An additional lysis procedure during arthrocentesis of the temporomandibular joint

Abstract

Background Arthrocentesis of the temporomandibular joint (TMJ) is an easy, highly efficient, minimally invasive procedure for treating temporomandibular joint disorders (TMDs). However, in some cases of mouth opening limitation (MOL), routine arthrocentesis is ineffective due to severe fibrotic adhesion in the superior joint space of the TMJ. In this condition, mechanical lysis of the adhesions might be needed to resolve the MOL, as well as other symptoms, such as chronic pain. Currently, this can be achieved by arthroscopic surgery or open TMJ surgery. The objective of this study was to introduce and evaluate our trial of the adhesion lysis procedure during arthrocentesis of the TMJ using normal 18-gauge needles. Results In this study, 40 patients with MOL due to disc derangement underwent conventional arthrocentesis at first and then physical detachment was conducted using the same needle. The change in maximum mouth opening (MMO) and the pain at the TMJ were recorded before, during, and after treatment according to our protocol. The mean increase in MMO after conventional arthrocentesis was 6.6 ± 4.2mm. The mean increase in MMO after the detachment procedure with the same needle was 4.2 ± 2.0 mm. The MMO in ten patients was significantly increased after the detachment procedure than after arthrocentesis alone. In all cases, the pain intensity in the TMJ significantly decreased over time, whereas the MMO increased over time. No adverse effect was observed in all joints during our observation periods. Conclusion We confirmed that our simple lysis procedure with the same needle of the arthrocentesis of the TMJ could not only improve the MMO more than after a conventional arthrocentesis but also resolve severe adhesion of the joint space that was ineffective by conventional arthrocentesis. Although this additional lysis procedure is simple, it might reduce the number of cases of more invasive procedures such as arthroscopic surgery or open TMJ surgery.

State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review

“…In addition, pain reduction was comparable between these two techniques, as the double technique showed a VAS reduction from a mean value of 6.6 to 1.2 and the single-puncture technique showed a reduction from a mean value of 6.0 to 0.4, also without significant differences in the paired t -tests. Thus, concluding that both the single-or double technique are similarly efficient in the reduction in pain and increasing mouth opening in patients with DDWOR [ 3 , 6 , 7 , 8 , 9 , 16 , 17 , 18 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Increased values of MMO following the operation interfered with the more decreased VAS reported by patients in the analyzed material.…”

“…These observations are consistent with the observations of other authors [ 18 ]. Additionally, the manual lysis of adhesions with the use of a needle during arthrocentesis may be beneficial in increasing post-operative MMO, according to [ 21 ].…”

Can the Autogenous Nanofat Injection Improve the Symptoms of Patients With Temporomandibular Joint Internal Derangement? A Prospective Observational Clinical Study

“…In the progression of ID, chronic inflammation results in joint space adhesion to varying degrees; this could limit the condylar head and disc’s natural movement, increasing joint space friction and further aggravating disc displacement. Clinically, this results in limited mouth opening 26 …”

“…Clinically, this results in limited mouth opening. 26 Chęciński et al 27 stated that the role of stem cells in painful joints appears to be related to getting the inflammatory signals down, leading to decrease pain and inflammation since adiposederived stem cells (ADSCs) have anti-inflammatory properties permitting a reparative phase and slowing down degradation. Stem cells presented in high quality and large numbers in nanofat emulsion show regeneration potential over peripheral nerve tissues; these cells can differentiate in vitro into components that resemble Schwann cells in phenotype.…”

Evaluating Role of Arthrocentesis in Management of Internal Derangement of TMJ

“…Concerning the management of TMJ the complex anatomy of TMJ plays a vital role since it has its components that attached the most versatile part of human body. It has its several components performing and aiding in multitude of functions (1). Each instance of TMD is different and complex, thus diagnosis involves a thorough examination of the individual patient's history and symptoms as well as a range of methods.…”