TMJ arthroscopic level 1 vs arthrocentesis in the management of internal derangement of the temporomandibular joint.

OBJECTIVES: The technique of lysis and lavage has shown excellent success rates in treating internal derangement of the temporomandibular joint (TMJ). This procedure has been shown to reduce pain and improve joint mobility, sometimes even in patients suffering from advanced stages of degenerative joint disease (Wilkes IV to V). There are two different approaches to lavage and arthrolysis: arthrocentesis and TMJ arthroscopy. The objective was to assess both approaches' efficacy in managing internal derangement of TMJ. METHOD AND MATERIALS: In total, 92 patients with clinical and radiographic documentation of internal derangement of the TMJ unresponsive to nonsurgical therapy were randomized to one of two surgical groups: arthroscopic lysis and lavage level 1 (64 patients) and arthrocentesis (28 patients). Radiologic changes in the joint, pain (visual analog scale), interincisal distance, lateral and protrusive movements, and clicks and sounds of the joints were recorded. Data were compared presurgically (T0) and in postoperative periods of 1 week (T1), and 1 (T2), 3 (T3), and 6 (T4) months. RESULTS: Both surgical modalities achieved a similar outcome. A gradual improvement was demonstrated during the follow-up periods with no reliance on radiologic changes to the joint or the TMJ diagnosis. More than that, significant differences were encountered in all parameters but protrusion between T0 and T4. Pain decreased from 7.16 ± 2.48 to 1.75 ± 1.98 for the arthroscopic group and from 7.53 ± 2.69 to 1.00 ± 1.86 for the arthrocentesis group (P = .000). CONCLUSION: Both the approaches of arthrocentesis and arthroscopic level 1 reduced pain and improved mouth opening and lateral and protrusive movements over time.

The efficiency of extended postoperative antibiotic prophylaxis in orthognathic surgery: A prospective, randomized, double-blind, placebo-controlled clinical trial.

Postoperative antibiotics are commonly administered in orthognathic surgery, despite the fact that there is no consensus regarding their efficacy. The objective of this study was to investigate the effectiveness of postoperative antibiotics in orthognathic surgery by conducting a prospective, randomized, double-blind, placebo-controlled trial. Patients were randomly allocated into one of two study groups: the intervention group (treated with 1 g of intravenous (IV) amoxicillin-clavulanate TID) or the placebo group (treated with 50 mL of IV 0.9% NaCl TID). The infection rate was assessed using clinical and laboratory parameters. The intervention group included 38 patients, with 40 patients in the placebo group. Baseline and surgical characteristics were comparable between both groups. Mean postoperative C-reactive protein (CRP) and temperature were similar for both groups. Serous discharge was observed in two patients (both in the placebo group), and one of them required surgical intervention. Overall, infection rate was similar in both groups (p-value > 0.1). To conclude, administration of postoperative antibiotics in healthy, young patients undergoing orthognathic surgery did not show a significant advantage in reducing surgical infection rate.