Arthrocentesis and Temporomandibular Joint Disorders a Conservative Alternative to Surgical Treatments

Study Overview
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Brief Summary
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This study aims to evaluate the efficacy of arthrocentesis in the treatment of internal derangement of the temporomandibular joint (TMJ).

Detailed Description
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This work was designed as a prospective case series clinical study. Patients imaging was evaluated with Cone-Beam Computed Tomography and Nuclear Magnetic Resonance at the beginning of the treatment and after the last arthrocentesis.

Conditions
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TMJ Internal Derangement

Intervention / Treatment
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* Procedure: TMJ arthrocentesis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: TMJ pain TMJ noises and click history of unsuccessful conservative management (NSAID and occlusal bite) occlusal bite still present Exclusion Criteria: degenerative joint disease (such as osteoarthritis, rheumatoid arthritis etc.) history of condylar fractures or previous TMJ trauma TMJ surgery

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 62 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| arthrocentesis in TMJ internal derangement<br>30 patients with TMJ internal derangement and pain with history of failed conservative management. | Procedure: TMJ arthrocentesis<br>* lavage of the superior TMJ space with saline and sodium hyaluronate (SH)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain decrease | Patients were followed up for 1 year. The mean pre-operative pain, using visual analog scale, showed an average decrease of 6.7 at 1 year. | baseline (preop), 1 week, 1 month, 2 months, 6 months, 12 months (postop) | 
| increase in the mouth opening | The mean maximum mouth opening(MMO) pre-operatively was 15,8 mm and increased to 34 mm immediately following arthrocentesis which increased by 0.5-1 mm at every month followup with mean MMO of 39,4 mm at 6 months. Thereafter it remained consistent till 1 year. The mean increase in the mouth opening at 1 year was 23,6 mm | Baseline (preop), 1 week, 1 month, 2 months, 6 months, 12 months (postop) | 
| TMJ click and noises reduction | At the end of 1 year, (75%) patients stated no evidence of clicking. | Baseline (preop), 12 months (postop) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of subjects showing signs of TMJ inflammation or structural alterations at Magnetic Resonance Imaging and Cone Beam Computerized Tomography pre- and postop. | 40% of subjects who showed clear signs of inflammation showed significant improvement, in 30% with structural alterations was evident the absence of intra-articular adhesions and debris, in 30% with internal derangement did not appear any radiographic change. | Baseline (preop)- 60 days postop | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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TMJ arthrocentesis, internal derangement, conservative treatment