Efficacy of needle aspiration in patients with oral-maxillofacial abscesses: A retrospective study of 15 consecutive patients.

The aim of this study was to determine the adequacy and safety of needle aspiration (NA) as an alternative to open surgical drainage for oral-maxillofacial abscesses. Fifteen consecutive patients who were diagnosed with oral-maxillofacial abscesses via contrast-enhanced CT from January 2020 to December 2020 were included. All patients were on antibiotics and treated with NA under local anaesthesia using a 20 mL syringe. Data collection included patient characteristics, signs and symptoms, physical examinations, laboratory tests, imaging findings, and outcomes. Next-generation sequencing (NGS) was used to identify the infectious microorganisms from the abscess samples. The study included 15 patients with oral-maxillofacial abscesses. None of our 15 patients required surgical incision and drainage, although repeat aspiration was required. However, after the first NA, the pain was reportedly extremely relieved for all patients. The average duration of antibiotic treatment was 9.20 ± 5.15 days (range 4-23 days). The abscess-affected spaces mainly included the masseter space and submandibular space. Odontogenic infection was the most common aetiology in 15 patients (10/15). The average volume of the abscesses on CT was 5866.26 ± 3627.18 mm3. The main pathogens identified in this study were Prevotella oris (5/15), Peptostreptococcus stomatis (4/15) and Porphyromonas endodontalis (2/15). According to the results of our study, the data support the use of NA as an effective, minimally invasive treatment modality for oral-maxillofacial abscesses. Surgeons should familiarise themselves with this technique, as it can easily be performed in the clinic using local anaesthesia, culture samples may be obtained, and airway obstruction and pain may be relieved.

Evaluation of the Efficacy of Ultrasound-Guided Local Lauromacrogol Injection Combined with Aspiration for Cesarean Scar Pregnancy: A Novel Treatment.

OBJECTIVES: To evaluate the efficacy of ultrasound-guided local lauromacrogol injection combined with aspiration for treating cesarean scar pregnancy (CSP). METHODS: From July 2016 to December 2016, 18 patients diagnosed with CSP were treated with ultrasound-guided local lauromacrogol injection combined with aspiration. Clinical data and outcome were analysed. RESULTS: All patients were treated successfully. The amount of bleeding ranged between 10 and 50 mL. The duration of hospitalization ranged between 2 and 11 days. Serum ß-human chorionic gonadotropin (ß-hCG) decreased to the nondetectable level within 19-41 days. Menstruation recovery occurred after 10-24 days of normalization of serum ß-hCG level. Reproductive functions were preserved, and there were no untoward effects or complications. CONCLUSIONS: Ultrasound-guided local lauromacrogol injection combined with aspiration is an effective CSP therapy, as it was associated with a high success rate, short hospitalization and fast recovery. However, its wider application and popularization have to be validated on a larger patient population affected by CSP.

Management of Ranula in a Child by Modified Micro-Marsupialization Technique: A Case Report.

Ranulas pose a challenging situation, both clinically and surgically, because of their location on the floor of the mouth, an area that exhibits tightly-netted vital structures. Several treatments have been proposed, including excision with or without removal of the sublingual gland, marsupialization with or without cauterization of the roof of the lesion, drainage of the lesion, and micro-marsupialization. It has been suggested that a modified micro-marsupialization technique can establish drainage of saliva and formation of new permanent epithelized tracts along the path of sutures, thereby reducing the recurrence. This paper presents a report of a ranula in a 12 year-old child that was successfully managed using a modified micro-marsupialization procedure.

Comparative treatment outcomes of menopausal and nonmenopausal women after arthrocentesis.

OBJECTIVES: Most of the patients treated for temporomandibular joint disorders constituted from the female population, and this situation is generally hypothesized and demonstrated in several studies. Arthrocentesis of the temporomandibular joint is a minimally invasive and effective treatment method in the management of patients with stage III and stage IV Wilkes syndrome. This study was aimed at assessing the effectiveness of this method between menopausal and nonmenopausal female patients. STUDY DESIGN: A total of 59 patients (25 menopausal and 34 nonmenopausal) were evaluated according to the visual analog scale for pain and chewing function scores, joint sound, and maximum mouth opening. RESULTS: In both groups, the parameters were detected statistically significant according to follow-up periods. The menopausal group showed better results than the nonmenopausal group at 6-month controls. CONCLUSION: In conclusion, arthrocentesis is a satisfactory treatment modality in the management of temporomandibular joint derangements. Female reproductive hormone levels may affect the success of this procedure.

Outcomes of arthrocentesis for the treatment of internal derangement pain: with or without corticosteroids?

PURPOSE: Arthrocentesis (AC) is an acceptable treatment modality in the treatment of internal derangement (ID) pain. This study evaluated outcomes of AC on pain relief of ID pain with or without corticosteroids. MATERIALS AND METHODS: This single-blind clinical trial was conducted on 60 patients with ID pain who were randomly assigned to 2 groups (30 in each group) for AC. The AC of the upper joint space was then performed by using Ringer lactate under local anesthesia in both groups. In the second group, the procedure was followed by the administration of a single-dose intra-articular dexamethasone (8 mg). Assessments were made at baseline (T0), 1 month (T1), and 6 months (T6) after AC; pain, maximum mouth opening, and joint sounds before and after treatment up to 6 months were evaluated. Pain severity was documented according to Visual Analogue Scale. Age, sex, and skeletal maxillomandibular relationship were considered as variable factors, and irrigation with or without corticosteroids was a predictive factor of the study. Pain, click, and maximum mouth opening were other assessment outcomes of the study. RESULTS: Comparison of age, sex, and skeletal relationship did not show any significant differences between the 2 groups. Results did not demonstrate any difference for click between the 2 groups. Comparison of pain severity in T0, T1, and T2 between the 2 groups did not show any significant differences (P < 0.05). The repeat measure test revealed a significant change in T0, T1, and T2 for both groups (P < 0.001). MMO significantly changed between T0 and T1 and T0 and T6 in the 2 groups without any significant differences between them. CONCLUSIONS: The AC is an effective procedure for a short-term reduction of pain in temporomandibular disorder cases. It seems that AC using Ringer solution with or without corticosteroids may have the same effect on pain relief.

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.

Treatment effectiveness of arthrocentesis plus hyaluronic acid injections in different age groups of patients with temporomandibular joint osteoarthritis.

PURPOSE: To investigate for treatment effectiveness in different age groups of patients with temporomandibular joint osteoarthritis who underwent a cycle of 5 weekly arthrocenteses plus hyaluronic acid injections. MATERIALS AND METHODS: We implemented a retrospective study on 76 patients followed up for 1 year. Outcome variables were pain levels at rest and during chewing, subjective masticatory efficiency, functional limitation, perceived efficacy, and jaw range of motion. Three age groups of patients were identified, and treatment effectiveness was compared among groups by means of a multistrata permutation test. RESULTS: All the partial P values of the subtests related to the age groups, adjusted according to the close testing method for controlling multiplicity, were significant: P = .009 (aged <45 years), P = .001 (aged 45-65 years), and P = .001 (aged >65 years). For the younger age group, the treatment had a significant effect only on the pain at mastication and on the subjective efficacy. For the other age groups, the treatment effectiveness was evident with regard to almost all the considered symptoms. CONCLUSIONS: Our findings suggested that the treatment protocol was more effective in patients older than 45 years, thus having important clinical implications regarding attempts to define tailored treatment protocols for patients with temporomandibular disorders.

Total antioxidant capacity and total oxidant status of synovial fluids in patients with temporomandibular joint pain and dysfunction.

OBJECTIVES: The objective of this study was to investigate whether a relationship exists between total antioxidant capacity (TAC) and total oxidant status (TOS) of synovial fluids (SFs) of temporomandibular joint (TMJ) pain patients with pain and dysfunction. MATERIALS AND METHODS: Forty-two patients with TMJ pain were included in this study. TAC and TOS values of SFs were measured with a novel colorimetric method. Independent t test and correlations were used to analyze the data. RESULTS: TAC of SFs in patients with TMJ pain and limited mouth opening (LMO; n = 21) were significantly lower (P = 0.03) than patients without LMO (n = 21). TOS of SF was negatively correlated with duration of the disease. There was no correlation between TAC, TOS, and VAS scores of the patients as well as age and maximum mouth opening values. CONCLUSIONS: Antioxidant response to oxidative changes (TAC and TOS) in SF decreased as the stage of dysfunction increased. CLINICAL RELEVANCE: Local administration of antioxidant agents might be considered in management of TMJ pain and dysfunction to prevent possible increased oxidative stress.

Vertical fracture of mandibular condyle treated with intra-articular pumping therapy: a case report.

We report a patient with vertical fracture of the mandibular condyle visualized by computed tomography (CT). A 43-year-old woman visited our department the day after the injury occurred. At the initial examination, she experienced pain in the left temporomandibular joint (TMJ) when opening her mouth. Maximum mouth opening distance was 15 mm. Routine radiography showed normal findings, but CT revealed vertical fracture of the left mandibular condyle. Based on clinical findings, conservative therapy consisting of intra-articular pumping therapy and training for mouth opening was initiated. After 10 days, mouth opening distance increased to 36 mm, and pain in the left TMJ disappeared.

Arthrocentesis for the treatment of internal derangements of the temporomandibular joint.

Internal derangements of the temporomandibular joint (TMJ) are characterized by displacement of the intra-articular disc, which acts as an obstacle to normal joint movement and results in clicking and popping sounds or locking and an inability to open the mouth widely. These conditions may be painless or they may be associated with pain, especially during function. The most common causes are trauma, which results in an immediate displacement of the disc, or chronic parafunction, which results in degenerative changes in the articular surfaces, increased friction, and gradual disc displacement.

Shrinking of a Tarlov cyst.

A 65-year-old patient presenting with left labial and perirectal pain was diagnosed with bilateral Tarlov cysts. Upon treatment of the left Tarlov cyst (the right was asymptomatic) using image-guided aspiration and subsequent injection of the cyst with fibrin sealant, the cyst reduced in size. To our knowledge, there are currently no other documented cases in which the Tarlov cyst reduced in size following this procedure. This case would seem to suggest that clinicians are poorly informed with regard to Tarlov cysts. These cysts are more common in Caucasian women, many of whom are told their cysts are not responsible for their pain or that they are not treatable. However, there is clear evidence that some Tarlov cysts are symptomatic and minimally invasive procedures have been developed to treat them. As they primarily occur in women, it is possible gender bias may also play a role in the delayed diagnosis of the patient's pain.

Temporomandibular joint arthrocententesis: evaluation of results and review of the literature.

AIM: This study was designed to investigate the effects of arthrocentesis on the improvement of internal derangement symptoms and jaw function in a series of patients with anterior disc displacement and closed lockjaw. PATIENTS AND METHODS: The study was based on a review of patients records before and after treatment using clinical examinations and radiographs. Visual analog scales were used to measure pain before and after arthrocentesis. Six patients (12 temporomandibular joints) with closed lock symptoms (2 cases) and internal derangements (4 cases) were treated at the Oswaldo Cruz Hospital. The mean follow-up was 11.5 months. RESULTS: The mean maximum vertical opening before treatment was 31.83 mm and after arthrocentesis was 36.50 mm. The visual analog scale for pain before treatment was 7 points (mean) and after arthrocentesis the mean was 4.3. CONCLUSION: Arthrocentesis was shown to be effective in reducing pain and increasing jaw motion in this series of cases.

Effectiveness and satisfaction evaluation of patients submitted to TMJ arthrocenthesis: a case series.

The aim of this study was to evaluate the effectiveness and level of satisfaction of patients who underwent TMJ arthrocentesis under local anesthesia by considering the following parameters: joint pain, mouth opening, mastication, and satisfaction. Fourteen patients (13 women and one man; mean age, 37.6 years with TMJ arthralgia were selected. The patients underwent arthrocentesis under local anesthesia, and pain intensity was measured before, during, and 1 year after treatment using a visual analog pain scale (VAS 0-100 mm). A Likert scale was used to assess patients' opinion regarding the improvement of mouth opening and mastication. After treatment, patients were questioned on levels of satisfaction provided by arthrocentesis in regard to their quality of life. At the end of 1 year, patients showed a marked improvement in their pain clinical picture (p < 0.0001). Mouth opening and mastication, evaluated separately and then correlated (R2 = 0.925, p < 0.0001), also showed a marked improvement. When questioned, all patients reported being satisfied with the treatment outcome.

Leak-proof puncture of ovarian cysts: instant mounting of plastic bag using cyanoacrylate adhesive.

BACKGROUND: Reliable leak-proof aspiration of cyst contents is required for treatment of large ovarian cysts by minilaparotomy. TECHNIQUE: Through a small abdominal wound a transparent plastic bag was instantly mounted onto the cyst surface using an ethyl-2-cyanoacrylate adhesive. A 1-2-cm-wide cut was made in the consolidated cyst wall through the inside of the bag and the contents directly aspirated. The fluid was trapped inside the bag without leaking into the abdominal cavity. This method can also be applied to relatively small cysts by holding the cyst just beneath the wound. EXPERIENCE: We used this method in 30 patients with unilateral ovarian cysts and in one patient with an ovarian cyst associated with an ipsilateral paraovarian cyst. All patients were successfully treated without spillage, although in one case a large mucinous ovarian cyst ruptured before surgery. CONCLUSION: Minilaparotomy using the instant adhesive is cost-effective, safe, reliable, and easily implemented. This procedure is also applicable to relatively small cysts and is a viable alternative to laparoscopic surgery for treatment of dermoid cysts showing considerable calcification.

Effects of a single arthrocentesis and a COX-2 inhibitor on disorders of temporomandibular joints. A preliminary clinical study.

Our aim was to examine the short-term effect of combined treatment with single arthrocentesis and a COX-2 inhibitor on 26 patients with severe symptoms of temporomandibular joint (TMJ) disorders. The severity of the disorders was graded according to the degree of restriction of mouth opening and pain score on a visual analogue scale. Synovial fluid was collected from the superior joint space of the affected TMJ, and arthrocentesis was done with isotonic saline, 200ml. Subsequently, etodolac, 400mg/day, was given for 2 weeks. At 14 days, patients were re-examined and further specimens of synovial fluid were collected. Patients generally lost their symptoms and the severity of the disorders improved significantly (P<0.01). The concentrations of total protein and albumin in synovial fluid decreased with no statistical significance. However, the concentration of matrix metalloproteinase-3 and its ratios to total protein and albumin did decrease significantly (P<0.05). Our results suggest that a larger controlled study is necessary to clarify the contributory effect of arthrocentesis and etodolac for patients with severe symptoms of TMJ disorders.

Effectiveness of treatment with viscosupplementation in temporomandibular joints with or without effusion.

The objective of this study was to determine whether the effectiveness of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) degenerative disorders depends on the presence of intra-articular effusion. In this study of case-control design, two groups of 25 patients were recruited: patients with a clinical diagnosis of painful chronic TMJ osteoarthritis and magnetic resonance imaging (MRI) signs of TMJ degeneration, with (effusion group) or without (no effusion group) MRI evidence of TMJ effusion. All patients underwent five weekly single-needle arthrocenteses plus medium molecular weight HA and 6 months of follow-up. Several clinical outcome parameters were assessed. For all variables, analysis of variance (ANOVA) for repeated measures was performed to assess the existence of significant within-group and between-group treatment effects. Over time, both groups showed significant improvements in all outcome parameters, which were maintained at the 6-month follow-up (P<0.05). Between-group comparisons showed that the treatment effects did not differ significantly for either the primary outcome variable (pain levels: F=0.849, P=0.548) or secondary outcome variables (chewing efficiency: F=0.854, P=0.544; functional limitation: F=1.35, P=0.226; mouth opening: F=0.658, P=0.707). The null hypothesis that there are no differences in treatment effectiveness between patients with and without effusion could not be rejected.

Arthrocentesis as initial treatment for temporomandibular joint arthropathy: a randomized controlled trial.

OBJECTIVE: To determine the effectiveness of arthrocentesis compared to conservative treatment as initial treatment with regard to temporomandibular joint pain and mandibular movement. PATIENTS AND METHODS: In this randomized controlled trial, 80 patients with arthralgia of the TMJ (classified according to the Research Diagnostic Criteria for Temporomandibular Disorders) were randomly assigned to one of the two treatment groups. One group received arthrocentesis as initial treatment (n = 40), the other group received conventional treatment including soft diet, physical treatment and occlusal splint therapy (n = 40). Follow-up was after 3, 12 and 26 weeks post treatment. Prior to treatment, and at every follow-up assessment, pain intensity was measured (VAS 0-100 mm at rest, and VAS 0-100 mm during movement) and maximum mouth opening (MMO) (mm interincisor distance). Furthermore patients were asked to fill out several surveys concerning the impact of mandibular impairment on their daily life, and psychosocial aspects. RESULTS: After 26 weeks, the TMJ pain (mm VAS at rest, and mm VAS during movement) had declined comparably in both groups (arthrocentesis n = 36; conservative treatment n = 36) and MMO (mm interincisor distance) had slightly improved. GEE models showed significant differences between arthrocentesis as initial treatment and conservative treatment, indicating that the arthrocentesis group improved more rapidly with regard to TMJ pain (VAS at rest p = 0.008; regression coefficient ß = -8.90 (95% confidence interval -15.50, -2.31), VAS during movement p = 0.003; regression coefficient ß = -10.76 (95% confidence interval -17.75, -3.77)) and MMO (p = 0.045; regression coefficient ß = -2.70 (95% confidence interval -5.35, -0.06)) compared to conservative treatment. CONCLUSIONS: Arthrocentesis as initial treatment reduces pain and functional impairment more rapidly compared to conservative treatment. However, after 26 weeks, both treatment modalities achieved comparable outcomes. TRIAL REGISTRATION NUMBER: www.trialregister.nl: NTR1505.

Evaluating the additional effects of arthrocentesis on the condylar pathways of temporomandibular joint in patients with internal derangement treated with stabilizing splint.

OBJECTIVES: The purpose of this investigation is to find out the differences in the condylar pathways of the temporomandibular joint (TMJ) in patients treated with stabilizing splint and arthrocentesis accompanied by stabilizing splint in 6 months period. STUDY DESIGN: Forty patients who were assigned a clinical diagnosis of internal derangement of the TMJ were included in this study. Full arch stabilizing splints were made for all patients. Patients were divided into two groups; group A (patients who underwent arthrocentesis), group B (patients who did not underwent arthrocentesis). Computerized axiography was performed for each group before therapy (T0), on the 3(rd) month (T1), after arthrocentesis (TA) (for group A) and on 6th month (T2). Curve parameters were recorded in three-dimension; X axis (posteroanterior), Y axis (mediolateral), Z axis (superoinferior). Also the distance from the starting point of the movement on sagittal plane (S) was calculated. RESULTS: There was a significant increase in the value of Z (p = 0.014) and S (p = 0.038) in mediotrusion movement in group A. Also, there was a significant increase in the value of Z (p = 0.007) in protrusion/retrusion movement, value of Z (p = 0.019) and S value (p = 0.002) in mediotrusion movement and value of Y in open/close movement in group B. CONCLUSIONS: No positive effects on condylar pathways of an additional arthrocentesis to splint therapy alone in patients with internal derangement were found in this study.

Osteogenic efficacy of bone marrow concentrate in rabbit maxillary sinus grafting.

Maxillary sinus grafting is required to increase bone volume in the atrophic posterior maxilla to facilitate dental implant placement. Grafting with autogenous bone (AB) is ideal, but additional bone harvesting surgery is unpleasant. Alternatively, bone substitutes have been used but they limit new bone formation. The strategy of single-visit clinical stem cell therapy using bone marrow aspirate concentrate (BMAC) to facilitate new bone formation has been proposed. This study aimed to assess bone regeneration capacity of autologous BMAC mixed with bovine bone mineral (BBM) in maxillary sinus grafting. Twenty-four white New Zealand rabbits were used and their maxillary sinuses were randomly assigned for grafting with 4 different materials. Rates of new bone apposition in augmented sinuses were measured and bone histomorphometry were examined. Significant increase in the quantity of nucleated cells and colony forming unit-fibroblasts were confirmed in BMAC. Mesenchymal stem cells in BMAC retained their in vitro multi-differentiation capability. Higher rates of mineral appositions in the early period were detected in BBM + BMAC and AB than BBM alone, though they are not significantly different. Graft volume/tissue volumes in BBM and BBM + BMAC were found to be higher than those in AB and sham.