Efficacy of Low-Level Laser Therapy in Management of Temporomandibular Joint Pain: A Double Blind and Placebo Controlled Trial.

Background: Stomatognathic system is an interaction of the muscles of mastication, dentition, neural component, and temporomandibular joint. Any dysfunction in this system may lead to temporomandibular disorders (TMDs). Various non-surgical modalities have been employed for treating TMDs. Aim and objectives: The aim of the study was to objectively evaluate the effects of low-level laser therapy (LLLT) in treatment of patients with TMDs. Materials and Methods: Sixty individuals diagnosed with TMDs were divided randomly into two groups (Group I-placebo and Group II -LLLT). A series of 20 sessions of LLLT applied both in closed mouth and maximum mouth opening position were given over a period of 08 weeks. Assessment was done in terms of improvement in mouth opening, pain, clicking, and deviation of mandible. The data collected were analyzed statistically. Results: The results showed improvement in the pain reduction, improvement in the maximum mouth opening, reduction in deviation, and clicking in both groups but better treatment outcome in the low-level laser group. Conclusion: Though conservative measures improved the symptoms in TMD but LLLT has shown better results in comparison with the placebo group. Being non-surgical can be employed in combination with other modes for effectively treating such disorders. Keywords: Pain, Dysfunction, Temporomandibular joint disorders (TMDs), Low-level laser therapy (LLLT).

Validity of IL-6 and Arthrocentesis in the Cause and Management of Internal Derangement of TMJ.

Purpose: The aim of this clinical study was to evaluate the level of Interleukine-6 (IL-6), pre and post arthrocentesis to validate it as a biomarker in the Internal Derangement (ID) of TMJ. Material and Methods: This study included 30 patients (20 females and 10 males) of Temporo-Mandibular Dysfunction (TMD) with Disc displacement without reduction (DDwoR) Wilkes stage III, who were refractory to conservative management. Arthrocentesis was performed as a therapeutic modality. Synovial fluid aspirates were obtained prior to arthrocentesis and post arthrocentesis with 300 ml of Ringer Lactate solution into the superior joint compartment for the assessment of level of IL-6. The clinical parameters used for correlating the level of IL-6 were degree of pain (VAS I), chewing ability (VAS II), Maximal Mouth Opening (MMO) in both pre and post op phase with the follow-up period of 01 day, 01 week, 01 month, 03 month and 06 month and the results were compared. ELISA was performed to analyze the levels of IL-6 in the aspirates. The clinical parameters and the level of IL-6 were recorded and analyzed statistically. Results: The study showed ID of TMJ (Wilkes stage III) s are more prevalent in females especially in the fourth decades of life with the mean age of 38.4 years. The post operative assessment in terms of pain, maximum mouth opening, lateral movements of the mandible and the levels of IL-6 were found to be statistically significant with a P value <0.01. Conclusion: This study validates the role of IL-6 as a definitive biomarker for the pathogenesis of ID of TMJ Wilkes stage III and arthrocentesis proved to be a minimally invasive therapeutic modality for its management.

Hemophilic pseudotumor of the mandible in a patient with hemophilia B.

INTRODUCTION: Hemophilic pseudotumor is a rare complication occurring in patients with hemophilia, frequently seen in the femur, tibia, pelvic bones, iliac bones, or rarely in the maxillofacial region. CASE REPORT: A 7-year-old male reported with a spontaneous extra-oral swelling that was managed with pre-operative transfusion of factor IX along with curettage of the lesion. Our report presents only the fourth case in literature wherein this tumor presented in a patient with hemophilia B. FINDING: Hemophilic pseudotumor is a rare entity in the maxillofacial region. High degree of suspicion is required for diagnosis, and close coordination between the medical and surgical teams aids in management.

Comparison of ultrasonography with conventional radiography in the diagnosis of zygomatic complex fractures.

PURPOSE: Zygomatic complex fractures have changed in patterns of occurrence, severity, and, more importantly, in the mode of injury. Protection of the globe and maintaining the width of the face are the more important roles of the complex. Diagnosis and treatment planning of such fractures become imperative in the sequencing of repair if and where indicated, especially in the case of isolated zygomatic complex fractures. Exploring the versatility of ultrasonography (US), in diagnosing zygomatic complex fractures in comparison to conventional radiography in a double-blind study, the objective of this study was to evaluate the efficacy of US and to explore the possibility of making US examination a mainstay in the primary diagnosis of such fractures. MATERIAL AND METHOD: The prospective, double-blind study design included 32 patients suspected of having sustained isolated zygomatic complex fractures. The patients underwent US examination and radiographic examination in the form of para-nasal sinus (PNS) and sub-mentovertex (SMV) views for comparison. RESULTS: A sensitivity of 100% was seen in favor of US in the areas of the fronto-zygomatic suture (FZ), arch, infra-orbital, and buttress areas. Statistically significant differences (p < .01) was seen in areas of the arch and buttress region and in the infra-orbital area. CONCLUSION: Although US showed 100% sensitivity in detection of fracture lines at three articulations of the four that make up the zygomatic complex, it lacked in quantifying the amount and degree of displacement of the fractured segments, which hampered accurate treatment planning.