Lavage Volume of Arthrocentesis in the Management of Temporomandibular Disorders: A Systematic Review and Meta-Analysis

Abstract

The aim of this study was to investigate the most effective lavage volume of arthrocentesis in the management of temporomandibular disorders. A comprehensive electronic search, based on the PRISMA guidelines, was performed, which included a computer search with specific keywords, a reference list search and a manual search. The inclusion criteria were the following: a randomized controlled trial, at least 20 subjects who underwent arthrocentesis, mention of the irrigation materials used for the arthrocentesis, mention of the irrigation volumes used for the arthrocentesis, MMO and pain measured as VAS or NRS, were reported as outcome figures, mention of a specific diagnosis or signs and symptoms, and inclusion of the data on the MMO or VAS/NRS at 6-month follow-up. Sixteen publications were enrolled in the meta-analysis, comparing arthrocentesis with a lavage volume <150 mL and arthrocentesis with a lavage volume ≥150 mL, in the efficacy of the improvement in the mouth opening and pain reduction. The results revealed the group with a lavage volume <150 mL had a greater improvement in the mouth opening and pain reduction. However, results are to be interpreted with caution, due to the paucity of the randomized controlled literature and other confounding factors. Further high-quality studies are required to provide a better conclusion to the treatment outcomes of the different lavage volumes.

Temporomandibular Joint Injections and Lavage: An Overview of Reviews

“…AC with a small volume of lavage fluid (less than 150 mL) is as effective, if not more, as a high-volume procedure [17]. A USG-guided AC does not lead to a better outcome than an unguided intervention [50].…”

“…More and more attention is being paid to aspects of injection therapy other than the type of preparation administered. Differences in the therapeutic protocols proposed by different groups of scientists are significant and include (1) the specific site of deposition (compartments of the joint cavity and pericapsular tissues); (2) the volume of the substance injected; (3) the number of interventions; (4) intervals between interventions [16][17][18][19].…”

“…In the case of rinsing the joint cavity, attempts are also made to examine the differences between the following techniques: (1) two-needle; (2) two-way needle; (3) one-way needle (pumping technique) [20][21][22][23][24]. Furthermore, arthrocentesis protocols also differ in terms of the following: (1) the type of irrigant; (2) the volume of the rinsing agent; (3) single use or repetition of the intervention at different time intervals [17,23,25]. It is common to combine lavage with active substance administration in one intervention.…”

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

“…Whether the ideal state after lavage can be achieved with less lavage volume remains to be studied. 64 …”

Tratamiento de Elección entre Inyecciones Infiltrativas y Artrocentesis para el Manejo de Dolor y Limitaciones de Apertura Bucal en Trastornos de la Articulación Temporomandibular: una Revisión de Literatura

“…La articulación temporomandibular es una articulación sinovial bilateral que se encuentra a ambos lados del complejo craneomandibular, desempeña un papel importante en funciones como la masticación, la deglución, el habla y movimientos automáticos como el bostezar, se estima que realiza entre 2000 y 2500 movimientos aproximadamente durante el día (Gonzales Sanchez et al, 2023). La disfunción de la articulación temporomandibular es un proceso continuo y multidimensional que afecta a las estructuras relacionadas ocasionando trastorno interno (Chung et al, 2019), este conjunto de condiciones comunes de dolor facial afectan alrededor del 6% al 12% de la población general (Tsui et al, 2022) y presentan una prevalencia cinco veces mayor en mujeres (D. T. S. Li et al, 2021). Produce inflamación, dolor y una reducción de la movilidad articular por acumulación de citoquinas inflamatorias que llegan a producir daño a las estructuras de la ATM, lo que resulta en un deterioro de la calidad de vida del paciente (Chęciński et al, 2023;Zwiri et al, 2020).…”