Temporomandibular Joint Arthrocentesis for Internal Derangement with Disc Displacement Without Reduction

Abstract

Temporomandibular joint (TMJ) disc derangement is defined as a malpositioning of the articular disc relative to the condyle and eminence. Arthrocentesis of the TMJ is a minimally invasive chair side procedure for the patients with TMJ internal derangement. This case report presents convincing results to keep arthrocentesis as an imperative procedure to relieve such patients of their acute symptoms. TMJ dynamics has also been discussed for an in-depth understanding of the pathology in cases with internal derangement.

Evaluation of success criteria for temporomandibular joint arthrocentesis

“…Since the introduction of arthrocentesis, the indication range for this procedure has broadened34910. Since arthrocentesis is a minimally invasive surgical procedure, it is preferred for the treatment of ID of the TMJ10111819.…”

“…They cause various joint symptoms, most frequently limitations in and pain during mouth opening, and may also lead to degenerative changes in the cartilage and bone structures of the joint123. The most frequent cause of TMJ dysfunction is internal derangement (ID), which refers to alteration of the joint's normal path of motion, largely involving the function of the articular disc134. The severity of ID is assessed using the Wilkes classification, which consists of five stages ranging from symptom-free slight forward displacement to degenerative arthritic changes accompanied by severe symptoms5.…”

“…The area of indication for arthrocentesis is especially broad6789. Many studies have shown that arthrocentesis is an effective treatment for disc displacement without reduction410. Arthrocentesis is extremely effective in eliminating joint adhesions, removing inflammatory cytokines, correcting joint function in the early stage of disease, and reducing pain7811.…”

Assessment of Low Level Diode Laser Therapy versus Arthrocentesis in Management of Temporomandibular Joint Internal Derangement.

“…Lavage of the upper joint space reduces pain by removing inflammation mediators from the joint , increasing mandibular mobility by removing intra-articular adhesions, eliminating the negative pressure within the joint, recovering disc and fossa space, and improving disc mobility, which reduces the mechanical obstruction caused by the anterior position of the disc .the results of arthrocentesis were in agreement with studies. [20,24,25] Analysing results of clicking sound in study groups indicated beneficial effect of both treatment modalities in reducing clicking with no statistical significant difference between them. The effect of arthrocentesis in on the clicking sound has been reported in a lot of publication to reduce joint pain, improve function, and reduce clicking as the arthrocentesis is considered an evident method to treat TMJ disc derangement .…”

Single-Needle Arthrocentesis with Upper Compartment Distension versus Conventional Two-Needle Arthrocentesis: Randomized Clinical Trial

“…Arthrocentesis has been indicated as an effective treatment approach in patients with DDWOR [ 1 , 5 – 7 , 14 ]. Regarding the possible variations, the literature seems inconclusive when evaluating the different single puncture arthrocentesis techniques such as using two needles' fusion to one puncture devise [ 15 ] or using additional sodium hyaluronate with arthrocentesis [ 3 ].…”