J Korean Assoc Oral Maxillofac Surg.  2019 Feb;45(1):9-14. 10.5125/jkaoms.2019.45.1.9.

Clinical factors affecting the outcome of arthocentesis

• Andrabi SW
• Malik AH
• Shah AA

• KMID: 2461486
• DOI: http://doi.org/10.5125/jkaoms.2019.45.1.9

Abstract

OBJECTIVES
This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement.
MATERIALS AND METHODS
Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (≤25 years, >25 and ≤40 years, >40 and ≤60 years), VAS pain level (≤5, >5 and ≤7, >7 and ≤10), and ROM ( < 25 and ≥25 mm). Odds ratios (ORs) were used to describe the proportional benefit of each variable the on successful outcome of arthrocentesis. For the OR to be clinically relevant or even clinically noticeable, we assumed that the OR would need to be larger than 2.
RESULTS
Mean preoperative pain score was 6.49±1.560 and at 6 months postoperative was 0.46±1.147 with an average decrease of pain score 6 (P < 0.001). The mean preoperactive maximum mouth opening was 26.14±4.969 mm and mean maximum mouth opening at 6-month inerval was 38.92±3.392 mm. The mean increase in the mouth opening was a mean difference of 12.78 mm (P < 0.001). Logistic regression showed that the maximum benefit occurred in patients aged < 25 years (OR, 12.01; P=0.012), a VAS pain level of >7 (OR, 11.25; P=0.039), and a maximum vertical opening of < 25 mm (OR, 7.70; P=0.038).
CONCLUSION
Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatment.

Keyword

Temporomandibular joint; Internal derangement; Arthrocentesis

Figure

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  Fig. 1 Landmarks for arthrocentesis.

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  Fig. 2 Arthrocentesis in progresis.

Reference

1. Carvajal WA, Laskin DM. Long-term evaluation of arthrocentesis for the treatment of internal derangements of the temporomandibular joint. J Oral Maxillofac Surg. 2000; 58:852–855. discussion 856-7. PMID: 10935583.

2. Dolwick MF. Intra-articular disc displacement. Part I: its questionable role in temporomandibular joint pathology. J Oral Maxillofac Surg. 1995; 53:1069–1072. PMID: 7643277.

3. Frost DE, Kendell BD. Part II: the use of arthrocentesis for treatment of temporomandibular joint disorders. J Oral Maxillofac Surg. 1999; 57:583–587. PMID: 10319833.

4. Truelove EL, Sommers EE, LeResche L, Dworkin SF, Von Korff M. Clinical diagnostic criteria for TMD. New classification permits multiple diagnoses. J Am Dent Assoc. 1992; 123:47–54.

5. McCain JP, Hossameldin RH. Arthroscopic arthroplasty of the temporomandibular joint. In : Haggerty CJ, Laughlin RM, editors. Atlas of operative oral and maxillofacial surgery. Ames: Wiley Blackwell;2015. p. 271–280.

6. Alpaslan C, Bilgihan A, Alpaslan GH, Güner B, Ozgür Yis M, Erbaş D. Effect of arthrocentesis and sodium hyaluronate injection on nitrite, nitrate, and thiobarbituric acid-reactive substance levels in the synovial fluid. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89:686–690. PMID: 10846121.

7. Nishimura M, Segami N, Kaneyama K, Sato J, Fujimura K. Comparison of cytokine level in synovial fluid between successful and unsuccessful cases in arthrocentesis of the temporomandibular joint. J Oral Maxillofac Surg. 2004; 62:284–287. discussion 287-8. PMID: 15015157.

8. Nitzan DW, Dolwick MF, Martinez GA. Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg. 1991; 49:1163–1167. discussion 1168-70. PMID: 1941330.

9. Kaneyama K, Segami N, Nishimura M, Sato J, Fujimura K, Yoshimura H. The ideal lavage volume for removing bradykinin, interleukin-6, and protein from the temporomandibular joint by arthrocentesis. J Oral Maxillofac Surg. 2004; 62:657–661. PMID: 15170274.

10. Moses JJ, Sartoris D, Glass R, Tanaka T, Poker I. The effect of arthroscopic surgical lysis and lavage of the superior joint space on TMJ disc position and mobility. J Oral Maxillofac Surg. 1989; 47:674–678. PMID: 2732826.

11. Dimitroulis G, Dolwick MF, Martinez A. Temporomandibular joint arthrocentesis and lavage for the treatment of closed lock: a follow-up study. Br J Oral Maxillofac Surg. 1995; 33:23–26. discussion 26-7. PMID: 7718523.

12. Yura S, Totsuka Y, Yoshikawa T, Inoue N. Can arthrocentesis release intracapsular adhesions? Arthroscopic findings before and after irrigation under sufficient hydraulic pressure. J Oral Maxillofac Surg. 2003; 61:1253–1256. PMID: 14613079.

13. Emshoff R. Clinical factors affecting the outcome of arthrocentesis and hydraulic distension of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100:409–414. PMID: 16182161.

14. Murakami K, Hosaka H, Moriya Y, Segami N, Iizuka T. Short-term treatment outcome study for the management of temporomandibular joint closed lock. A comparison of arthrocentesis to nonsurgical therapy and arthroscopic lysis and lavage. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 80:253–257. PMID: 7489265.

15. Nishimura M, Segami N, Kaneyama K, Suzuki T. Prognostic factors in arthrocentesis of the temporomandibular joint: evaluation of 100 patients with internal derangement. J Oral Maxillofac Surg. 2001; 59:874–877. discussion 878. PMID: 11474440.

16. Israel HA, Diamond B, Saed-Nejad F, Ratcliffe A. Osteoarthritis and synovitis as major pathoses of the temporomandibular joint: comparison of clinical diagnosis with arthroscopic morphology. J Oral Maxillofac Surg. 1998; 56:1023–1027. discussion 1028. PMID: 9734762.

17. Israel HA, Saed-Nejad F, Ratcliffe A. Early diagnosis of osteoarthrosis of the temporomandibular joint: correlation between arthroscopic diagnosis and keratan sulfate levels in the synovial fluid. J Oral Maxillofac Surg. 1991; 49:708–711. discussion 712. PMID: 2056369.

18. Murakami K, Segami N, Fujimura K, Iizuka T. Correlation between pain and synovitis in patients with internal derangement of the temporomandibular joint. J Oral Maxillofac Surg. 1991; 49:1159–1161. discussion 1162. PMID: 1941329.

19. Sakamoto I, Yoda T, Tsukahara H, Imai H, Enomoto S. Comparison of the effectiveness of arthrocentesis in acute and chronic closed lock: analysis of clinical and arthroscopic findings. Cranio. 2000; 18:264–271. PMID: 11202846.

20. Monje-Gil F, Nitzan D, González-Garcia R. Temporomandibular joint arthrocentesis. Review of the literature. Med Oral Patol Oral Cir Bucal. 2012; 17:e575–e581. PMID: 22322493.

21. Kim YH, Jeong TM, Pang KM, Song SI. Influencing factor on the prognosis of arthrocentesis. J Korean Assoc Oral Maxillofac Surg. 2014; 40:155–159. PMID: 25247144.