Does arthroscopy cause more complications than arthrocentesis in patients with internal temporomandibular joint disorders? Systematic review and meta-analysis.

The objective of this study was to compare, through a systematic review with a meta-analysis, the relative risks of arthroscopy and arthrocentesis in the temporomandibular joint. MEDLINE/PUBMED, EMBASE, Cochrane Library (CENTRAL), Web of Science, SCOPUS were the researched databases, as well as grey literature and manual searches. The search results showed 656 studies, but only five met the eligibility criteria. The evaluation included 194 joints (104 patients): 101 were arthroscopy and 93 arthrocentesis. Complications were observed in four patients undergoing arthroscopy (two with temporary facial paralysis and two with prolonged cervical oedema) and in three patients undergoing arthrocentesis (two with severe bradycardia and one with prolonged cervical oedema). The meta-analysis demonstrated a relative risk of 0.99 for complications after arthroscopy compared with arthrocentesis, but the results showed no statistical differences. In conclusion, this systematic review suggests that there is no increased risk of complications with arthroscopy than arthrocentesis. When complications were present, they were temporary.

Effects of co-administered dexamethasone and nimesulide on pain, swelling, and trismus following third molar surgery: a randomized, triple-blind, controlled clinical trial.

This study aimed to determine the effect of the co-administration of dexamethasone 8mg and nimesulide 100mg given 1h before mandibular third molar surgery. A prospective, randomized, triple-blind, split-mouth clinical trial was developed at the study institution in Pernambuco, Brazil. A pilot study was first performed (95% confidence interval, 80% test power, and 5% error), and a sample of 40 patients aged between 18 and 40 years was selected. The patients were randomized and divided into two groups: dexamethasone+placebo and dexamethasone+nimesulide. The following parameters were evaluated: pain (visual analogue scale), total number of rescue analgesics taken, time taken to first rescue analgesic consumption, oedema, trismus, and patient satisfaction. The paired t-test and the Wilcoxon test were used to compare means. Statistically significant differences were found between the groups in pain values at 2, 4, and 12h postoperative, and in the total number of rescue analgesics and time taken to first rescue analgesic ingestion (P<0.05), with results in favour of dexamethasone+nimesulide administration. Oedema and trismus were similar in the two treatment groups and decreased over time postoperatively. The co-administration of dexamethasone and nimesulide reduces pain intensity and the need for rescue medication after third molar surgery.