Do intra-articular injections of analgesics improve outcomes after temporomandibular joint arthrocentesis?: A systematic review and meta-analysis.

OBJECTIVES: Intra-articular analgesics are increasingly being used after temporomandibular joint (TMJ) arthrocentesis but without clear evidence on its efficacy. The aim of this study was to review the role of intra-articular analgesic injected after TMJ arthrocentesis in improving post-operative outcomes. METHODS: PubMed, Embase, Scopus, BioMed Central, CENTRAL and Google Scholar databases were searched from inception up to 15th April 2020. Randomised controlled trials (RCTs) on adult patients with temporomandibular joint disorders (TMDs) comparing any intra-articular analgesic with control after arthrocentesis were included. Risk of bias was assessed by Cochrane Collaboration's Risk of Bias-2 tool. RESULTS: Nine RCTs were included. Four studies used non-steroidal anti-inflammatory drugs (NSAIDs) and five used opioids after arthrocentesis. Descriptive analysis of NSAID studies indicated that intra-articular NSAIDs may not improve pain and maximal mouth opening (MMO) after TMJ arthrocentesis. Meta-analysis indicated a statistically significant reduction of pain with the use of opioids at 1 week, 1, 3, and 6 months. Similarly, MMO was significantly improved with intra-articular opioids at 1 week, 1 and 6 months. Data were analysed from a limited number of studies with a small sample size. The quality of the included studies was low. CONCLUSIONS: Low-quality evidence suggests that intra-articular NSAIDs may have no effect on pain and MMO after TMJ arthrocentesis. Intra-articular opioids may improve pain and MMO at short-term follow-up. Results are to be interpreted with caution considering several limitations of the review. Further high-quality trials with large sample size are needed to provide better evidence.

Arthrocentesis vs conservative therapy for the management of TMJ disorders: A systematic review and meta-analysis.

OBJECTIVE: Arthrocentesis is being widely used as an invasive treatment modality for managing temporomandibular joint (TMJ) disorders. The current review aimed to assess if arthrocentesis as the first line of therapy leads to better outcomes as compared to conservative management of TMJ disorders. METHODS: PubMed, Scopus, Embase, Web of Science, and CENTRAL were searched up to 20th June 2022 for randomized controlled trials comparing TMJ arthrocentesis vs conservative management as first-line therapy for TMJ disorders. RESULTS: Eight trials were included. Our analysis indicated significantly reduced pain scores in patients undergoing TMJ arthrocentesis as compared to conservative therapy at 1 month (MD: -0.82 95% CI: -1.43, -0.20 I2=56% p = 0.01) and 6 months (MD: -1.38 95% CI: -2.45, -0.32 I2=86% p = 0.01), but not at 3 months of follow-up (MD: -0.66 95% CI: -1.68, 0.37 I2=82% p = 0.21). The results were not stable on sensitivity analysis. There was no difference in MMO between the TMJ arthrocentesis and conservative therapy groups at 1 month (MD: -0.06 95% CI: -3.67, 3.54 I2=88% p = 0.97), 3 months (MD: -0.35 95% CI: -3.95, 3.25 I2=89% p = 0.85) and 6 months (MD: 0.00 95% CI: -3.34, 3.34 I2=86% p = 0.10). CONCLUSION: Analysis of a small number of trials with high inter-study heterogeneity indicates that first line TMJ arthrocentesis may result in a significant but small improvement in pain scores but without any additional improvement in MMO as compared to conservative therapies. Current evidence does not provide strong support for the use of TMJ arthrocentesis as the first line of therapy for TMDs.

Ultrasound-guided vs conventional arthrocentesis for management of temporomandibular joint disorders: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to compare outcomes between ultrasound (US)-guided arthrocentesis and conventional arthrocentesis for the management of temporomandibular joint disorders (TMDs). METHODS: PubMed, Embase, Scopus, BioMed Central, CENTRAL, and Google scholar databases were searched up to April 1 2020 for randomized control trials (RCTs) comparing US-guided and conventional arthrocentesis. RESULTS: Four RCTs were included. Pooled analysis did not demonstrate any statistically significant difference in pain or maximal mouth opening (MMO) scores after 1 week and 1 month of follow-up between US-guided and conventional arthrocentesis. Studies also reported data on intra-operative needle relocations and operating time but with conflicting results. CONCLUSION: This study indicates that the use of US during arthrocentesis may not improve postoperative pain and MMO in the short term. Data on intra-operative outcomes are scarce and conflicting for any definitive conclusions. Further high-quality adequately powered RCTs are required to strengthen current evidence.

Transient deformation during the Milashan Tunnel construction in northern Sangri-Cuona Rift, southern Tibet, China observed by Sentinel-1 satellites.

Using 3-year Sentinel-1 C-band synthetic aperture radar (SAR) data, we observed prominent ground subsidence around the construction site of the Milashan Tunnel, which is on top of the northern Sangri-Cuona Rift (SCR) in southern Tibet. The most deformed area extends ∼7 km in the north-south direction and ∼6 km in the east-west direction, with a peak subsidence rate of over 10 mm/a in the line of sight direction of both the descending and ascending satellites. Aside from the long-term ground subsidence arising directly from underground water outflow and rock excavation, a regional aseismic fault slip episode is also evident. The aseismic slip event began in May 2016 and ended in July 2016. The surface aseismic displacements can be explained by normal faulting with mainly down-dip movement and a modest right-lateral strike-slip component on a nearly north-south trending fault. The aseismic deformation triggered by the Milashan Tunnel construction demonstrates the sensitive response of crustal-scale tectonics to human activity, which poses high seismic hazards for the heavily populated region.