wlek202301121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
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.
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Affiliation(s)
| | - Roman Ohonovskyi
- DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE
| | | | - Lidiya Minko
- DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY, LVIV, UKRAINE
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Er N, Gülfeşan Çanakçı F. Temporomandibular joint arthrocentesis videos on YouTube: Are they a good source of information? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e310-e315. [PMID: 35278759 DOI: 10.1016/j.jormas.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND YouTube has been increasingly used as a source of information by patients in the field of health, but many studies revealed poor information quality. This study evaluated the content and quality of YouTube videos on Temporomandibular Joint Arthrocentesis (TMJA) as an information resource for patients. MATERIAL AND METHODS YouTube search with the two keywords "temporomandibular joint arthrocentesis" and "temporomandibular joint lavage" was performed. The first 160 videos were listed for each term according to relevancy. Results were assessed for inclusion and categorized for source, purpose, target, arthrocentesis method described, and the narrator of the videos. An evaluation was performed independently by two oral and maxillofacial surgeons. The quality of videos was analyzed for the content and defined as poor, moderate, and excellent. DISCERN was also performed by scoring between 0 and 5. RESULTS A total of 43 videos were evaluated. The most upload source was individual users (46.5%) and the most video upload purpose was information for professionals (37.2%). The method with the most information about was the two-needle technic, which had a rate of 44.2 percent. The average usefulness score of the videos was 3.00 and 57.1% of the videos resulted in poor quality. A statistically significant positive high correlation was found between DISCERN and usefulness scoring (r = 0.793; p < 0.001). CONCLUSION The majority of YouTube videos are of poor quality and this situation affects the patients' decisions about treatment. Health professionals should be aware of the content on YouTube and produce high-quality, accurate, and up-to-date information for patient education.
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Affiliation(s)
- Nilay Er
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Trakya University, Edirne 22030, Turkey.
| | - F Gülfeşan Çanakçı
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Trakya University, Edirne 22030, Turkey
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Evaluation of Patient Comfort and Impact of Different Anesthesia Techniques on the Temporomandibular Joint Arthrocentesis Applications by Comparing Gow-Gates Mandibular Block Anesthesia with Auriculotemporal Nerve Block. Pain Res Manag 2022; 2022:4206275. [PMID: 36090766 PMCID: PMC9453085 DOI: 10.1155/2022/4206275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Aim Temporomandibular disorders (TMDs) are clinical situations that are characterized by pain, sound, and irregular movements of the temporomandibular joints. The most common method in the treatment of TMDs is arthrocentesis. This study aims to compare the effect of conventional extraoral auriculotemporal nerve block (ANB) and Gow-Gates (GG) mandibular anesthesia techniques on patient comfort in an arthrocentesis procedure. Materials and Methods We performed this study on 40 patients who underwent TMJ arthrocentesis with ANB (n = 20) or GG (n = 20) mandibular anesthesia techniques at the Marmara University Faculty of Dentistry between 2016 and 2019. The predictor variable was the type of an anesthesia technique, and the outcome variables included were pain, maximum mouth opening (MMO), and protrusive movement (PM). They were compared at the preoperative period and 3rd and 6th month periods. Statistical analysis included means with standard deviations, a one-way ANOVA for continuous data, and the results were evaluated at the significance level of p < 0.05. Results No statistically significant difference was observed between the VAS values, MMO, and PM averages of preoperative, 3rd and 6th months of ANB and GG (p=0.142, p=0.209, and p=0.148). Conclusion Both anesthesia techniques have provided effective results in terms of pain and functional jaw movements in the postoperative period in arthrocentesis treatment.
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8
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Rajput A, Bansal V, Dubey P, Kapoor A. A Comparative Analysis of Intra-articular Injection of Platelet-Rich Plasma and Arthrocentesis in Temporomandibular Joint Disorders. J Maxillofac Oral Surg 2022; 21:168-175. [PMID: 35400915 PMCID: PMC8934820 DOI: 10.1007/s12663-020-01351-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Temporomandibular joint disorders (TMDs) are progressive disorders which lead to development of arthralgia and functional disabilities of temporomandibular joint. The treatment of the TMDs is controversial; noninvasive and minimally invasive therapies have shown a success rate of 70 to 85% for its management. The objective of present study is to evaluate and compare the efficacy of intra-articular platelet-rich plasma (PRP) and arthrocentesis in management of TMDs. Materials and Methods Twenty-four patients with complaint of reduced mouth opening, joint noise, pain, jaw deviation, not responding to medicinal treatment and coming under group II/III of RDC/TMD were included. Patients were randomly and equally divided in two groups. In group A, arthrocentesis was performed, whereas group B patients underwent intra-articular injections of PRP. Patients were clinically evaluated preoperatively to 12 months postoperatively. Result Both the groups showed significant improvement in painless mouth opening (P < 0.01), lateral movements towards unaffected side (P < 0.05) and reduction in pain complaint (P < 0.01). Arthrocentesis group also showed significant improvement in maximum mouth opening (P < 0.01). Conclusion On comparison, both groups were found to have effective treatment modality. However, arthrocentesis has higher success rate for pain elimination, and PRP is more effective in correction of joint noise and jaw deviation.
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Affiliation(s)
- Akash Rajput
- Department of Oral and Maxillofacial Surgery, Subharti Dental College & Hospital, Swami Vivekanand Subharti University, Meerut, India
| | - Vishal Bansal
- Department of Oral and Maxillofacial Surgery, Subharti Dental College & Hospital, Swami Vivekanand Subharti University, Meerut, India
| | - Prajesh Dubey
- Department of Oral and Maxillofacial Surgery, Subharti Dental College & Hospital, Swami Vivekanand Subharti University, Meerut, India
| | - Ankit Kapoor
- Department of Oral and Maxillofacial Surgery, Subharti Dental College & Hospital, Swami Vivekanand Subharti University, Meerut, India
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Ramakrishnan D, Kandamani J, Nathan KPS. Comparison of intraarticular injection of platelet-rich plasma following arthrocentesis, with sodium hyaluronate and conventional arthrocentesis for management of internal derangement of temporomandibular joint. Natl J Maxillofac Surg 2022; 13:254-261. [PMID: 36051804 PMCID: PMC9426706 DOI: 10.4103/njms.njms_94_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/02/2020] [Accepted: 05/18/2021] [Indexed: 11/07/2022] Open
Abstract
Aim: The aim of the study is to compare the efficacy of platelet-rich plasma (PRP) for the management of internal derangement of temporomandibular joint (TMJ). Settings and Design: Thirty-three patients were selected from the pool of patients visiting the department of oral and maxillofacial surgery. Simple randomization was done. Subjects and Methods: Patients with anterior disc displacement without reduction (DDWOR) were indicated for arthrocentesis. Group A patients are treated with PRP, Group B patients with sodium hyaluronate following arthrocentesis, and Group C patients were treated with arthrocentesis alone. Postoperative pain and maximal incisal opening are the primary outcomes evaluated. Statistical Analysis Used: The collected data were analyzed with IBM. SPSS statistics software 23.0 version and the one-way ANOVA with Tukey's post hoc test were used. Results: The mean age is 33 years, with female predominance. The statistical significant differences (P < 0.05) in pain and MIO between the 3 groups at the end of 3rdweek, 4thweek, and 3rd month postoperatively are seen in PRP group comparative to other groups. Conclusions: Our study has concluded that the intraarticular injection of PRP is an effective management for anterior DDWOR of TMJ than intraarticular injection of sodium hyaluronate and arthrocentesis in, reducing the pain and improving the interincisal distance in patients with DDWOR, thus providing a rapid recovery and improved quality of life.
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Singh N, Dubey SK, Bhanawat N, Rai G, Kumar A, Vatsa R. Management of Internal Disc Derangement Using Normal Saline and Sodium Hyaluronate: A Comparative Study. J Pharm Bioallied Sci 2021; 13:S207-S211. [PMID: 34447077 PMCID: PMC8375797 DOI: 10.4103/jpbs.jpbs_675_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Arthrocentesis of the temporomandibular joint (TMJ) is the unadorned form of surgical therapy which comprises of lavage of inflammatory enzymes and mediators and improve joint mobility and eliminate pain by pressure of the lavage solution in the upper compartment of TMJ. Objectives: The current study was conducted to assess and compare the effectiveness of arthrocentesis with normal saline alone and in conjunction with sodium hyaluronate (SH) injection in the treatment of internal derangement of the TMJ. Methodology: Sixty patients with internal derangement of the TMJ were randomly divided into two equal groups; Group 1 was performed with normal saline and Group 2 with normal saline followed by 1 ml of SH. The patients were followed up after 1 week to check for any postoperative complications and 1, 2, and 3 months for subsequent sessions and changes in subjective and objective variables. Results: The increase in mouth opening from preoperative to 3 months' postoperatively was 4.9 mm for Group 1 and 6.43 mm for Group 2. The change in the pain score (visual analogue scale scale) in Group 1 from the preoperative session to 3 months' follow-up was 7.23–4.1 and in Group 2 was 7.36–3.7. The difference in clicking/popping in Group 1 from preoperative session to 3 months' follow-up was 2.43–1 and in Group 2 was 2.4–0.53. Conclusion: Patients refractory to conservative treatment showed promising results with arthrocentesis with SH than arthrocentesis alone in treatment of TMJ internal derangement.
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Affiliation(s)
- Neha Singh
- Trauma Centre and Superspeciality Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | - Nilesh Bhanawat
- Department of Oral and Maxillofacial Surgery, Pacific Dental College and Research Centre, Pacific Medical University, Udaipur, Rajasthan, India
| | - Gaurav Rai
- Department of Oral and Maxillofacial Surgery, Buddha Institute of Dental Science, Patna, Bihar, India
| | - Abhishek Kumar
- Department of Oral and Maxillofacial Surgery, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India
| | - Ritesh Vatsa
- Department of Dentistry, Sri Krishna Medical College Hospital, Muzaffarpur, Bihar, India
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Hosgor H. Is arthrocentesis plus hyaluronic acid superior to arthrocentesis alone in the treatment of disc displacement without reduction in patients with bruxism? J Craniomaxillofac Surg 2020; 48:1023-1027. [DOI: 10.1016/j.jcms.2020.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/11/2020] [Accepted: 07/19/2020] [Indexed: 12/21/2022] Open
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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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Custódio ALN, Cameron A, Bakr M, Little C, Chrcanovic BR, Reher P. Positioning accuracy assessment of minimally invasive percutaneous injection techniques for the treatment of temporomandibular disorders. Dentomaxillofac Radiol 2020; 50:20200313. [PMID: 32706994 DOI: 10.1259/dmfr.20200313] [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] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the accuracy of an extraoral CBCT-planned 3D-printed surgical guide aimed to percutaneous injection of substances into the temporomandibular joint (TMJ) and the lateral pterygoid muscle (LPM). METHODS Nine human cadaver heads were used. Pre-planning CBCT and facial scans were obtained and three percutaneous injection sites were planned: one for the lower compartment of the TMJ and two for the LPM. A digital surgical guide was then designed with small titanium sleeves and printed by a 3D printer. After the injections, new CBCT scans with the needles in place were obtained in order to assess the accuracy of the procedure in relation to the virtual planning. RESULTS The mean values for angle deviation were very low (range 1.13o-4.08o), the same happening for the mean difference in the length reached (range 1.82-2.64 mm), as well as for the mean difference in the needle tip dislocation (range 0.94-2.03 mm). CONCLUSION The guide seems to be a reliable tool for accurate percutaneous injection of drugs into the inferior compartment of the TMJ and the LPM. Further studies are necessary to test the efficacy and validate the method in an in vivo study.
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Affiliation(s)
- Antônio Luís Neto Custódio
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Andrew Cameron
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - Mahmoud Bakr
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - Chris Little
- Queensland College of Art, Griffith University, Gold Coast, Australia
| | | | - Peter Reher
- School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
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Derwich M, Mitus-Kenig M, Pawlowska E. Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E225. [PMID: 32397412 PMCID: PMC7279162 DOI: 10.3390/medicina56050225] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives: There are an increasing number of patients applying for dental treatment who suffer from temporomandibular joint osteoarthritis (TMJOA). Osteoarthritis may be the cause of the pain in the area of temporomandibular joints, but its course may also be absolutely asymptomatic. The aim of this study was to present an interdisciplinary approach to TMJOA, including current diagnostics and treatment modalities on the basis of the available literature. Materials and Methods: PubMed and Scopus databases were analyzed using the keywords: ((temporomandibular joint AND osteoarthritis) AND imaging) and ((temporomandibular joint AND osteoarthritis) AND treatment). The bibliography was supplemented with books related to the temporomandibular joint. After screening 2450 results, the work was based in total on 98 publications. Results and Conclusions: Osteoarthritis is an inflammatory, age-related, chronic and progressive degenerative joint disease. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT), together with clinical symptoms, play significant roles in TMJOA diagnosis. Current MRI techniques seem to be clinically useful for assessment of bony changes in temporomandibular joint (TMJ) disorders. Treatment of TMJOA requires a complex, interdisciplinary approach. TMJOA treatment includes the cooperation of physiotherapists, rheumatologists, gnathologists, orthodontists and quite often also maxillofacial surgeons and prosthodontists. Sometimes additional pharmacotherapy is indicated. Thorough examination of TMJ function and morphology is necessary at the beginning of any orthodontic or dental treatment. Undiagnosed TMJ dysfunction may cause further problems with the entire masticatory system, including joints, muscles and teeth.
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Affiliation(s)
- Marcin Derwich
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Maria Mitus-Kenig
- Department of Prophylaxis and Experimental Dentistry, Jagiellonian University in Krakow, 31-007 Krakow, Poland;
| | - Elzbieta Pawlowska
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
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Palma LF, Rocha PR, Chaddad Neto FEA, Smith RL, de Moraes LOC. Irrigation fluid volume requirement for conventional arthrocentesis of the temporomandibular joint: a cadaver study. Int J Oral Maxillofac Surg 2020; 49:1459-1463. [PMID: 32278624 DOI: 10.1016/j.ijom.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/28/2020] [Accepted: 03/16/2020] [Indexed: 11/19/2022]
Abstract
Temporomandibular joint (TMJ) arthrocentesis is considered an effective and minimally invasive procedure for certain conditions related to temporomandibular disorders. The ideal irrigation volume for arthrocentesis lavage has not yet been defined. Therefore, the aim of this study was to evaluate the efficacy of different saline solution volumes in removing methylene blue from the TMJ space of fresh human cadavers. Nineteen cadavers were selected and 1ml of 10μM methylene blue solution was injected into the upper joint space unilaterally. Conventional arthrocentesis was then conducted by infusion of 300ml of 0.9% saline solution, collecting a 1-ml sample from the drained quantity for every 25ml injected. Finally, the samples were assayed by measuring photo absorbance of the methylene blue solution. There was a statistically significant difference between the irrigation volumes regarding the removal of methylene blue solution from the joint space (P<0.001), specifically between the first 25 ml and 200 ml (P=0.014), 225 ml (P=0.001), 250 ml (P<0.001), and 275 ml (P=0.001). Based on this ex vivo study, a 25-ml perfusion volume appears to be sufficient for joint lavage in conventional arthrocentesis of the TMJ.
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Affiliation(s)
- L F Palma
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, SP, Brazil.
| | - P R Rocha
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, SP, Brazil
| | - F E A Chaddad Neto
- Discipline of Neurosurgery, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | - R L Smith
- Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, SP, Brazil
| | - L O C 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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Polat ME, Yanik S, Odabasi O. Retrospective evaluation of the duration of arthrocentesis in the treatment of temporomandibular joint diseases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:201-205. [PMID: 32109596 DOI: 10.1016/j.jormas.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study investigated the duration of arthrocentesis in treatment of patients with different diagnoses of temporomandibular disorders. METHODS This retrospective study evaluated the duration of arthrocentesis used for 65 patients who were diagnosed with osteoarthritis (OA), disc displacement with reduction (DDWR), or disc displacement without reduction (DDWoR), in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders protocol. RESULTS Mean operation times were 423.79 (± 66.77) seconds in OA patients, 459.92 (± 56.67) seconds in DDWR patients, and 609.00 (± 106.88) seconds in DDWoR patients; these significantly differed among groups (P < 0.001). In addition, post hoc analyses revealed statistically significant differences in mean operation times between DDWoR and OA (P<0.05) and DDWoR and DDWR (P<0.05). CONCLUSION The appropriate duration of arthrocentesis may vary among joint disorders, and the duration of arthrocentesis in DDWoR treatment is longer than that in DDWR and OA treatments. In addition there was no relationship between the age or gender and operation time of the patients. Changes in anatomic structures due to temporomandibular diseases are presumed to influence the duration of arthrocentesis treatment.
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Affiliation(s)
- M E Polat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Harran University, 63300 Sanlıurfa, Turkey.
| | - S Yanik
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Harran University, 63300 Sanlıurfa, Turkey.
| | - O Odabasi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yildirim Beyazit University, 06010 Ankara, Turkey.
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17
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Kævanc B, Muazzez S, Cagræ D. Complications of temporomandibular joint arthrocentesis. SANAMED 2020. [DOI: 10.24125/sanamed.v15i1.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Arthrocentesis is a frequently performed and accepted minimally invasive and predictable procedure in the treatment of temporomandibular joint disorders. This review aimed to evaluate arthrocentesis complications. The literature search has included PubMed, Google Scholar, and EMBASE databases by using terms "((TMJ OR TEMPOROMANDIBULAR JOINT OR TMD OR TEMPOROMANDIBULAR DISORDER) AND ARTHROCENTESIS) AND COMPLICATION". Publications up to 2019 were examined. Seven studies involving arthrocentesis complications were included. Although arthrocentesis is considered as a cost-effective and safe procedure, complications may be seen due to its proximity to important anatomical structures. Most of these complications are short-lived and can easily be managed in the outpatient clinic; however, some severe complications have rarely been reported in the literature. The practitioners who perform this procedure should be aware of these possible complications and be able to manage them in the clinic.
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Rao JKD, Sharma A, Kashyap R, Walecha K, Siwach V, Arya V. Comparison of efficacy of sodium hyaluronate and normal saline arthrocentesis in the management of internal derangement of temporomandibular joints - A prospective study. Natl J Maxillofac Surg 2019; 10:217-222. [PMID: 31798259 PMCID: PMC6883885 DOI: 10.4103/njms.njms_26_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/23/2016] [Accepted: 03/26/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: The aim of the present study was to evaluate the efficacy of arthrocentesis with and without sodium hyaluronate (SH) injection in the treatment of patients with temporomandibular joint (TMJ) internal derangement. Materials and Methods: The study consisted of 20 patients with chief complaints of limited mouth opening, TMJ pain, and jaw deviation. Patients with disc displacement with reduction and closed lock were randomly divided into two groups. In Group 1, only arthrocentesis was performed, and in Group 2, arthrocentesis plus intra-articular injection of SH was performed. Arthrocentesis was performed under aseptic conditions using normal saline. Clinical evaluation was done for maximum mouth opening (MMO), TMJ pain, and jaw deviation before the procedure and 1 week, 2 weeks, 1 month, and 3 months following arthrocentesis. Results: The mean visual analog scale (VAS) score change was statistically significant in Group 1 and Group 2 for within the group analysis. There was statistically significant difference in VAS score between Group 1 and Group 2 at all time intervals postoperatively. The increase in MMO from preoperative to 3 months postoperatively was statistically significant for within the group analysis. There was a reduction in mandibular deviation in both Group 1 and Group 2, but the difference was not statistically significant. There was no statistically significant difference in deviation between the two groups. Conclusion: Arthrocentesis with SH is superior to arthrocentesis alone in treating patients suffering with TMJ internal derangement, who are refractory to conservative treatment.
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Affiliation(s)
- J K Dayashankara Rao
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
| | - Aadya Sharma
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
| | - Rahul Kashyap
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
| | - Khushboo Walecha
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
| | - Vijay Siwach
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
| | - Varun Arya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
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Hohenberger GM, Schwarz AM, Grechenig P, Grechenig C, Krassnig R, Weiglein AH, Feigl GC. Success Rate in Puncture of the Temporomandibular Joint. Clin Anat 2019; 33:683-688. [PMID: 31581305 DOI: 10.1002/ca.23489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 11/08/2022]
Abstract
Puncture of the temporomandibular joint (TMJ) is a minimally invasive treatment for various jaw disorders. This study used a cadaveric model to evaluate the procedure from two entrance points with respect to hit ratio and possible complications, such as extraarticular extrusion of injection fluid. Ten heads, embalmed with Thiel's method, were investigated. A straight line drawn with a colored pen connected the center of the tragus and the lateral canthus. The first portal "A" was located at a distance of 1 cm anterior and 2 mm caudal from the center of the tragus. Portal "B" was located 2 cm anterior and 1 cm caudal starting from the same reference point. Punctures "A" and "B" were performed alternately on the right and left sides. Specimens were dissected and the local distribution of the injected latex was recorded. With Approach A, four punctures (40%; 4/10) reached the TMJ, whereas with Approach B, six injections (60%; 6/10) entered the TMJ. There were no statistically significant differences between the tested puncture methods (P = 0.0317) and body sides (P = 1). With each method, for example, 35% (7/20) each, the injected latex was either periarticular or retromandibular. In a further 20% (4/20), it was located subperiosteally alongside the ramus of mandible. The latex was injected into the infratemporal fossa and the external acoustic meatus in one case each (each 5%). There was no statistically significant difference between the techniques. The adjacent anatomy has to be kept in mind during TMJ puncture as the complication rate was remarkably high, suggesting that ultrasound guided intraarticular injection could improve the hit rate. Clin. Anat., 33:683-688, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Gloria Maria Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | | | - Peter Grechenig
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
| | - Christoph Grechenig
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Renate Krassnig
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Heinrich Weiglein
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
| | - Georg Christoph Feigl
- Division of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria
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20
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Heo HA, Yoon HJ. Clinical outcomes of patients with bilateral anterior disc displacement without reduction and erosive change of the temporomandibular joint after performance of unilateral arthrocentesis and stabilisation splint therapy. J Oral Rehabil 2019; 47:307-312. [PMID: 31557342 DOI: 10.1111/joor.12897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/21/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
The efficacy of a combination treatment of arthrocentesis and stabilisation splint for patients with bilateral anterior disc displacement without reduction (ADDWoR) and erosive change of the TMJ remains controversial. To evaluate clinical outcomes of patients with ADDWoR and erosive change of the TMJ after performance of unilateral arthrocentesis and stabilisation splint therapy. A retrospective study of 44 patients (37 females, 7 males, mean age of 34 years) with bilateral ADDWoR and erosive change of the TMJ were included in this study. Their clinical outcomes before and after arthrocentesis and stabilisation splint therapy were compared. Evaluation criteria were as follows: (a) Maximal mouth opening (MMO); (b) Right and left maximal lateral movement (RLM, LLM) and maximal protrusive movement (PM); (c) Visual analog scale (VAS) pain score during MMO, RLM, LLM and PM; and (d) VAS pain score during palpation of masticatory muscles. Wilcoxon signed-rank test, Mc Nemar test and paired t test were used for statistical analysis. Differences in VAS pain score between arthrocentesis and non-arthrocentesis sites were not statistically significant except MMO and LLM (P < .05) after 6 months. Differences in mean VAS pain scores for all variables between before arthrocentesis and 6 months follow-up in the arthrocentesis site were statistically significant. (P < .01). Unilateral arthrocentesis on more symptomatic TMJ and subsequent stabilisation splint therapy was highly successful for pain and achievement of normal range of mandibular movements in patients with both ADDWoR and bony change.
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Affiliation(s)
- Hyun-A Heo
- Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Joong Yoon
- Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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21
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Aliyev T, Berdeli E, Şahin O. An unusual complication during arthrocentesis: N. facialis paralysis, with N. lingualis and N. alveolaris inferior anesthesia. J Dent Anesth Pain Med 2019; 19:115-118. [PMID: 31065594 PMCID: PMC6502763 DOI: 10.17245/jdapm.2019.19.2.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/12/2019] [Accepted: 03/19/2019] [Indexed: 11/23/2022] Open
Abstract
This case report aims to review complications that can occur during arthrocentesis and report an unusual complication observed in a 55-year-old man. The patient received arthrocentesis in an attempt to treat painful locking episodes of his right temporomandibular joint (TMJ). One hour after the operation, the patient experienced temporary facial paralysis in the area of the facial nerve and anesthesia of the lingual and alveolar inferior nerves. No persistent complications were detected during the postoperative follow-up. We suspected this complication occurred after anesthetic solution overflowed from a traumatic perforation in the joint capsule to the infratemporal area during the operation. To our knowledge, this complication has not been previously reported in the literature.
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Affiliation(s)
- Toghrul Aliyev
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Turkey
| | - Eynar Berdeli
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Turkey
| | - Onur Şahin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, İzmir Katip Çelebi University, İzmir, Turkey
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22
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Keskinruzgar A, Cankal DA, Koparal M, Simsek A, Karadag AS. Investigation of the effects of temporomandibular joint arthrocentesis on blood volume of the retinal structures. J Dent Anesth Pain Med 2019; 19:37-44. [PMID: 30859132 PMCID: PMC6405342 DOI: 10.17245/jdapm.2019.19.1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 01/31/2019] [Accepted: 02/09/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Arthrocentesis is a minimally invasive surgical procedure that is used to alleviate the symptoms of temporomandibular joint (TMJ) disorders. The aim of this study was to investigate the effect of arthrocentesis on the blood supply to the retinal structures. Materials and Methods Arthrocentesis was performed on 20 patients with TMJ disorders, and choroidal thickness (CT) in patients was measured to evaluate retinal blood circulation. The blood volume of the retinal structures was evaluated ipsilaterally before and after arthrocentesis, and these measurements were then compared with measurements obtained from the contralateral side. Results Before arthrocentesis, there were no differences in retinal blood volumes between the ipsilateral and contralateral sides (P = 0.96). When ipsilateral CT measurements taken before and after arthrocentesis were compared, retinal blood supply was found to have significantly decreased after arthrocentesis (P = 0.04). When contralateral CT measurements taken before and after arthrocentesis were compared, retinal blood supply was also found to have decreased after arthrocentesis, but not significantly (P = 0.19). Conclusion The solution of local anesthesia with epinephrine applied before the arthrocentesis procedure was found to reduce the blood volume of the retinal structures. To the best of our knowledge, this is the first study that has investigated the blood volume of the retinal structures following arthrocentesis.
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Affiliation(s)
- Aydin Keskinruzgar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey
| | - Dilek Aynur Cankal
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Mahmut Koparal
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey
| | - Ali Simsek
- Department of Ophthalmology, Medical School, Adiyaman University, Adiyaman, Turkey
| | - Ayse Sevgi Karadag
- Department of Ophthalmology, Medical School, Adiyaman University, Adiyaman, Turkey
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Bergstrand S, Ingstad HK, Møystad A, Bjørnland T. Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint osteoarthritis. J Oral Sci 2019; 61:82-88. [PMID: 30814387 DOI: 10.2334/josnusd.17-0423] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study evaluated the long-term effectiveness of intra-articular temporomandibular joint arthrocentesis for patients with osteoarthritis and compared arthrocentesis/lavage alone with arthrocentesis/lavage and injected hyaluronic acid. Forty patients met the inclusion criteria, and 37 completed long-term follow-up (approximately 4 years). The patients were randomly allocated to two groups: arthrocentesis with lavage alone (A-group, n = 17) or combined with hyaluronic acid treatment (AS-group, n = 20). Standard two-needle arthrocentesis was performed. Pain and joint sounds were measured at baseline and approximately 4 years after treatment. Reported pain, as indicated by visual analogue scale (VAS) score, significantly decreased from baseline to the final follow-up examination in both groups. Mean VAS score decreased from 64 to 16 (P < 0.001) in the A-group and from 63 to 25 (P < 0.001) in the AS-group. Average maximum incisor opening increased significantly in both groups but did not significantly differ between groups (P = 0.223). Joint sounds did not significantly improve within groups (A-group, P = 0.495; AS-group, P = 0.236). Both methods resulted in significant long-term improvements in pain and jaw function.
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Affiliation(s)
- Sara Bergstrand
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
| | - Hanne K Ingstad
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
| | - Anne Møystad
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
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Grossmann E, Poluha RL, Iwaki LCV, Santana RG, Iwaki Filho L. The use of arthrocentesis in patients with temporomandibular joint disc displacement without reduction. PLoS One 2019; 14:e0212307. [PMID: 30759144 PMCID: PMC6374052 DOI: 10.1371/journal.pone.0212307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/31/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of the use of the arthrocentesis in patients with disc displacement without reduction (DDWOR). Two hundred and thirty-four (234) patients with DDWOR were evaluated and the following data collected: gender; affected side; age (years); duration of the pain (months); patient's perception of pain (measured by Visual Analogue Scale [VAS 0-10]); maximal interincisal distance (MID) (mm); and joint disc position, determined by magnetic resonance imaging. Data were obtained in two different moments: before the arthrocentesis (M1) and three or four months later (M2). Paired t-Student Test, Scores Test and Wilcoxon Test showed a statistical significant difference (p<0.0001) between the M1 and M2 for the variables VAS and MID. There was an alteration in the joint disc position in 93.88% of the cases after arthrocentesis. There was no association between the general characteristics of the patients on the M1 and the results of the arthrocentesis (p>0.05). It can be concluded that the arthrocentesis is efficient in reducing the pain, in increasing interincisal distance, and altering the joint disc position in patients with DDWOR regardless gender, age side and pain duration.
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Affiliation(s)
- Eduardo Grossmann
- Department of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail: ,
| | | | | | | | - Liogi Iwaki Filho
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
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Soni A. Arthrocentesis of Temporomandibular Joint- Bridging the Gap Between Non-Surgical and Surgical Treatment. Ann Maxillofac Surg 2019; 9:158-167. [PMID: 31293946 PMCID: PMC6585213 DOI: 10.4103/ams.ams_160_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Abhishek Soni
- Department of Oral Medicine and Radiology, Modern Dental College and Research Center, Indore, Madhya Pradesh, India
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Yapici-Yavuz G, Şimşek-Kaya G, Oğul H. A comparison of the effects of Methylprednisolone Acetate, Sodium Hyaluronate and Tenoxicam in the treatment of non-reducing disc displacement of the temporomandibular joint. Med Oral Patol Oral Cir Bucal 2018; 23:e351-e358. [PMID: 29680845 PMCID: PMC5945235 DOI: 10.4317/medoral.22237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/18/2018] [Indexed: 12/03/2022] Open
Abstract
Background This clinical study aimed to radiologically and clinically compare the effect of intra-articular injection of methylprednisolone, sodium hyaluronate or tenoxicam following arthrocentesis with that of arthrocentesis alone in patients with non-reducing disc displacement. Material and Methods A total of 44 patients radiographically diagnosed with non-reducing disc displacement of the temporomandibular joint (TMJ) were randomly divided into four treatment groups, as follows: Group 1, arthrocentesis alone; Group 2, arthrocentesis plus methylprednisolone acetate; Group 3, arthrocentesis plus sodium hyaluronate; Group 4, arthrocentesis plus tenoxicam. Maximum mouth opening (MMO), lateral movement, pain severity and tenderness of TMJ and muscles of mastication on palpation were measured before treatment and at 1 week and 1, 3 and 6 months after treatment. Disc position, presence or absence of disc reduction, level of effusion, joint movement and joint space were also evaluated using magnetic resonance imaging (MRI) before treatment and 6 months after treatment. Results No significant differences in treatment success were found among the four groups. MRI findings did not vary significantly among the groups, but pre- and post-operative MRI findings varied significantly within all four groups (p<0.001). Conclusions According to the data from this study, it may be concluded that either arthrocentesis alone or arthrocentesis with methylprednisolone acetate or sodium hyaluronate or tenoxicam intra-articular injections are similarly effective and promising methods in the treatment of TMJ with non-reducing disc displacement. Key words:Non-reduction disc displacement, arthrocentesis, methylprednisolone, sodium hyaluronate, tenoxicam.
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Affiliation(s)
- G Yapici-Yavuz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey,
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Kumar S, Kiran K, Yadav A. Temporomandibular Joint Arthrocentesis: A Prospective Study and Audit of 500 Joints of Central India. J Int Soc Prev Community Dent 2018; 8:124-129. [PMID: 29780737 PMCID: PMC5946520 DOI: 10.4103/jispcd.jispcd_361_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/23/2018] [Indexed: 11/21/2022] Open
Abstract
Aim and Objectives: Aim of this study was to compare prospective effectiveness of arthrocentesis of temporomandibular joint by single- and double-needle technique in central India population. Materials and Methods: Out of 230 patients, 500 joints were included in the study and were randomly selected into two groups: single needle and double needle. Follow-up of patients were done as 1 week, 1 and 3 months. (The statistical analysis was done using SPSS [Statistical Package for Social Sciences] Version 15.0 Statistical Analysis Software). Results: Both techniques were equally effective at reducing pain and increasing the maximal mouth opening. The single-needle technique was easier to perform and required a shorter operative time (P < 0.01). Conclusion: The results obtained indicate that single versus double arthrocentesis techniques were equally effective in reducing the pain and increasing the mouth opening and reducing the clicking sound. However, single-needle technique was easier to perform and required a shorter operative time.
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Affiliation(s)
- Shailesh Kumar
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kamini Kiran
- Department of Oral and Maxillofacial Pathology and Microbiology, Seema Dental College, Rishikesh, Uttarakhand, India
| | - Anurag Yadav
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Utter Pradesh, India
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Grossmann E, Poluha RL, Iwaki LCV, Santana RG, Filho LI. Predictors of arthrocentesis outcome on joint effusion in patients with disk displacement without reduction. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:382-388. [PMID: 29422400 DOI: 10.1016/j.oooo.2017.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/28/2017] [Accepted: 12/13/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the preoperative variables in patients with articular disk displacement without reduction that may influence the results of arthrocentesis on joint effusion (JE). STUDY DESIGN The records of 203 patients with clinical signs and symptoms of unilateral painful disk displacement without reduction and JE, confirmed by magnetic resonance imaging (MRI), and treated with arthrocentesis were selected. The following preoperative data were recorded: sex; age; joint side; pain duration; pain intensity, measurement with the visual analogue scale; and maximum interincisal distance (MID). All patients underwent a second MRI examination 3 to 4 months postoperatively to assess JE. The sample was then divided into 2 groups: group 1 (n = 160) comprised patients with no signs of JE; and group 2 (n = 43) comprised patients still showing signs of JE. Univariate and multivariate analyses were used to compare the groups. RESULTS Among the studied variables, pain duration (P = .0175), pain intensity (P < .0001), and MID (P = .0085) were shown to affect arthrocentesis outcomes. The longer the pain duration (odds ratio [OR] = 0.930), the more intense was the pain (OR = 0.346), and the smaller the MID (OR = 0.562), the less were the chances of arthrocentesis completely eliminating JE. CONCLUSIONS Pain duration, pain intensity, and MID can be used as predictors for the effect of arthrocentesis on JE outcomes and considered during treatment planning.
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Affiliation(s)
- Eduardo Grossmann
- Craniofacial Pain Applied to Dentistry, Department of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | | | | | | | - Liogi Iwaki Filho
- Oral and Maxillofacial Surgery, Department of Dentistry, State University of Maringá, Maringá, Brazil
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Şentürk MF, Yazıcı T, Gülşen U. Techniques and modifications for TMJ arthrocentesis: A literature review. Cranio 2017; 36:332-340. [DOI: 10.1080/08869634.2017.1340226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mehmet Fatih Şentürk
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Süleyman Demirel University, Isparta, Turkey
| | - Tayfun Yazıcı
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Süleyman Demirel University, Isparta, Turkey
| | - Uğur Gülşen
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Bülent Ecevit University, Zonguldak, Turkey
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Vaira LA, Raho MT, Soma D, Salzano G, Dell'aversana Orabona G, Piombino P, De Riu G. Complications and post-operative sequelae of temporomandibular joint arthrocentesis. Cranio 2017; 36:264-267. [PMID: 28618979 DOI: 10.1080/08869634.2017.1341138] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate intraoperative complications and postsurgical sequelae associated with arthrocentesis of the TMJ, including injection of Sodium Hyaluronate. METHODS This retrospective study evaluated 433 arthrocentesis procedures performed in 315 patients between January 2009 and August 2016. The authors reviewed the complications identified during the procedure and the follow-up period. RESULTS Temporary swelling of the periarticular tissues (95.1%) or the external auditory canal (23.5%), ipsilateral temporary open bite (68.8%), frontalis and orbicularis oculis paresis (65.1%), preauricular hematoma (0.4%), and a case of vertigo (0.2%) were the complications detected. CONCLUSIONS TMJ arthrocentesis remains a procedure with a minimum number of important complications. If present, complications are generally temporary, caused by the anesthetic effect or by the soft tissue edema created by the fluid extravasation created by the irrigation procedure, and can be managed on an outpatient basis.
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Affiliation(s)
- Luigi Angelo Vaira
- a Operative Unit of Maxillo-Facial Surgery , University of Sassari , Sassari , Italy.,b Operative Unit of Maxillo-Facial Surgery , University of Naples "Federico II" , Naples , Italy
| | - Maria Teresa Raho
- a Operative Unit of Maxillo-Facial Surgery , University of Sassari , Sassari , Italy
| | - Damiano Soma
- a Operative Unit of Maxillo-Facial Surgery , University of Sassari , Sassari , Italy
| | - Giovanni Salzano
- b Operative Unit of Maxillo-Facial Surgery , University of Naples "Federico II" , Naples , Italy
| | | | | | - Giacomo De Riu
- a Operative Unit of Maxillo-Facial Surgery , University of Sassari , Sassari , Italy
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Comparison of the effectiveness of three different treatment methods for temporomandibular joint disc displacement without reduction. Int J Oral Maxillofac Surg 2017; 46:603-609. [DOI: 10.1016/j.ijom.2017.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 10/25/2016] [Accepted: 01/23/2017] [Indexed: 11/19/2022]
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Vaira LA, Soma D, Meloni SM, Dellàversana Orabona G, Piombino P, De Riu G. Vertiginous crisis following temporomandibular joint athrocentesis: a case report. Oral Maxillofac Surg 2017; 21:79-81. [PMID: 27924428 DOI: 10.1007/s10006-016-0603-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
Temporomandibular joint arthrocentesis and arthroscopy have recently exceeded open surgeries for disorders that failed to respond to conservative treatment. The efficacy of arthrocentesis in reestablishing normal mouth opening and reducing pain and dysfunctions is now commonly accepted, but in contrast to arthroscopy, there are no large series studies on arthrocentesis complications. We report the major complication occurred in our experience: a case of a patient that complained of a violent vertigo, without hearing disorders, following the procedure.
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Affiliation(s)
- Luigi Angelo Vaira
- Operative Unit of Maxillofacial Surgery, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy.
- Operative Unit of Maxillofacial Surgery, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy.
| | - Damiano Soma
- Operative Unit of Maxillofacial Surgery, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | - Silvio Mario Meloni
- Dental School, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
| | | | - Pasquale Piombino
- ENT Operative Unit, Second University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Giacomo De Riu
- Operative Unit of Maxillofacial Surgery, University of Sassari, Viale San Pietro 43B, 07100, Sassari, Italy
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Camino Junior R, Manzi MR, Carvalho MFD, Luz JGDC, Pimentel AC, Deboni MCZ. Manual reduction of articular disc after traumatic extraction of mandibular third molar: a case report. Dental Press J Orthod 2015; 20:101-7. [PMID: 26560828 PMCID: PMC4644926 DOI: 10.1590/2177-6709.20.5.101-107.oar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 12/20/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Disc displacement without reduction with limited opening is an intracapsular biomechanical disorder involving the condyle-disc complex. With the mouth closed, the disc is in an anterior position in relation to the condylar head and does not reduce with mouth opening. This disorder is associated with persistent limited mandibular opening. CASE REPORT The patient presented severe limitation to fully open the mouth, interfering in her ability to eat. Clinical examination also revealed maximum assisted jaw opening (passive stretch) with less than 40 mm of maximum interincisal opening. Magnetic resonance imaging was the method of choice to identify the temporomandibular disorders. CONCLUSION By means of reporting this rare case of anterior disc displacement without reduction with limited opening, after traumatic extraction of a mandibular third molar, in which manual reduction of temporomandibular joint articular disc was performed, it was possible to prove that this technique is effective in the prompt restoration of mandibular movements.
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Affiliation(s)
| | | | | | - João Gualberto de Cerqueira Luz
- Department of Oral and Maxillofacial Surgery and Traumatology, School of Dentistry, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Ângelo DF, Sousa R, Pinto I, Sanz D, Gil FM, Salvado F. Early magnetic resonance imaging control after temporomandibular joint arthrocentesis. Ann Maxillofac Surg 2015; 5:255-7. [PMID: 26981483 PMCID: PMC4772573 DOI: 10.4103/2231-0746.175756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Temporomandibular joint (TMJ) lysis and lavage arthrocentesis with viscosupplementation are an effective treatment for acute disc displacement (DD) without reduction. Clinical success seems to be related to multiple factors despite the lack of understanding of its mechanisms. The authors present a case report of 17-year-old women with acute open mouth limitation (12 mm), right TMJ pain-8/10 visual analog scale, right deviation when opening her mouth. The clinical and magnetic resonance imaging (MRI) diagnosis was acute DD without reduction of right TMJ. Right TMJ arthrocentesis was purposed to the patient with lysis, lavage, and viscosupplementation of the upper joint space. After 5 days, a new MRI was performed to confirm upper joint space distension and disc position. Clinical improvement was obtained 5 days and 1 month after arthrocentesis. Upper joint space increased 6 mm and the disc remained displaced. We report the first early TMJ MRI image postoperative, with measurable upper joint space.
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Affiliation(s)
- David Faustino Ângelo
- Department of Stomatology, Santa Maria University Hospital - North Lisbon Hospital, Lisbon, Portugal
| | - Rita Sousa
- Department of Neuroradiology, Santa Maria University Hospital - North Lisbon Hospital, Lisbon, Portugal
| | - Isabel Pinto
- Department of Maxilofacial, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - David Sanz
- Department of Maxilofacial, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - F Monje Gil
- Department of Oromaxilofacial, Hospital Infanta Cristina, Badajoz, Spain
| | - Francisco Salvado
- Department of Stomatology, Santa Maria University Hospital - North Lisbon Hospital, Lisbon, Portugal
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Damlar I, Esen E, Tatli U. Effects of glucosamine-chondroitin combination on synovial fluid IL-1β, IL-6, TNF-α and PGE2 levels in internal derangements of temporomandibular joint. Med Oral Patol Oral Cir Bucal 2015; 20:e278-83. [PMID: 25662545 PMCID: PMC4464914 DOI: 10.4317/medoral.20242] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/18/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aim of the present study was to evaluate the effects of glucosamine-chondroitin sulphate combination on internal derangements of temporomandibular joint in clinical and biochemical manners. MATERIAL AND METHODS This randomized clinical study included 31 cases reporting joint tenderness, in which disc displacement was detected on MR imaging. In all patients, synovial fluid sampling was performed under local anesthesia. In the study group, the patients were prescribed a combination of 1500 mg glucosamine and 1200 mg chondroitin sulphate, while patients in the control group were only prescribed 50 mg tramadol HCl (twice daily) for pain control. After 8 weeks, synovial fluid sampling was repeated in the same manner. The levels of pain, maximum mouth opening (MMO), synovial fluid IL-1ß, IL-6, TNF-α and PGE2 measured before and after pharmacological intervention were compared. RESULTS The reduction in pain levels was significant in both groups. There was no significant difference between two groups in terms of pain reduction. The improvement in MMO was significant in the study group but it was not in the control group. The MMO improvement was significantly higher in the study group compared to the control group. In the study group, significant decrease was observed in PGE2 level, while the decreases in IL-1β, IL-6 and TNF-α levels were not significant. In the control group, no significant decrease was observed in any of the inflammatory cytokines after 8 weeks, moreover IL-1ß and IL-6 levels were increased. Alterations of IL-1ß and IL-6 levels were significant in study group while TNF-α and PGE2 levels were not, compared to control group. CONCLUSIONS In conclusion, these results might suggest that glucosamine-chondroitin combination significantly increases the MMO and decreases the synovial fluid IL1β and IL6 levels in internal derangements of TMJ compared to tramadol. The modifications of synovial fluid TNF-α and PGE2 levels do not reach statistical significance. This combination also provides efficient pain relief in similar level with tramadol, a narcotic analgesic.
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Arthrocentesis and temporomandibular joint disorders: clinical and radiological results of a prospective study. Int J Dent 2013; 2013:790648. [PMID: 24319462 PMCID: PMC3844254 DOI: 10.1155/2013/790648] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/06/2013] [Indexed: 11/18/2022] Open
Abstract
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.
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