The Impact of Sodium Hyaluronate TMJ Injection on Pain and Mandibular Movements in Patient With Temporomandibular Disorders (Clinical Study) (The Effect of Hyaluronic Acid Injection on TMJ pain & Mandibular Movements)

AIMS: In this part of study we assess the effect of HA in pain & mandibular movements. MATERIALS AND METHODS: This study include 21 patients with TMDs were diagnosed clinically and confirmed by Trans cranial radiography. The age range was from 18 to 50 years old, with a mean of 30.03 years. Three cycles of intra articular injections of 0.6 ML sodium hyaluronate were performed weekly for three successive weeks. Pain intensity was measured by the visual analog scale. Maximal mouth opening, clicking, joint noise, and lateral movements were measured before and one week after first ,second & third injections. RESULTS: This study include 21 patients 5 males & 16 females , with age ranged 18-50 years ,the majority of patients were at age ranged between 21-40 years, which represent 66.6% of, concerning gender distribution female to male ratio was 3:1. only 7 patients( 33.3%) have osteoarthritis . High significant relation between pain & OA. Firedman test 44.406 df,3 , significance 0.00 osteoarthritis were more frequent in female which represent 85.8% (6 patients) than male patien,t which represent 14.2% (one patient) there is no significant relation between osteoarthritis & sex, Friedman test = . 527 , p≥ 0.005. The minimum maximum, means & standard deviation of visual analogue scale(VAS) before & one week after the first ,second & third injections of HA were recorded, VAS value before treatment was 6.28 & it decrease gradually to 3.3 ,2.2 till it become 0.8 in group c (one week after the third injection) . Highly significant difference p≤0.001in VAS before & one week after the first ,second & third injections of HA. A significant difference in VAS one week after the first & second injections of HA. & one week after the second & third injections of HA.P≤ 0.005, while highly significant difference one week after the first & third injections of HA P≤ 0.001. The minimum maximum, means & standard deviation of interincisal distance ID in millimeters before & one week after the first ,second & third injections of HA were recorded. The mean interincisal distance was 35.4 mm before injection & it become 42.7 mm one week after the third injection. A a significant difference in ID before &one week after the first & second injections of HA. P≤ 0.005 while highly significant difference p≤0.001in ID before & one week after the third injection of HA.Non significant difference in ID one week after the first, second & third injections of HA p≥0.005. The minimum maximum, means & standard deviation of the lateral right & left madibular movements in millimeters before & one week after the first ,second & third injections of HA. ,it shows that the mean right lateral movement is7.619 mm before the injection & it become 8.8mm one week after the third injection ,while the mean of left lateral movement is 7.3 mm which become 8.8 mm one week after the third injection of HA. High significant difference p≤0.001 in lateral movements before & one week after the first ,second & third injections of HA, except before & one week after the second & third injections in right lateral movement which show significant difference P≤ 0.005. Non significant difference p≥0.005 in lateral movements one week after the first , second & third injections & one week after the second & third injections of HA. CONCLUSION: The intra articular injection of HA in TMJ in a patients with TMDs is an effective & safe method in reducing pain & improving vertical & horizontal movements of mandible & their effect appear obviously after the first injection. So this treatment modalities can be considered as the best reversible type of treatment as it is a safe ,effective with no complications, not costy as compared with other modalities like bite palates , no side effect as with pharmacological therapy, & an immediate relief of signs & symptoms can be gained.