Arthrocentesis For Temporomandibular Joint Pain Dysfunction Syndrome.

BACKGROUND: Temporomandibular joint (TMJ) dysfunction is painful condition of facial musculoskeletal system. Arthrocentesis is less invasive treatment of TMJ dysfunctions. It has been used to treat variety of TMJ disorders. The objective of this study was to determine the success of arthrocentesis in TMJPDS patients where conservative treatment had failed. METHODS: This descriptive case study of 45 patients was completed in 6 months at Outpatient Department of Oral and Maxillofacial Surgery, Mayo hospital Lahore. TMJPDS Patients who were unresponsive to conservative treatment were included in this study. The study consisted of a single arthrocentesis procedure performed by a single oral surgeon per patient. Visual Analogue Scale was used to record pain while maximum mouth opening was measured by the interincisal distance in millimetres, at 1 month and 2 months after the treatment. Success was measured two months after arthrocentesis. RESULTS: Thirty (66.7%) patients had no pain and 15 (33.3%) patients had mild pain. Similarly, 16 (35.5%) patients had maximum mouth opening more than 30mm and 29 (64.5%) patients had less than 30 mm mouth opening, two months after arthrocentesis procedure. CONCLUSIONS: Arthrocentesis is very effective in patients suffering from TMPDS by reducing pain and discomfort and increase in mouth opening. This procedure should be considered in TMPDS patients who do not respond to conservative treatment.

Sodium hyaluronate: an effective adjunct in temporomandibular joint arthrocentesis.

BACKGROUND: Internal derangement of the temporomandibular joint (TMJ) is one of the most common forms of temporomandibular disorders. The minimally invasive treatments such as arthrocentesis as well as arthroscopic lysis and lavage are often used as a first-line surgical treatment or in conjunction with nonsurgical modalities with low morbidity and high efficacy. Sodium hyaluronate (SH) has been proposed as an alternative therapeutic agent with similar therapeutic effects. OBJECTIVE: A prospective study was carried out for evaluation of efficacy of TMJ arthrocentesis with and without injection of SH in management of internal derangements. MATERIAL AND METHODS: A total of 30 patients suffering from internal derangement of TMJ were selected for this study. Patients were randomly divided into the following two groups: group 1-arthrocentesis-only group and group 2-arthrocentesis + SH group. Each group constituted 15 patients. RESULTS: Six-month postoperative mean mouth opening (MMO) increase was 13.61 ± 1.64 and 15.53 ± 3.01 mm in group 1 and group 2, respectively. At 6 months, there was marked improvement in masticatory efficiency with mean increase of 5.07 ± 0.13 in group 1 and 6.40 ± 0.04 in group 2. Mean pain reduction was 5.27 ± 0.67 and 6.48 ± 0.44 in group 1 and group 2, respectively. CONCLUSION: Although our series comprised a limited number of cases and a short follow-up period, initial results suggested that arthrocentesis with SH injection seemed to be superior to art.

Training in surgery of the temporomandibular joint: perceptions of trainees in oral and maxillofacial surgery in the United Kingdom.

Surgery of the temporomandibular joint (TMJ) is emerging as a subspecialty in its own right within Oral and Maxillofacial Surgery (OMFS). Recent guidelines on training and practice within this area have laid down standards of competence in certain procedures, and asked for evidence of "exposure" to others at the point of completion of higher training in OMFS. Provision of surgery of the TMJ is becoming more centralised within tertiary referral centres, with resulting disparity in opportunities for clinical experience in different training regions. We sought to gain a national perspective about this, and establish whether all trainees are truly equal when it comes to exposure to surgery of the TMJ during higher surgical training. An electronic survey was distributed to all members of an online Yahoo! group forum reserved for specialty trainees in OMFS. From those surveyed, 25 (48%) stated they had no experience of arthroscopy, while 19 (37%) and 38 (75%) reported no exposure to operations for alloplastic and autogenous replacement of the TMJ, respectively. A mode score of 1 out of 5 (44%, n=22) was returned when they were asked to rate the likelihood of considering TMJ surgery as a subspecialty. The current survey highlights variable exposure to operating on the TMJ across geographical divides within the UK, and little interest among trainees in pursuing the subspecialty as a career.

Surgical treatment of temporomandibular disorder in a 24-year-old male patient with ganglion cyst.

Ganglion cysts are common pseudocystic masses, whereas those arising from the temporomandibular joint (TMJ) are rare entities. We report a case of ganglion cyst of the right TMJ with symptomatic bilateral TMJ internal derangement in a 24-year-old man. Disk repositioning using bone anchors and excision of the ganglion cyst were performed. A unique characteristic of inflammatory infiltrates was revealed in the specimen, and the relationship between these 2 distinct entities and probable pathogenesis of infectious involvement are discussed.

An osteochondroma of the mandibular condyle.

OBJECTIVE: Osteochondroma is rarely seen in the facial region, especially around the condyle. Here, we report a case of condylar osteochondroma, aiming to assist the diagnosis and treatment of the tumor. METHODS: A case of osteochondroma of the left mandibular condyle in a 49-year-old man was presented. Medical records with x-ray, computed tomographic scan, and bone scan of histologically proven osteochondroma of mandibular condyle were obtained. RESULTS: The patient underwent a surgical resection and had fewer functional changes as well as less dysfunction of the temporomandibular joint. CONCLUSIONS: The current study highlights the fact that, despite its rarity in the mandibular condyle, surgical resection is an effective treatment method. The decision, however, depends on how much swing of the mandible is required after surgery for correction of asymmetry and occlusion.

Temporomandibular joint disorder and inner ear pruritus: resolution by eminectomy.

Recurrent dislocation of the temporomandibular joint (TMJ) disk is caused by many factors. Dislocation can result in an acute or chronic closed lock condition. Temporomandibular joint dysfunction is often presented with otalgia symptoms. Other aural symptoms such as deafness, tinnitus, pressure/blockage, and vertigo are also commonly presented together with TMJ dysfunction (Clin Otolaryngol Allied Sci. 1980;5:23-36). However, pruritus associated with TMJ dysfunction in the inner ear has never been reported in the literature. We report a case history of TMJ dysfunction and associated inner ear pruritus, which are both resolved by eminectomy.

Is autogenous abdominal fat transplantation into a large temporomandibular joint defect following removal of failed alloplastic prosthesis a definitive treatment?

PURPOSE: To evaluate the long-term clinical outcome after the removal of failed major alloplastic temporomandibular joint (TMJ) implants and the placement of an autologous abdominal fat graft. MATERIALS AND METHODS: A long-term clinical follow-up was performed in 4 patients who underwent removal of a failed alloplastic implant and insertion of an autologous abdominal fat graft under 1-stage surgical management. Postsurgical use of pain medication was documented and the vertical interincisal opening measurement was obtained at the follow-up visit. Long-term computed tomographic (CT) scans were available for 3 of 4 patients and evaluated for fat graft retention by a radiologist. Hounsfield units were used. RESULTS: The study showed long-term (average, 4.7 years) clinical success, including normal jaw function (≥30-mm vertical opening) and freedom from the use of pain-relieving medication. Long-term CT scans (average, 5 years after surgery) documented fat graft retention in 3 patients (-80 HU). CONCLUSION: Autogenous fat graft placement alone, after major TMJ alloplastic removal, provides excellent long-term clinical success.

Arthrocentesis procedure: using this therapeutic maneuver for TMJ closed lock management.

Temporomandibular joint (TMJ) disorder is a term that encompasses a number of overlapping conditions, such as closed lock. Closed lock of the TMJ is considered a consequence of a nonreducing deformed disc acting as an obstacle to the sliding condylar head that usually causes a decrease in the maximum mouth opening and acute pain. The management of the TMJ is still controversial. Thus, arthrocentesis of the TMJ is a valuable modification of the traditional method of arthroscopic lavage, which consists of washing the joint in order to remove chemical inflammatory mediators and intra-articular adhesions, changing intra-articular pressure. TMJ disorder has always presented as a therapeutic challenge to maxillofacial surgeons. Therefore, this paper aimed to describe a clinical report of a closed lock of the left TMJ in a 19-year-old female subject who was successfully treated by arthrocentesis procedure.

Malocclusion as a common occurrence in temporomandibular joint arthroscopic disc repositioning: outcomes at 49 days after surgery.

PURPOSE: To evaluate the incidence, clinical manifestation, and prognosis of malocclusion after arthroscopic disc repositioning and suturing of the temporomandibular joint (TMJ). PATIENTS AND METHODS: The study included 211 patients (270 joints) with internal derangement of the TMJ who underwent arthroscopic disc repositioning and suturing from November 2005 to August 2006. The occlusion was checked and recorded preoperatively and at different intervals (0, 3, 7, 14, 21, 28, 35, 42, and 49 days after surgery) for all patients. The incidence of malocclusion after surgery was determined for every follow-up period. The χ(2) test was applied to assess the statistical significance of the changes of the incidence of malocclusion. RESULTS: The incidences of malocclusion were 100%, 80.1%, 67.8%, 46.9%, 28.9%, 18.0%, 15.7%, 14.6%, and 14.2% at 0, 3, 7, 14, 21, 28, 35, 42, and 49 days after surgery, respectively. There was a significant difference between neighboring follow-up periods within 28 days after surgery, whereas there was no significant difference from 28 to 49 days after surgery (P > .05). The main clinical manifestations of malocclusion were posterior open bite on the surgery side, incisal prematurities, and mandible midline deviated or nondeviated. CONCLUSION: Malocclusion commonly occurs after TMJ arthroscopic disc repositioning and suturing. However, it will improve within 28 days after surgery in most patients. If malocclusion lasts over 28 days, appropriate treatments should be considered.

Temporomandibular joint dysfunction and orthognathic surgery: a retrospective study.

BACKGROUND: Relations between maxillo-mandibular deformities and TMJ disorders have been the object of different studies in medical literature and there are various opinions concerning the alteration of TMJ dysfunction after orthognathic surgery. The purpose of the present study was to evaluate TMJ disorders changes before and after orthognathic surgery, and to assess the risk of creating new TMJ symptoms on asymptomatic patients. METHODS: A questionnaire was sent to 176 patients operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri) from 01.01.2006 to 01.01.2008. 57 patients (35 females and 22 males), age range from 16 to 65 years old, filled the questionnaire. The prevalence and the results on pain, sounds, clicking, joint locking, limited mouth opening, and tenseness were evaluated comparing different subgroups of patients. RESULTS: TMJ symptoms were significantly reduced after treatment for patients with pre-operative symptoms. The overall subjective treatment outcome was: improvement for 80.0% of patients, no change for 16.4% of patients, and an increase of symptoms for 3.6% of them. Thus, most patients were very satisfied with the results. However the appearance of new onset of TMJ symptoms is common. There was no statistical difference in the prevalence of preoperative TMJ symptoms and on postoperative results in class II compared to class III patients. CONCLUSIONS: These observations demonstrate that: there is a high prevalence of TMJ disorders in dysgnathic patients; most of patients with preoperative TMJ signs and symptoms can improve TMJ dysfunction and pain levels can be reduced by orthognathic treatment; a percentage of dysgnathic patients who were preoperatively asymptomatic can develop TMJ disorders after surgery but this risk is low.

Pterygoid dysjunction: new minimally invasive technique for the treatment of painful temporomandibular joint dysfunction.

PURPOSE: To evaluate the efficacy of pterygoid dysjunction for the surgical management of temporomandibular joint (TMJ) pain and dysfunction. MATERIALS: This study was composed of 10 patients (20 joints), of whom 2 patients had bilateral joint pain. Patients were those who complained of TMJ pain and dysfunction with mild to moderate internal derangement and who have failed to respond to all methods of conservative management. Only patients whose complaints of pain were confined to the pterygoid muscles on palpation were considered for this study. Clinical examination included pain and tenderness in relation to joint, muscles of mastication, movement of joint, and abnormal joint noises. METHODS: Under general anesthesia, pterygomaxillary dysjunction was done bilaterally, the pterygoid plates were pushed backward, and the outcome was evaluated using computed tomography. RESULTS: Immediately after operation, most patients were free from pain, and the intensity of pain was reduced in the rest of the patients. There was progressive improvement of mouth opening, and clicking was reduced in most of the patients in the late postoperative phase. Follow-up and regular counseling were done for 2 years. Clicking and mouth opening have considerable significance, but all patients were free from pain and were comfortable, except for some patients who have simple complaints, which are irrelevant to this study. CONCLUSIONS: Although the total number of patients was too small to arrive at any definitive conclusion, the encouraging results, especially the relief from pain, show that this technique has a significant role in the treatment of painful TMJ dysfunction, with mild to moderate internal derangement, and is devoid of other major complications.

Critical appraisal of methods used in randomized controlled trials of treatments for temporomandibular disorders.

AIMS: To evaluate the quality of methods used in randomized controlled trials (RCTs) of treatments for management of pain and dysfunction associated with temporomandibular muscle and joint disorders (TMJD) and to discuss the implications for future RCTs. METHODS: A systematic review was made of RCTs that were implemented from 1966 through March 2006, to evaluate six types of treatments for TMJD: orthopedic appliances, occlusal therapy, physical medicine modalities, pharmacologic therapy, cognitive-behavioral and psychological therapy, and temporomandibular joint surgery. A quality assessment of 210 published RCTs assessing the internal and external validity of these RCTs was conducted using the Consolidated Standards of Reporting Trials (CONSORT) criteria adapted to the methods of the studies. RESULTS: Independent assessments by raters demonstrated consistency with a mean intraclass correlation coefficient of 0.63 (95% confidence interval). The mean percent of criteria met was 58%, with only 10% of the RCTs meeting the four most important criteria. CONCLUSIONS: Much of the evidence base for TMJD treatments may be susceptible to systematic bias and most past studies should be interpreted with caution. However, a scatter plot of RCT quality versus year of publication shows improvement in RCT quality over time, suggesting that future studies may continue to improve methods that minimize bias.

Influence of the upper joint surface and synovial lining in the outcome of chronic closed lock of the temporomandibular joint treated with arthroscopy.

PURPOSE: Temporomandibular joint (TMJ) arthroscopy has been reported to be an effective and reliable technique for the treatment of chronic closed lock (CCL) of the TMJ. The purpose of the present study was to evaluate whether the status of the joint surface and the synovial lining directly visualized with arthroscopy could determine postoperative results in patients with CCL of the TMJ. MATERIALS AND METHODS: In all, 257 of 500 patients (344 joints) fulfilled the inclusion criteria for CCL of the TMJ. Of these patients, 172 with unilateral TMJ involvement were finally selected for the study. Synovitis and chondromalacia were chosen as the main features for evaluation of the joint surface and synovial lining. Two groups of patients were established: 1) patients with scarce affectation (synovitis grades I-II and chondromalacia grades I-II); and 2) patients with severe affectation (synovitis grades III-IV and/or chondromalacia grades III-IV). Pain and maximal interincisal opening were chosen as dependent variables. All patients were assessed at 1, 3, 6, 12, and 24 months postoperatively. The paired-samples Student's t test was used to compare mean values for pain (using a visual analog scale) and maximal interincisal opening (MIO) both pre- and postoperatively. The Student's t test for unpaired data was applied for the statistical analysis. A P value less than .05 was considered statistically significant. RESULTS: Synovitis grades I-II were arthroscopically observed in 87 (50.58%) patients, whereas synovitis grades III-IV were present in 72 (41.86%) patients. Chondromalacia grades I-II were arthroscopically observed in 66 (38.37%) patients, whereas chondromalacia grades III-IV were present in 54 (31.39%) patients. A statistically significant decrease in pain (P < .001) with a parallel increase in mouth opening (P < .001) after arthroscopy was observed for patients with synovitis I-II, synovitis III-IV, chondromalacia I-II, and chondromalacia III-IV during the whole follow-up period. A significant difference (P = .01) in relation to VAS score was observed between patients with synovitis I-II and patients with synovitis III-IV at month 6 postoperatively. However, this difference did not persist during the rest of the follow-up period, as was the case in relation to mouth opening. No significant differences were observed in relation to decrease of pain and increase of MIO between patients with chondromalacia I-II and patients with chondromalacia III-IV at any time during the follow-up period. Although mean values for pain were lower in patients with synovitis I-II plus chondromalacia I-II in comparison to patients with synovitis III-IV plus chondromalacia III-IV for the whole follow-up period, no statistical significant differences were observed. In relation to the increase in mouth opening, slightly higher values were observed for patients with synovitis I-II plus chondromalacia I-II, although no statistical differences were observed with regard to patients presenting with synovitis III-IV plus chondromalacia III-IV. CONCLUSION: A significant decrease in pain with a parallel increase in MIO was achieved from month 1 postoperatively in patients with any grade of synovitis and/or chondromalacia. No statistical difference in pain or function was observed between patients with scarce involvement of the joint surface and the synovial lining and patients with severe involvement after arthroscopy.

Diagnosis and treatment of dynamic closed-mouth jaw locking in a dog.

CASE DESCRIPTION: A 5-year-old neutered male English Bulldog was evaluated for intermittent closed-mouth jaw locking of approximately 1 week's duration. CLINICAL FINDINGS: Initial physical examination revealed a nonpainful inability to open the jaw with and without manual assistance; however, manipulation of the jaw after the dog was sedated for diagnostic imaging restored jaw function. Anesthesia was subsequently induced, and computed tomography was performed with the jaw open and closed; contrast agent-enhanced images of the closed jaw were also obtained. No abnormalities of the temporomandibular joints or retrobulbar space were detected. Fluoroscopic examination of movement of the temporomandibular joints revealed a dynamic interference of the rostrodorsal aspect of the coronoid process of the left mandibular ramus with the medial surface of the frontal process of the left zygomatic bone or the left orbital ligament. TREATMENT AND OUTCOME: Partial excision of the coronoid process of the left mandibular ramus was performed. The dog recovered without complication and was able to open and close its jaw and eat within 6 hours after surgery. No additional episodes of jaw locking were detected during the 6 months after surgery. CLINICAL RELEVANCE: To the authors' knowledge, closed-mouth jaw locking in animals attributable to dynamic interference of the rostrodorsal aspect of the coronoid process of a mandibular ramus with the medial surface of the frontal process of a zygomatic bone or an orbital ligament has not been described. Surgical excision of the coronoid process of the mandibular ramus appeared to provide a successful outcome in the dog of this report.

Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery.

Body dysmorphic disorder (BDD) is a severe psychiatric disease with delusions about defects in appearance for which patients seek surgical help. This is the first European study to determine the half-year prevalence of BDD in a maxillofacial outpatient clinic. A total of 160 patients with maxillofacial problems completed a validated self-report questionnaire, while a staff member scored maxillofacial defects on a severity scale. Twenty-eight (17%) patients had excessive concerns about their appearance, which negatively influenced their psychosocial functioning; 16 patients (10%; 95%CI 5-15%) screened positive for BDD. The high prevalence of problems related to psychosocial functioning and the occurrence of BDD in maxillofacial patients means that maxillofacial surgeons should take psychological concerns about physical defects into account.

Operative versus simple arthroscopic surgery for chronic closed lock of the temporomandibular joint: a clinical study of 344 arthroscopic procedures.

Arthroscopic surgery has been reported to decrease pain in relation to the TMJ, improving maximal interincisal opening (MIO). The aim of the present study was to report the clinical outcome of arthroscopic surgery for the treatment of chronic closed lock (CCL) of the TMJ. Five hundred consecutive patients (670 joints) with TMJ derangement who underwent arthroscopy between 1995 and 2004 were retrospectively analysed. All were classified as II-V according to Wilkes. Within the series, various arthroscopic procedures were performed. The inclusion criteria for CCL of the TMJ were met by 257 patients (344 joints). The mean age was 30.24 years; 237 (92%) were female and 20 (8%) male. Mean preoperative visual analogue scale score for evaluation of TMJ pain was 53.21+/-23.02. Mean MIO was 24.75+/-4.89 mm. Following arthroscopy, a significant decrease in TMJ pain was achieved (p<0.0001). For MIO, mandibular protrusion and lateral excursion movements, a significant increase in mean values was observed following surgery (p<0.0001). No statistical differences were observed between arthroscopic lysis and lavage and operative arthroscopy in relation to postoperative pain or MIO at any stage of the follow-up period. Arthroscopy should be considered as a first-line treatment for CCL of the TMJ.

Resection of the disc and suspension of the lateral wall with the temporal fascia in advanced internal derangement of the temporomandibular joint.

The abnormal relation between the disc, the condyle, and the temporal bone indicates internal derangement of the temporomandibular joint. The primary symptoms and findings are: limited and painful opening of the jaw, preauricular pain, and clicking sounds or crepitus. We operated on 11 patients admitting for advanced temporomandibular dysfunction. The abnormally stretched disc was tightened by resection of a wedge of tissue from the posterior of the disc and suturing of the edges. A pedicled flap of temporal fascia was turned on to the joint and its surroundings to mimic a lateral joint capsule. All patients were satisfied with the results as they had less pain and improved mouth opening. The procedures provided satisfactory symptomatic relief and supportive findings.

High condylectomy and disc repositioning compared to arthroscopic lysis, lavage, and capsular stretch for the treatment of chronic closed lock of the temporomandibular joint.

OBJECTIVE: The article shows the 1-yr results comparing the efficacy of open-surgery high condylectomy and disc repositioning and the arthroscopic procedure of lysis, lavage and capsular stretch in patients with chronic closed lock of the temporomandibular joint (TMJ). STUDY DESIGN: Twenty patients with a clinical and radiologic diagnosis of chronic closed lock were randomly chosen to be treated with either open surgery or arthroscopy. Each patient was evaluated with a visual analog scale (VAS) for pain and a mandibular functional impairment questionnaire (MFIQ). The evaluation also included a clinical examination. Each patient was recorded at baseline before surgery and at 1-yr follow-up. Statistical analysis was made to evaluate whether differences in MFIQ, VAS, maximum opening and protrusion, lateral joint tenderness, muscle tenderness, crepitation, and clicking at 1-yr follow-up from baseline were significant. Results were considered statistically significant when P < .05. RESULTS: Both open surgery and arthroscopic surgery reduced pain and improved mandibular function. The severity of pain was significantly reduced in both groups (P = .005). In both the open and arthroscopy groups mandibular function improved significantly (P = .005). The clinical examination showed similar good results for the 2 surgical procedures. At 1-yr follow-up a majority of patients from both the open (80% of the patients) and the arthroscopy (70% of the patients) groups fulfilled the criterion of a cutoff point for maximum interincisal opening of equal or more than 35 mm (P = 0.005); all the patients in both groups fulfilled the criterion of the cutoff point for maximum protrusion of more than 5 mm (P = .007). At 1-yr follow-up, clicking was the same as before surgical procedures; no patient in the open group showed crepitation, but crepitation was found in patients in the arthroscopy group. Joint tenderness and pain on lateral palpation as well as muscle tenderness and pain were reduced in all the cases, disappearing in some of them, but the difference was significant only regarding joint tenderness (open surgery, P = .016; arthroscopy, P = .031). CONCLUSIONS: Open-surgery high condylectomy and disc repositioning and the arthroscopic procedure of lysis, lavage and capsular stretch are both effective surgical methods to treat symptomatic patients with a diagnosis of chronic closed lock of the TMJ. Because of the minimally invasive character of the arthroscopic procedure, it should be considered as the first choice in the surgical treatment of the TMJ.

[Effect analysis of surgery for treating abnormal styloid process].

OBJECTIVE: To analyze the relationship between pharyngeal paraesthesia and abnormal styloid process, and to evaluate the surgery outcome. METHODS: One hundred and four patients with styloid process abnormality, especially those with pharyngeal paraesthesia were studied preoperatively and postoperatively. RESULTS: Among 104 patients who complained about foreign body sensation of the pharynx and a sore throat, after partial removal of styloid process, 71.2% (74/104) cured (symptoms disappeared), 12.5% (13/104) improved, while 16.3% (17/104) had no improvement. The responding rate was 83.7% (87/104). CONCLUSIONS: Not all abnormality of styloid process subjects would have pharyngeal paraesthesia, so for this kind of cases a more comprehensive analysis is necessary. Surgery via mouth is preferable.

[Arthrocentesis--a highly efficient therapy for acute TMJ arthropathy]. / Die Arthrozentese als hochwirksame Akuttherapie der Kiefergelenkarthralgie.

PURPOSE: This clinical study deals with the efficiency of arthrocentesis in acute arthropathy of the temporomandibular joint (TMJ). PATIENTS AND METHODS: In total 142 patients (41.5 years average) were included in the examination. Inclusion criteria were a restriction of mouth opening <40 mm and/or TMJ pain >3 on a visual analog scale (VAS). The first examination took place the day before surgery; follow-up was performed 1 day and 4 weeks after arthrocentesis. Study parameters were active mouth opening, TMJ pain on preauricular or intra-auricular palpation, myalgia of the temporalis or masseter muscle, and a deviation clicking or crepitation during mouth opening. Arthrocentesis was performed in all patients under general anesthesia by a double puncture, continuous rinsing technique in an inferolateral approach as recommended by Murakami. The upper temporomandibular joint space was rinsed with 250 ml of a physiological sterile saline solution and a pressure of 200 mmHg. RESULTS: Arthrocentesis resulted in a highly significant increase of mouth opening and a highly significant reduction of TMJ pain on palpation (p<0.001). CONCLUSION: It can be postulated that TMJ arthrocentesis represents a highly efficient therapy of acute TMJ arthropathy. Whether the results have to be judged as a palliative short-time therapy or if even long-term results can be achieved has to be proved by long-term follow-up studies.