Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 116
Filtrar
1.
Br J Oral Maxillofac Surg ; 62(7): 632-636, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38987055

RESUMEN

The aim of this paper was to determine the optimal needle depth for temporomandibular joint (TMJ) arthrocentesis using magnetic resonance imaging (MRI), with the aim of improving procedural safety and efficacy in clinical practice. A retrospective analysis of 264 TMJ MRIs from 132 patients at Istanbul Medipol Mega University Hospital was conducted. T2-weighted MRI sequences were utilised to measure distances from skin to joint capsules at varying needle entry points, applying the double puncture technique. The study adhered to ethical standards with appropriate approvals. The analysis revealed significant gender-related variations in needle depths (females showing shorter distances than males, p < 0.05). No significant gender differences were found in condylar angles. An inverse correlation between age and condylar angle suggested age-related anatomical changes. Crucially, a 20 mm needle depth was identified as safer and more effective than the previously recommended 25 mm. This study underscores the necessity of revising needle depth to 20 mm in TMJ arthrocentesis. These findings hold significant implications for improving procedural safety and catering to demographic variations.


Asunto(s)
Artrocentesis , Imagen por Resonancia Magnética , Agujas , Articulación Temporomandibular , Humanos , Femenino , Masculino , Artrocentesis/métodos , Estudios Retrospectivos , Imagen por Resonancia Magnética/métodos , Adulto , Persona de Mediana Edad , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/patología , Anciano , Adolescente , Adulto Joven , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/patología
2.
J Coll Physicians Surg Pak ; 34(6): 717-722, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38840358

RESUMEN

OBJECTIVE: To determine the clinical applicability of the modified concentric cannula technique (CCT), focusing on the duration of the arthrocentesis, the number of reposition of cannula, and the occurrence of complications. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ankara Yildirim Beyazit University, Ankara, Turkiye, between September 2021 and May 2022. METHODOLOGY: Forty patients with Wilkes III temporomandibular joints (TMJ) internal derangement were identified and 13 patients who met the inclusion criteria were reviewed. The main outcomes regarding the clinical applicability of modified CCT included the duration of arthrocentesis, the number of reposition of cannula, and the occurrence of complications. RESULTS: The values of maximum mouth opening (MMO) without pain and MMO without assistance measured in the immediate postoperative period and at the 4th and 8th postoperative weeks were found to be significantly higher than the pre-arthrocentesis values. The values of MMO with assistance measured in the immediate postoperative period and at the 8th postoperative week were also significantly higher than the baseline values. Compared with preoperative values, notable decreases in pain scores were observed at the 4th (p = 0.003) and 8th (p = 0.002) postoperative weeks. The assessment of the jaw dysfunction also revealed significantly lower scores at the 4th (p = 0.024) and 8th (p <0.001) postoperative weeks. CONCLUSION: Modified CCT of arthrocentesis substantially decreased pain and improved mandibular functions in patients with internal derangement of TMJ. Additionally, this technique could be performed with a reduced number of cannula relocations and required a shorter operative time even with the use of a higher irrigation volume during the lavage procedure. KEY WORDS: Arthrocentesis, Temporomandibular joint disorder, Temporomandibular joint.


Asunto(s)
Artrocentesis , Trastornos de la Articulación Temporomandibular , Humanos , Artrocentesis/métodos , Masculino , Femenino , Trastornos de la Articulación Temporomandibular/cirugía , Adulto , Persona de Mediana Edad , Punciones/métodos , Agujas , Resultado del Tratamiento , Adulto Joven , Articulación Temporomandibular/cirugía , Rango del Movimiento Articular , Cánula
3.
Ned Tijdschr Tandheelkd ; 131(5): 223-230, 2024 05.
Artículo en Holandés | MEDLINE | ID: mdl-38715535

RESUMEN

The initial treatment of symptomatic disorders of the temporomandibular joint typically consists of a conservative approach, in which medication (painkillers and muscle relaxants), orofacial physiotherapy and splints are most important. In most cases, minimally invasive treatment options, such as arthrocentesis, arthroscopy or joint injections, are only considered when conservative methods provide insufficient symptom reduction. There is, however, an ongoing debate about the optimal treatment strategy due to an increasing body of evidence concerning the superior effectiveness in symptom reduction of minimally invasive treatment options with regard to conservative treatments. If these minimally invasive treatment options are also ineffective, open joint surgery may be considered as a last option for a select group of patients.


Asunto(s)
Artroscopía , Procedimientos Quirúrgicos Mínimamente Invasivos , Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/terapia , Artroscopía/métodos , Resultado del Tratamiento , Articulación Temporomandibular/cirugía , Artrocentesis/métodos
4.
Int J Oral Maxillofac Surg ; 53(9): 779-786, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38702202

RESUMEN

Disc displacement without reduction (DDwoR) can cause pain and limitations in mouth opening, with a significant impact on function. The optimal management strategy for DDwoR is unclear. Treatments include conservative management such as mandibular manipulation, occlusal splints, and patient education/self-management, as well as arthrocentesis, which is a minimally invasive procedure. The aim of this systematic review and meta-analysis was to ascertain whether there is a role for arthrocentesis in the management of DDwoR. Studies analysing the outcomes pain and maximum mouth opening (MMO) in patients with DDwoR treated by arthrocentesis or occlusal coverage devices were eligible for inclusion. Following a database search, six studies with a total of 343 participants were found to be eligible for analysis (three prospective observational studies, one retrospective observational study, one non-randomized single-blind clinical trial, and one unblinded randomized clinical trial). When compared to occlusal coverage splints, arthrocentesis demonstrated a slight improvement in pain, although this was statistically non-significant (standardized mean difference (SMD) -0.50, 95% confidence interval (CI) -1.04 to 0.05, P = 0.07; I2 = 81%), and a significant improvement in MMO (SMD 0.79 mm, 95% CI 0.24-1.35 mm, P = 0.005; I2 = 79%). However, due to the significant heterogeneity between studies and the high risk of bias, along with the paucity of double-blind randomized controlled clinical trials, definitive conclusions cannot be drawn for this clinical question.


Asunto(s)
Artrocentesis , Ferulas Oclusales , Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/terapia , Artrocentesis/métodos , Luxaciones Articulares/terapia , Disco de la Articulación Temporomandibular , Dimensión del Dolor
5.
J Craniofac Surg ; 35(4): 1236-1240, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38727210

RESUMEN

Temporomandibular joint (TMJ) arthrocentesis is one of the most commonly used non-invasive surgical interventions in the treatment of refractory pain and dysfunction associated with internal derangement. Several adjunctive therapies have been used in combination with arthrocentesis in an attempt to increase its efficacy and long-term maintenance. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor which is used in different chronic pain conditions. This study aimed to assess the efficacy of duloxetine in combination with arthrocentesis compared with arthrocentesis alone. Twenty-eight patients with chronic TMJ pain were included and randomly allocated into 2 groups (control and study groups). The control group included patients who underwent TMJ arthrocentesis only, and the study group included patients who underwent arthrocentesis followed by giving duloxetine (30 mg) orally twice daily for 3 months. Pain, maximum mouth opening, and level of anxiety and depression were assessed preoperatively and followed at regular intervals of 1 week, 1 month, 3 months, and 6 months postoperatively. Pain was significantly reduced in both groups at all postoperative intervals and was significantly lower in the study group than the control group at 6 months. Maximum mouth opening increased significantly in both groups, but the difference between them was not significant. Level of anxiety and depression was significantly decreased in both groups, with no statistically significant difference between them. The results of this study indicate that duloxetine in combination with arthrocentesis may provide effective and long-term pain control; however, its use is associated with a higher risk of adverse events.


Asunto(s)
Artrocentesis , Clorhidrato de Duloxetina , Dimensión del Dolor , Trastornos de la Articulación Temporomandibular , Humanos , Clorhidrato de Duloxetina/uso terapéutico , Femenino , Masculino , Adulto , Trastornos de la Articulación Temporomandibular/tratamiento farmacológico , Trastornos de la Articulación Temporomandibular/cirugía , Artrocentesis/métodos , Resultado del Tratamiento , Terapia Combinada , Persona de Mediana Edad , Ansiedad , Depresión , Dolor Crónico/tratamiento farmacológico , Inhibidores de Captación de Serotonina y Norepinefrina/uso terapéutico , Inhibidores de Captación de Serotonina y Norepinefrina/administración & dosificación
6.
J Craniomaxillofac Surg ; 52(7): 850-854, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38724289

RESUMEN

This study aimed to assess and compare the efficacy of two distinct single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for managing disk displacement without reduction (DDwoR). Sixty patients with DDwoR were randomly and blindly assigned to two treatment groups (n = 30 each): group 1 - TMJ arthrocentesis with the classic concentric needle; and group 2 - TMJ arthrocentesis with the concentric needle-cannula system. The following variables were recorded and compared across the groups: patient's pain perception (visual analog scale - VAS, 0-10); maximal interincisal distance (MID, mm); facial edema (FE, presence or absence); and operation duration (OP, minutes). Patients in group 2 presented significantly lower values of VAS score and presence of FE (p < 0.05) when examining the data at 24 and 48 h after the arthrocentesis. They also showed an increase in MID values (p = 0.024) after 6 months. With regard to OP, no significant difference was observed between the groups. Performing a single-puncture TMJ arthrocentesis using a concentric needle-cannula system significantly reduced the patients' pain perception, and mitigated the presence of facial edema during the immediate postoperative period (at 24 and 48 h). Furthermore, it resulted in a notable increase in the MID after 6 months.


Asunto(s)
Artrocentesis , Cánula , Agujas , Trastornos de la Articulación Temporomandibular , Humanos , Artrocentesis/instrumentación , Artrocentesis/métodos , Femenino , Masculino , Método Simple Ciego , Adulto , Trastornos de la Articulación Temporomandibular/cirugía , Persona de Mediana Edad , Dimensión del Dolor , Luxaciones Articulares/cirugía , Resultado del Tratamiento , Adulto Joven
7.
Artículo en Inglés | MEDLINE | ID: mdl-38749875

RESUMEN

INTRODUCTION: Anterior displacement of the temporomandibular joint (TMJ) disc is a disorder in which the articular disc is dislocated from its correct position relative to the mandibular condyle and mandibular fossa. Traditionally, the initial treatment of disc displacements involves various conservative measures, including the use of a stabilizing interocclusal splint. However, in cases where there is associated limited mouth opening, as in the case of anterior disc displacement with reduction and intermittent block (ADDwRIB), and anterior disc displacement without reduction (ADDw/oR), arthrocentesis has been suggested as another modality of initial treatment due to its faster effect in preventing disease progression to a more advanced stage, as well as reducing the chances of pain chronification and central sensitization. OBJECTIVES: This study aimed to analyze whether there is a preponderance in efficacy between treatments with a stabilizing interocclusal splint or arthrocentesis in these patients. METHODS: A randomized, prospective, longitudinal clinical trial was conducted. The sample was obtained by convenience, between June 2021 and January 2023. Twenty-four patients with diagnoses of ADDwRIB and ADDw/oR were included. The diagnosis and clinical evaluations followed the DC/TMD criteria, and TMJ MRI was performed. Patients were randomly allocated to 2 treatment groups. Group 1 (n = 13): stabilizing interocclusal splint. Group 2 (n = 11): arthrocentesis. Patients were evaluated after 1, 2, 3, and 6 months for clinical parameters of pain, functionality, and psychosocial status. RESULTS: Both treatments were effective in reducing pain levels, with no statistically significant differences. Group 1 showed significantly greater mouth-opening levels compared to Group 2 (P = .041). CONCLUSION: Both groups showed significant improvements in various parameters evaluated throughout the study, indicating they are equally effective in pain control and most functional and quality of life parameters. However, the stabilizing interocclusal splint treatment was superior in restoring mouth opening.


Asunto(s)
Artrocentesis , Ferulas Oclusales , Dimensión del Dolor , Trastornos de la Articulación Temporomandibular , Humanos , Femenino , Masculino , Trastornos de la Articulación Temporomandibular/terapia , Artrocentesis/métodos , Adulto , Estudios Prospectivos , Resultado del Tratamiento , Luxaciones Articulares/terapia , Disco de la Articulación Temporomandibular , Estudios Longitudinales , Persona de Mediana Edad , Rango del Movimiento Articular
8.
J Oral Maxillofac Surg ; 82(7): 756-760, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38621667

RESUMEN

Temporomandibular joint internal disorders commonly present with limited mouth opening and pain. Treatment options range from invasive surgical procedures to minimally invasive interventions. This technical note aims to introduce a modification to the arthrocentesis technique in which a pressure infusion cuff (VBM Classic Infusor, Medizintechnik GmbH, Germany) is used for irrigation instead of syringes or peristaltic pumps. A pressure infusion cuff (bag) is an inflatable bag with a hand pump and a sphygmomanometer that allows monitorization of the pressure, and it is intended to apply pressure on intravenous fluid bags to assist with rapid infusion of fluids. This allows the operator to maintain an efficient and stable flow pressure throughout the procedure while avoiding occupational hand and wrist problems resulting from manual irrigation with syringes. Furthermore, pressure monitoring, as read on the sphygmomanometer of the cuff, facilitates the manipulation of the needles and adjustment of the pressure should the patient experience discomfort. This increases the patient's compliance, physician's comfort, and allows the collection of quantitative data in clinical studies.


Asunto(s)
Artrocentesis , Trastornos de la Articulación Temporomandibular , Humanos , Artrocentesis/métodos , Artrocentesis/instrumentación , Trastornos de la Articulación Temporomandibular/cirugía , Presión , Diseño de Equipo , Irrigación Terapéutica/instrumentación , Irrigación Terapéutica/métodos
9.
Br J Oral Maxillofac Surg ; 62(3): 324-328, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38453560

RESUMEN

Management of temporomandibular disorders (TMD) follows a stepwise approach of conservative management, minimally invasive surgery (arthrocentesis and arthroscopy), open surgery and alloplastic replacement. The majority of patients treated in primary care and managed initially in secondary care have myofascial pain and can be managed conservatively with rest, topical NSAIDs, muscle massage, and a bite orthosis. Those who fail to improve and have articular related pain with limitation of function should initially undergo arthroscopic investigation and arthrocentesis, which is effective at resolving symptoms in 80% of patients. Arthroscopy provides the best diagnostic aid should there be a failure to improve and should enable the surgeon to appropriately plan open surgery. Historically, surgical intervention was based on a 'one size fits all' philosophy with the surgeon carrying out a procedure which they are used to doing regardless of the pathology. Prior to arthroscopy this carried an '80% chance of getting 80% better' regardless of approach. Prior arthroscopy reduced success rates to 50%-60% and a better success rate is needed. Basing surgical intervention on the pathology encountered is a sensible approach to joint management, with the surgeon performing surgery on the articular surfaces or disc as indicated. Having used this approach over the last 15 years the author has achieved success rates of 80% in the longer term and this philosophy, rationale, and technique will be discussed along with analysis of more recent publications in the field.


Asunto(s)
Artroscopía , Trastornos de la Articulación Temporomandibular , Humanos , Artrocentesis/métodos , Artroplastia de Reemplazo/métodos , Artroscopía/métodos , Trastornos de la Articulación Temporomandibular/cirugía
10.
Int J Oral Maxillofac Surg ; 53(7): 584-595, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38395688

RESUMEN

There is currently no consensus on the best treatment for painful temporomandibular disc displacement without reduction (DDwoR), and no network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing all types of treatments for this condition has been conducted. The objective of this study was to compare and rank all treatments for DDwoR, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), arthrocentesis (Arthro) alone, Arthro plus intra-articular injection (IAI) of platelet-rich plasma (PRP), Arthro plus IAI of hyaluronic acid (HA), Arthro with exercises, Arthro plus occlusal splints, and manipulative therapy. Outcome variables were pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm). The mean difference with 95% confidence interval was estimated using Stata software. The GRADE system was used to assess the certainty of the evidence. A total of 742 patients from 16 RCTs were included in the NMA. Both direct meta-analysis and NMA showed that Arthro with IAI of co-adjuvants provided better pain reduction in the short term (≤3 months) than Arthro alone. However, the quality of the evidence was very low. In the intermediate term, Arthro alone or combined with co-adjuvants provided better pain reduction than conservative treatment, but with low-quality evidence. Conservative treatment significantly increased MMO in the short term compared to other treatments. In conclusion, the results of this NMA suggest that arthrocentesis with intra-articular injection of adjuvant medications may be superior to conservative treatments in reducing pain intensity at long-term follow-up, while no significant differences were found for the MMO outcome. However, the quality of evidence was generally low to very low, and further RCTs are needed to confirm these findings.


Asunto(s)
Artrocentesis , Ácido Hialurónico , Metaanálisis en Red , Dimensión del Dolor , Plasma Rico en Plaquetas , Ensayos Clínicos Controlados Aleatorios como Asunto , Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/terapia , Inyecciones Intraarticulares , Artrocentesis/métodos , Ácido Hialurónico/administración & dosificación , Ácido Hialurónico/uso terapéutico , Terapia por Luz de Baja Intensidad/métodos , Ferulas Oclusales , Luxaciones Articulares/terapia , Disco de la Articulación Temporomandibular , Dolor Facial/terapia , Dolor Facial/etiología , Terapia Combinada
11.
J Oral Rehabil ; 51(6): 1061-1080, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38400536

RESUMEN

BACKGROUND: Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet. OBJECTIVE: The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD? METHODS: The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases. RESULTS: The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I2 = 22%; TMJ pain: p = .0003, I2 = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I2 = 0%; TMJ pain: p = .28, I2 = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence. CONCLUSION: Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.


Asunto(s)
Luxaciones Articulares , Procedimientos Quirúrgicos Mínimamente Invasivos , Disco de la Articulación Temporomandibular , Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/terapia , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Luxaciones Articulares/cirugía , Disco de la Articulación Temporomandibular/cirugía , Resultado del Tratamiento , Artrocentesis/métodos , Rango del Movimiento Articular/fisiología , Ácido Hialurónico/uso terapéutico , Ácido Hialurónico/administración & dosificación , Inyecciones Intraarticulares
12.
J Oral Maxillofac Surg ; 82(6): 623-631, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38280727

RESUMEN

The understanding of the causes of temporomandibular joint pain and dysfunction has evolved over 50 years. Historically, the term internal derangement has been used to describe the abnormal relationship between the articular disc, condyle, and glenoid fossa, which was thought to correlate with patient symptoms. It is now known that the pathophysiology of intra-articular pain and dysfunction (IPD) involves synovitis, capsular impingement, symptomatic disc displacement, or a combination of these. Symptomatic disc displacement should only be considered to be a potential source of IPD after synovitis and capsular impingement have been treated. This philosophy provides the opportunity for most patients with IPD to be initially treated nonsurgically or with minimally invasive procedures such as arthrocentesis or arthroscopy.


Asunto(s)
Artroscopía , Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/terapia , Trastornos de la Articulación Temporomandibular/fisiopatología , Trastornos de la Articulación Temporomandibular/cirugía , Artroscopía/métodos , Dolor Facial/terapia , Artralgia/terapia , Artralgia/etiología , Artrocentesis/métodos
13.
Int J Oral Maxillofac Surg ; 53(6): 503-520, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38286713

RESUMEN

The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint disorders. Thirteen controlled studies on various patient outcomes were included after a systematic search in seven electronic databases. Meta-analyses were conducted separately for arthroscopic surgery (AS) and arthroscopic lysis and lavage (ALL), and short-term (<6 months), intermediate-term (6 months to 5 years), and long-term (≥5 years) follow-up periods were considered. No significant differences in pain reduction and complication rates were found between AS or ALL and arthrocentesis. Regarding improvement in maximum mouth opening (MMO), both AS at intermediate-term and ALL at short-term follow-up were equally efficient when compared to arthrocentesis. However, at intermediate-term follow-up, ALL was superior to arthrocentesis for MMO improvement (mean difference 4.9 mm, 95% confidence interval 2.7-7.1 mm). Trial sequential analysis supported the conclusion of the meta-analysis for MMO improvement for ALL versus arthrocentesis studies at intermediate-term follow-up, but not for the other meta-analyses. Insufficient evidence exists to draw conclusions regarding other patient outcomes or about comparisons between arthroscopy and conservative treatments. Due to the low quality of the primary studies, further research is warranted before final conclusions can be drawn regarding the management of temporomandibular joint disorders.


Asunto(s)
Artrocentesis , Artroscopía , Tratamiento Conservador , Trastornos de la Articulación Temporomandibular , Humanos , Artroscopía/métodos , Trastornos de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/terapia , Artrocentesis/métodos , Tratamiento Conservador/métodos
14.
J Craniomaxillofac Surg ; 52(3): 369-373, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38253472

RESUMEN

This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR). A total of 48 patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 24): Group 1, TMJ arthrocentesis with the addition of catheters and a vacuum pump to the second needle; Group 2, TMJ arthrocentesis without any addition device. The following variables were registered and compared between groups: patient's pain perception (visual analogue scale [VAS; 0-10]); maximal interincisal distance [MID; mm]; joint effusion (JE, presence or absence); facial edema (FE; presence or absence); and the operation duration (OP; minutes). Patients in Group 1 presented with significantly lower VAS scores (p < 0.001) and presence of FE (p = 0.03) in the post-operative period, also an increase in MID values (p = 0.026), and a reduction in JE (p = 0.022) after 3 months. Besides that, in this group, the procedure was performed significantly faster (p < 0.001). Performing arthrocentesis with the addition of a vacuum pump makes the procedure faster and yields better results in terms of pain, facial swelling, mouth opening and joint effusion.


Asunto(s)
Artrocentesis , Trastornos de la Articulación Temporomandibular , Humanos , Artrocentesis/métodos , Vacio , Resultado del Tratamiento , Punciones , Trastornos de la Articulación Temporomandibular/cirugía , Catéteres , Rango del Movimiento Articular , Articulación Temporomandibular
15.
Pediatr Emerg Care ; 40(1): 68-70, 2024 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-38157397

RESUMEN

ABSTRACT: Septic arthritis is one potential cause of pediatric joint effusion and pain that may lead to significant morbidity. We present a case where point-of-care ultrasound was used to identify and aspirate a joint effusion in a pediatric patient with septic arthritis of the ankle, facilitating timely diagnosis and care. We review the technique for arthrocentesis of the ankle and literature on point-of-care ultrasound in the diagnosis of pediatric septic arthritis.


Asunto(s)
Artritis Infecciosa , Artrocentesis , Humanos , Niño , Artrocentesis/métodos , Tobillo , Sistemas de Atención de Punto , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/terapia , Ultrasonografía Intervencional/métodos
16.
J Am Vet Med Assoc ; 261(12): 1-6, 2023 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-37793638

RESUMEN

OBJECTIVE: To determine if equine cadavers modified with joint distension would yield higher fluid volumes, require fewer needle redirects, and improve student self-efficacy. SAMPLE: 19 third-year veterinary students. METHODS: Voluntary participation was sought during 4 sessions of an equine arthrocentesis and diagnostic analgesia laboratory. Half of the sessions were provided with unmodified cadavers and half were provided with cadavers modified with joint distention. Prior to and after the laboratory, participating students completed surveys regarding their self-efficacy with arthrocentesis of the metacarpophalangeal and distal interphalangeal joints. During the study, the number of needle redirects and the volume of fluid obtained was recorded. RESULTS: Increased fluid volumes were obtained from the modified metacarpophalangeal and distal interphalangeal joints. No difference was identified in number of needle redirects between cadaver types for either joint. Self-efficacy scores increased at the end of the laboratory for arthrocentesis of the metacarpophalangeal joint in both modified and unmodified groups. Self-efficacy scores increased at the end of the laboratory for arthrocentesis of the distal interphalangeal joint for the modified but not unmodified groups. CLINICAL RELEVANCE: Modified equine cadavers provided a higher fluid yield following arthrocentesis compared to unmodified cadavers, but despite this, multiple attempts were required for proper needle placement. Performing equine arthrocentesis improved student self-efficacy with the task. Given our results, the model used for introduction to performing equine arthrocentesis may be less important than practice with the skill. In order to improve proficiency and self-efficacy, equine arthrocentesis should be provided multiple times throughout the veterinary curriculum.


Asunto(s)
Artrocentesis , Enfermedades de los Caballos , Animales , Caballos , Humanos , Artrocentesis/veterinaria , Artrocentesis/métodos , Autoeficacia , Articulaciones , Cadáver , Estudiantes , Enfermedades de los Caballos/diagnóstico
17.
J Craniomaxillofac Surg ; 51(11): 659-667, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37852891

RESUMEN

This 3-year prospective study evaluated the efficacy of temporomandibular joint (TMJ) arthrocentesis with viscosupplementation in different severity stages based on the Dimitroulis classification (categories 2-4 were included). TMJ arthrocentesis was performed under local anaesthesia, and the protocol consisted of a double-puncture technique with lavage of ≥150 cc Ringer Lactate plus viscosupplementation. Incobotulinum toxin A was administered 10-15 days preoperatively in patients with concomitant masticatory myalgia. The primary outcome was TMJ pain, assessed by visual analogue scale (VAS, 0-10), and the secondary outcomes were the maximum mouth opening (MMO, mm) and myalgia degree (0-3). All outcomes were assessed on the intervention day (T0) and after the procedure (T1) (minimum 1 month and then 3 months, 6 months, 1 year and every year since). A total of 108 patients were enrolled (mean age of 43.1 ± 18.9 years); 86 (80%) were women and 22 (20%) were men. Preoperative pain was 4.02 ± 3.12 (mean ± SD), MMO was 38.10 ± 9.56 (mean ± SD) and myalgia degree was 1.80 ± 1.18 (mean ± SD). After an average of 215.4 days (31-1253 days), a statistically significant improvement of pain (P < 0.0001), MMO (P = 0.005) and myalgia degree (P < 0.0001) was observed. The overall successful outcome of TMJ arthrocentesis with viscosupplementation was 76%. The authors observed increased arthrocentesis effectiveness and success rate with viscosupplementation in Dimitroulis category 2 (88.6%) compared to 3-4 (71.4%). An association was found between arthrocentesis with viscosupplementation failure and painful myalgia (ρ = 0.477; P < 0.0001). Thirteen patients (12%) underwent a second TMJ intervention after finalising the present trial. With a low complication rate, TMJ arthrocentesis with viscosupplementation led to an overall benefit for all the included patients. This study reinforces the important role of minimally invasive TMJ arthrocentesis as a first treatment option, with better results in the early stages compared to more severe stages.


Asunto(s)
Trastornos de la Articulación Temporomandibular , Viscosuplementación , Masculino , Humanos , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Artrocentesis/métodos , Estudios Prospectivos , Trastornos de la Articulación Temporomandibular/tratamiento farmacológico , Trastornos de la Articulación Temporomandibular/cirugía , Mialgia , Punciones
18.
J Oral Maxillofac Surg ; 81(10): 1204-1214, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37573887

RESUMEN

BACKGROUND: Arthrocentesis is a minimally invasive procedure with reported efficacy when used for lysis and lavage of the joint for symptomatic internal derangement, irrespective of the technique utilized. PURPOSE: The purpose of the study was to determine if the single puncture arthrocentesis (SPA) is superior to double puncture arthrocentesis (DPA) with respect to pain reduction and improved maximal mouth opening (MMO) for subjects with acute disc displacement without reduction. STUDY DESIGN AND SETTING: A single-blinded randomized prospective clinical trial was conducted at the tertiary referral center for temporomandibular joint disorders. All subjects were diagnosed with acute onset disc displacement without reduction based on history and magnetic resonance imaging findings. Subjects were randomized to SPA or DPA. PREDICTOR VARIABLE(S): The primary predictor variable was arthrocentesis technique (SPA vs DPA). MAIN OUTCOME VARIABLE(S): The primary outcome variables were pain and MMO, measured at 4 weeks. The duration for the procedure was recorded at the time of the surgery. COVARIATES: Age, sex, and the side affected were recorded. ANALYSES: Data were analyzed using analysis of variance to compare the primary outcome variables. Levene's, post hoc, and Bonferroni-Holm tests were used for intergroup comparisons with a P value of <0.05 being significant. RESULTS: Forty subjects completed the study. The mean age for the SPA and DPA groups was 28.3 (±3.9) and 29.1 (±4.1), respectively (P = .52). The sex distribution was 60 and 55% female in the SPA and DPA groups, respectively. The mean pain reduction in the SPA and DPA groups was from 8.30 (±0.86) to 0.90 (±0.78) and from 8.00 (±0.79) to 0.95 (±0.82), respectively (P < .0001). There was no difference in pain reduction between the groups (P = .05). The mean increase in MMO was 34.6 (±2.34) and 33.4 (±2.35) in the SPA and DPA groups, respectively (P < .0001). The difference between the groups was not significant (P = .12). The procedural time in the SPA and DPA groups was 14.15 ± 1.72 and 17.55 ± 1.66, respectively (P < .0001). CONCLUSION: SPA and DPA arthrocentesis appear to be equally efficacious for pain reduction and increasing MMO. SPA can be completed in less time than DPA and should be considered as a viable alternative to the conventional DPA technique.


Asunto(s)
Artrocentesis , Punciones , Humanos , Femenino , Masculino , Artrocentesis/métodos , Estudios Prospectivos , Resultado del Tratamiento , Dolor , Rango del Movimiento Articular , Articulación Temporomandibular
19.
RFO UPF ; 28(1)20230808. ilus, tab
Artículo en Portugués | LILACS, BBO | ID: biblio-1516328

RESUMEN

Objetivo: Apresentar as modalidades de tratamentos cirúrgicas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTMs). Revisão da literatura: As DTMs são muito frequentes e são responsáveis ​​por dor e desconforto em um número importante de pacientes. A avaliação e o diagnóstico são as chaves para determinar um plano de manejo adequado dessas doenças. Embora o tratamento conservador seja bem-sucedido na maioria dos pacientes, os tratamentos cirúrgicos podem ser a única opção para aqueles que não respondem ao tratamento conservador ou para casos com indicação cirúrgica inicial como, por exemplo, algumas neoplasias articulares. Dentre as alternativas cirúrgicas, podemos citar a artrocentese, artroscopia, reposicionamento do disco articular por cirurgia aberta, discectomia e tratamentos cirúrgicos para hipermobilidade e anquilose da articulação temporomandibular. Considerações finais: A seleção adequada dos casos é requisito obrigatório para uma intervenção cirúrgica bem-sucedida, a fim de alcançar o resultado desejado do tratamento, como alívio dos sintomas e melhora da função.


Aim: To present the most commonly used surgical treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: TMD is very common and is responsible for pain and dysfunction in a significant number of patients. Assessment and diagnosis are key to determining a management plan for these diseases. Although conservative treatment is successful in most patients, surgical treatments may be the only option for those who do not respond to conservative treatment or for some cases with an initial surgical indication, such as some joint neoplasms. Surgical alternatives include arthrocentesis, arthroscopy, repositioning of the articular disc by open surgery, discectomy and surgical treatments for temporomandibular joint hypermobility and ankylosis. Conclusions: Proper case selection is the mandatory requirement for successful surgical intervention in order to achieve the desired treatment outcome, such as symptom relief and improved function.


Asunto(s)
Humanos , Dolor Facial/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Artroscopía/métodos , Articulación Temporomandibular/cirugía , Discectomía/métodos , Artrocentesis/métodos
20.
Am J Emerg Med ; 71: 157-162, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37406477

RESUMEN

OBJECTIVE: Knee arthrocentesis can be performed by landmark (LM) or ultrasound (US) guidance. The goal of performing knee arthrocentesis is to obtain synovial fluid, however, it is also important to consider the number of attempts required and accidental bone contacts that occur. This study evaluates procedural success without bone contact in knee arthrocentesis and compares both LM and US guided techniques in a cadaver model. METHODS: This was a randomized crossover study comparing US vs LM guidance for arthrocentesis in a single academic center. Volunteers were randomized to perform both LM and US guided knee arthrocentesis on cadavers. The primary outcome was procedural success, defined as first attempt aspiration of synovial fluid without bone contact. Secondary outcomes included number of attempts, number of bone contacts, time to aspiration, and confidence. RESULTS: Sixty-one participants completed the study with a total of 122 procedures performed. Procedural success without bone contact was greater in the US group (84% vs 64% p = 0.02). Time to aspiration was longer for US (38.75 s vs 25.54 s p = 0.004). Participants were more confident with US compared to LM both before the procedure on a Visual Analog Scale from 1 to 100 (29 vs 21 p = 0.03) as well as after the procedure (83 vs 69 p = 0.0001). Participants had a greater median increase in confidence with US following training (44 vs 26 p = 0.01). CONCLUSIONS: Study participants had greater procedural success without bone contact when US guidance was used. The increase in confidence following training was greater for US guidance than the LM method. Use of US guidance may offer a benefit by allowing for better needle control and avoidance of sensitive structures for clinicians performing knee arthrocentesis.


Asunto(s)
Artrocentesis , Articulación de la Rodilla , Humanos , Artrocentesis/métodos , Estudios Cruzados , Ultrasonografía , Articulación de la Rodilla/diagnóstico por imagen , Cadáver , Ultrasonografía Intervencional/métodos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...