Relationship between effectiveness of arthrocentesis under sufficient pressure and conditions of the temporomandibular joint

Yura, Shinya; Totsuka, Yasunori

doi:10.1016/j.joms.2004.06.053

Cited by 53 publications

(41 citation statements)

References 12 publications

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“…We believe, as do other authors, 12 6 With regard to adhesions, it should be pointed out that it is a relatively frequent finding in joint pathology, although most appear in the anterior and medial recesses of the TMJ. 15 In fact, in our personal experience of more than 320 arthroscopies, we have never found an adhesion that was situated in the middle portion of the articular disc and fossa without associated synovitis (Fig.…”

supporting

confidence: 65%

“…6,10 Nitzan y Etsion, 11 explican el mecanismo de acción de la artrocentesis en el SDA con la hipótesis de que inyectando fluido en el espacio articular superior, las superficies son separadas por hidro-disección, ayudando a la restauración de la motilidad del disco articular. Nosotros, al igual que otros autores, 12 pensamos que el aumento de la presión intra-articular también contribuiría al despegamiento del disco de la fosa; por ello, tal vez una simple instilación sin lavado articular sería suficiente en muchos casos para resolver el SDA, aunque el posterior lavado que se realiza en la artrocentesis ayudaría a limpiar las numerosas toxinas, proteínas y sustancias inflamatorias que se acumulan en la articulación. 13 La artroscopia es una técnica altamente efectiva en la ATM y que además proporciona imágenes articulares, permitiendo actuar directamente sobre diferentes estructuras.…”

Section: Some Authors Have Defined the Possible Pathogenesis Of Adp Aunclassified

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Hallazgos artroscópicos en un caso de disco articular adherido de la ATM

López

Díaz

Gutiérrez

2005

Rev Esp Cirug Oral y Maxilofac

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Resumen: El síndrome de disco adherido (SDA) o stuck syndrome de la articulación temporomandibular (ATM) es un fenómeno que ha sido descrito recientemente y cuya fisiopatogenia es una alteración bioquímica que se produce en algunas ATMs con disfunción temporomandibular. En el presente artículo describimos un caso clínico y especialmente los interesantes hallazgos artroscópicos encontrados, que ayudarían a corroborar el mecanismo fisiopatogénico propuesto. Son de especial relevancia la correcta posición discal dentro de la articulación y una zona eritematosa encontrada en la sinovial que recubre la fosa-eminencia glenoidea de la articulación.Palabras clave: Síndrome de disco adherido; Stuck syndrome; Articulación temporomandibular. Recibido IntroducciónEl síndrome de disco adherido (SDA) fue inicialmente descrito por la Dra. Dorrit Nitzan en el año 1991, como una posible causa de limitación brusca de la apertura de la boca. 1,2 Posteriormente, ella misma estudió el proceso de lubrificación dentro de la articulación temporomandibular (ATM) basándose en la experiencia en cirugía ortopédica, 3 y finalmente lanzó la hipótesis patogénica de este síndrome. 4 El SDA (anchored disc phenomenon), también ha sido denominado como síndrome de disco anclado o stuck syndrome. Algunos autores lo incluyen dentro de las variantes del sín-drome de disfunción temporomandibular (SDTM), siendo una de las causas de bloqueo articular (closed lock). 5 Clínicamente, el SDA se manifiesta por una limitación generalmente brusca de la apertura oral y del movimiento de laterotrusión hacia el lado contralateral acompañados de dolor cuando se fuerza la apertura, con un end-feel duro. El diagnóstico de sospecha ha de confirmarse mediante un estudio con RM, en el cual característicamente se observará un disco inmóvil durante los movimientos de apertura y cierre de la boca. El tratamiento que tradicionalmente se ha propuesto consiste en algún tipo de procedimiento de cirugía mínimamente invasiva, bien artrocentesis o bien artroscopia. 5 El objetivo del presente artículo es mostrar algunos hallazgos artroscópicos curiosos que no han sido previamente descritos, encontrados en un caso clínico de SDA. Caso clínicoMujer de 37 años de edad que acudió a nuestras consultas derivada desde otro Centro por dolor en ambas articulaciones temporomandibulares desde hacía años. Refería haber realizado diversos tratamientos conservadores que no habían sido efectivos. Era portadora de una férula oclusal tipo Michigan desde hacía 1 año que le había producido una ligera mejoría. Refería que hace 4 meses sufrió un episodio súbito de limitación de la apertura de la boca acompañado de una aumento del dolor en la ATM izquierda y que desde entonces no había podido colocarse la férula. Ante la pregunta de si escucha ruidos articulares, comenta que hasta esa fecha oía chasquidos en ambas articulaciones al abrir y cerrar la boca, pero que a partir de ese episodio dejó de escucharlos. Había tenido otros episodios de bloqueos que se habían resuelto espontá-neamente. A la explo...

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supporting

confidence: 65%

Section: Some Authors Have Defined the Possible Pathogenesis Of Adp Aunclassified

Hallazgos artroscópicos en un caso de disco articular adherido de la ATM

López

Díaz

Gutiérrez

2005

Rev Esp Cirug Oral y Maxilofac

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“…Arthrocentesis under sufficient pressure can also remove adhesions, widen the joint spaces and improve mouth opening [3,15,16]. In patients who presented with limited mouth opening, significant improvement was seen in the immediate post-operative period and with reduction in pain, mouth opening further increased from third to sixth months.…”

Section: Discussionmentioning

confidence: 99%

Arthrocentesis for the Treatment of Internal Derangement of the Temporomandibular Joint

Neeli

Umarani

Kotrashetti

et al. 2010

J. Maxillofac. Oral Surg.

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Objective The study aims to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of the temporomandibular joint (TMJ). Study Design Thirty patients with TMJ internal derangement underwent arthrocentesis using saline. Pain using visual analog scale, maximum mouth opening, joint noises and mandible deviation were documented pre-operatively and post-operatively. Patients were followed for 1 year. Statistical analysis of pain was done by Wilcoxon signed Rank's test and dysfunction by students paired t test. Results The mean pre-operative pain was 4.8 ± 2.65 and post-operatively at 1 year was 0.27 ± 0.45 with an average decrease of 4.72 (P = 0.000). The mean maximal mouth opening pre-operatively was 29.8 ± 2.35 mm and postoperatively 41.9 ± 2.48 mm at 1 year. The mean increase in the mouth opening was 12.1 ± 3.0 mm (P = 0.000). Conclusion Arthrocentesis is simple, minimally invasive procedure with less risk of complications and significant benefits in patients with TMJ internal derangement.Internal derangement of the temporomandibular joint (TMJ) is characterized by displacement of the intra-articular disc, resulting in clicking and popping sounds. However, the displacement of the articular disc does not always cause a mechanical obstruction. These conditions may be painless or they may be associated with pain, especially during function. The most common causes are trauma, which results in an immediate displacement of the disc, or chronic parafunction, which results in degenerative changes in the articular surfaces, increased friction, and gradual disc displacement.TMJ internal derangement has always presented as therapeutic challenge to the maxillofacial surgeons. Up to 25% of the entire population has internal derangement of TMJ and usually they are treated with nonsurgical methods such as medications, physiotherapy and occlusal splints in the initial period [1]. When these methods are unsuccessful, they are often managed by surgical methods. The mainstay of surgical treatment is based on changing the morphology or position of the disc, or removal of the disc with or without replacement. There are variable reports of success with the open surgical methodologies and are associated with surgical risks and potential long term sequelae [2].New insights into the joint pathology of internal derangement were provided by the observations made during TMJ arthroscopic lysis and lavage and outcomes after such treatment. The physical action of lysis and lavage in the superior joint space, rather than disc repositioning, is believed to be responsible for the success of arthroscopic surgery [3,4]. This has led to the use of TMJ arthrocentesis as a relatively less invasive alternative to reduce the inflammation in the superior joint space and restore normal range of motion [3]. The study aims to discuss the role of arthrocentesis in the treatment of internal derangement of the TMJ and present clinical data relating to the efficacy of arthrocentesis. Materials and MethodsThis prospective clinica...

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“…Adhesions were classified as no adhesions (Figure 3c), mild adhesions (localized band-like or membrane-type adhesions) or severe adhesions (extensive wall-like adhesions). 7 When intra-articular adhesions were detected, treatment was given simultaneously. 7,8 Data collection and statistical analysis The presence and degree of adhesions in the upper joint space were investigated by fat-saturated T 2 weighted MRI and arthroscopic findings.…”

Section: Arthroscopic Examinationmentioning

confidence: 99%

Diagnostic accuracy on fat-saturatedT₂weighted MRI for diagnosis of intra-articular adhesions of the temporomandibular joint

Yura¹,

Nobata²,

Shima³

2012

Dentomaxillofacial Radiology

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Objective: The purpose of this study is to compare intra-articular adhesions of the temporomandibular joint (TMJ) between fat-saturated T 2 weighted MR images and arthroscopic findings. Methods: 50 patients (50 joints) with closed locking of the TMJ who were examined with MRI and then underwent arthroscopic surgery participated in this study. The concordance rate of intra-articular adhesions between fat-saturated T 2 weighted MR images and arthroscopic findings was studied using the kappa coefficient. Results: Intra-articular adhesions were seen on MRI in 21 joints (42%) and in arthroscopic findings in 26 joints (52%). Thus, five joints had false-negative results and mild adhesions were arthroscopically observed in these five joints. There was significant concordance between these two findings (p , 0.001). The kappa coefficient was 0.801, which was considered to be complete concordance. Conclusions: On fat-saturated MRI, a low signal intensity area and narrowing image in the joint space of the TMJ may indicate the presence of intra-articular adhesions or fibrosis.

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Relationship between effectiveness of arthrocentesis under sufficient pressure and conditions of the temporomandibular joint

Cited by 53 publications

References 12 publications

Hallazgos artroscópicos en un caso de disco articular adherido de la ATM

Hallazgos artroscópicos en un caso de disco articular adherido de la ATM

Arthrocentesis for the Treatment of Internal Derangement of the Temporomandibular Joint

Diagnostic accuracy on fat-saturatedT₂weighted MRI for diagnosis of intra-articular adhesions of the temporomandibular joint

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Relationship between effectiveness of arthrocentesis under sufficient pressure and conditions of the temporomandibular joint

Cited by 53 publications

References 12 publications

Hallazgos artroscópicos en un caso de disco articular adherido de la ATM

Hallazgos artroscópicos en un caso de disco articular adherido de la ATM

Arthrocentesis for the Treatment of Internal Derangement of the Temporomandibular Joint

Diagnostic accuracy on fat-saturatedT2weighted MRI for diagnosis of intra-articular adhesions of the temporomandibular joint

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Diagnostic accuracy on fat-saturatedT₂weighted MRI for diagnosis of intra-articular adhesions of the temporomandibular joint