Temporomandibular joint arthrocentesis for the treatment of osteoarthritis.

UNLABELLED: The aim of the study was to estimate the effect of arthrocentesis in the treatment of osteoarthritis of the temporomandibular joint (TMJ), evaluate and compare cytological and biochemical findings in the synovial fluid (SF) as well in venous blood samples and to determine the effectiveness of arthrocentesis with regard to TMJ pain intensity and mandibular movement. PATIENTS AND METHODS: Twenty three consecutive patients with a diagnosis of TMJ osteoarthritis (Wilkes´ stages III, IV) after noneffective conservative treatment were treated with arthrocentesis using push and pull technique (Alstergren et al. 1995). Preoperative radiographs and the scores pre- and posttreatment (after 6 months), maximal interincisal opening (MIO) and visual analogue scale (VAS) for pain estimation were performed. Blocking the auriculotemporal nerve with a 2 mL of 2% lidocaine solution, the needle was inserted into the upper joint compartment and connected with the three-way stopcock for infusion therapy (Discofix® Braun) and 2-3 mL of saline solution was pushed slowly to the upper compartment and then aspirated back. The first SF aspirate was allocated for the following analysis: SF viscosity, presence of crystals, SF rheumatoid factor (RF) compared to blood plasma RF. The washing was repeated 3-4 times until the aspirate was clear. RESULTS: After 6 months MIO improved significantly (p<0.05) and pain according to VAS had substantially decreased (p<0.01). Viscosity of the aspirate was 0.78 (medium), crystals were found in 5 patients (21.7%). There was not statistical significant difference between SF RF and plasma RF values (p>0.05).The effectiveness of arthrocentesis may be explained by the joint space expansion achieved with the introduction fluid, washing out inflammatory mediators, the particles of adhesions, fibrillations, crystals etc. CONCLUSIONS: Arthrocentesis with this technique for the treatment of TMJ osteoarthritis offer favourable results with regard to increasing MIO, reducing pain and dysfunction. The presence of crystals or chondromatosis granules in the synovial fluid and increased viscosity of the synovial fluid indicates a pathological condition of an inflammatory nature.

Relationship between radiographic changes in the temporomandibular joint and bone mineral density: a population based study.

OBJECTIVE. The aim of this population based study was to compare radiographic changes in the temporomandibular joint (TMJ) with the lumbar spine and femoral neck BMD. To find whether there is any relationship between TMJ radiographic changes, vitamin D (25(OH)D) and bone markers levels and the number of missing teeth. MATERIAL AND METHODS. The study included 95 randomly selected participants. Bilateral TMJ images were obtained using an orthopantomograph (OPTG) and were evaluated for presence of radiographic signs. BMD was measured by dual energy X-ray absorptiometry (DXA). BMD of the lumbar spine (LT score) and femur (FT score) was detected by DXA. The level of type I collagen telopeptide fragments (P1NP), of C-telopeptide crosslaps of type I collagen (CTX-1) and of 25(OH)D were also measured. RESULTS. Subjects with a lower LT score had significantly fewer occluding pairs of teeth (p=0.018) and were more frequent users of removable prostheses (p=0.008). Radiographic changes were negatively correlated with P1NP (p=0.041). CTX-1 correlated positively with P1NP (p<0.001) and negatively with 25(OH)D (p=0.042). Occluding pairs of teeth were positively correlated with the LT score (p=0.012) and FT score (p<0.001). Radiography showed changes in the TMJ of 57% of participants. Out of 95 participants, 60% demonstrated an abnormally low LT value. CONCLUSIONS. This population based study indicates that TMJ radiographic changes and teeth loss seems to be related to the low level of BMD and 25(OH)D level.

Long-term evaluation of arthroscopic surgery with lysis and lavage of temporomandibular joint disorders.

AIM: To estimate and analyse the long-term outcome of arthroscopy for the treatment of the temporomandibular joint (TMJ) internal derangements. PATIENTS AND METHODS: Twenty-nine patients (35 joints) who underwent TMJ arthroscopy under general anaesthesia due to osteoarthritis between years 2000 and 2007 (Wilkes stages IV and V) were included in this study. The age range at the time of surgery was from 18 to 69 years. The scores for preoperative maximal interincisal opening (MIO), and visual analogue scale (VAS) score for pain before arthroscopy, 6 months and 5 years after arthroscopy were compared. RESULTS: Fibrous adherences were found in all cases, fibrillations in 76% of cases. The most frequent radiographic sign was erosion (69%). There was a significant increase in the MIO postoperatively after 6 months (r(s)=0.56; n=29, p>0.01) that held during the longer-term follow-up (5 years) period (r(s)=0.58; p<0.001). VAS after 6 months was positively correlated to VAS after 5 years (r(s)=0.38; p=0.040). There were no significant differences between the results of follow-up when comparing the shorter (6 months) and longer (5 years) results. CONCLUSION: Arthroscopic lysis and lavage for the treatment of TMJ disorders offers favourable long-term stable results with regard to increasing MIO and reduced pain and dysfunction.