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2.
Oral Maxillofac Surg Clin North Am ; 30(3): 343-349, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29866448

RESUMO

Recurrent temporomandibular joint dislocation (TMJD) is a distressing entity to the patient and a therapeutic challenge to the treating provider. Absence of high-level evidence in literature among currently available treatment options creates a lack of consistency in management. This article reviews the current literature on common injectable agents used and the open surgical techniques. Based on the findings, an injectable agent is the initial treatment of choice for recurrent TMJD, with capsulorraphy and eminectomy being used in nonresponding patients.


Assuntos
Transfusão de Sangue Autóloga/métodos , Toxinas Botulínicas Tipo A/uso terapêutico , Luxações Articulares/tratamento farmacológico , Luxações Articulares/cirurgia , Fármacos Neuromusculares/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Transtornos da Articulação Temporomandibular/cirurgia , Humanos , Injeções Intra-Articulares , Recidiva
3.
Toxins (Basel) ; 10(5)2018 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-29693593

RESUMO

The aim of this study was to compare treatment outcomes following intramuscular injection of botulinum neurotoxin (BoNT) in patients with recurrent temporomandibular joint dislocation, with and without muscle hyperactivity due to neurological diseases. Thirty-two patients (19 women and 13 men, mean age: 62.3 years) with recurrent temporomandibular joint dislocation were divided into two groups: neurogenic (8 women and 12 men) and habitual (11 women and 1 man). The neurogenic group included patients having neurological disorders, such as Parkinson’s disease or oromandibular dystonia, that are accompanied by muscle hyperactivity. BoNT was administered via intraoral injection to the inferior head of the lateral pterygoid muscle. In total, BoNT injection was administered 102 times (mean 3.2 times/patient). The mean follow-up duration was 29.5 months. The neurogenic group was significantly (p < 0.001) younger (47.3 years) than the habitual group (84.8 years) and required significantly (p < 0.01) more injections (4.1 versus 1.7 times) to achieve a positive outcome. No significant immediate or delayed complications occurred. Thus, intramuscular injection of BoNT into the lateral pterygoid muscle is an effective and safe treatment for habitual temporomandibular joint dislocation. More injections are required in cases of neurogenic temporomandibular joint dislocation than in those of habitual dislocation without muscle hyperactivity.


Assuntos
Toxinas Botulínicas/uso terapêutico , Luxações Articulares/tratamento farmacológico , Doenças Musculares/tratamento farmacológico , Doenças do Sistema Nervoso/tratamento farmacológico , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Músculos Pterigoides , Recidiva , Adulto Jovem
4.
Foot Ankle Spec ; 11(5): 467-470, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29577748

RESUMO

Plantar dislocation of the first metatarsophalangeal (MTP) joint is exceedingly rare, and in prior reported cases, simple closed manipulation easily enabled reduction. We present here the first reported plantar dislocation that failed closed manipulation. We also report a technique involving injection of saline into the joint to facilitate reduction. The saline insufflation likely relieves buttonholing of the metatarsal head through the dorsal joint capsule. For first MTP joint plantar dislocations that fail reduction with manipulation, we recommend attempting injection of the joint with saline prior to subjecting the patient to open reduction. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case report.


Assuntos
Luxações Articulares/tratamento farmacológico , Articulação Metatarsofalângica/efeitos dos fármacos , Amplitude de Movimento Articular/fisiologia , Solução Salina/uso terapêutico , Adulto , Seguimentos , Humanos , Injeções Intra-Articulares , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/reabilitação , Masculino , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/lesões , Recuperação de Função Fisiológica , Contenções , Resultado do Tratamento
5.
J Craniofac Surg ; 29(5): e461-e465, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29533255

RESUMO

PURPOSE: The aim of this study was to compare and evaluate the efficacy of different concentrations of dextrose prolotherapy for the treatment of temporomandibular joint (TMJ) hypermobility. PATIENTS AND METHODS: A prospective, randomized clinical trial including patients with subluxation or dislocation was performed. The study comprised 40 patients. Patients were randomly divided into 4 groups: control group, 10% dextrose, 20% dextrose, and 30% dextrose group. Patients in all groups received injections into 4 different areas of each TMJ in 4 sessions at monthly intervals. Visual analog scale of TMJ pain intensity, maximum mouth opening (MMO), joint sounds, and frequency of luxations were recorded preoperatively and postoperatively after 1 month of last injection. The collected data were then statistically analyzed. RESULTS: Each group showed postoperatively significant improvement in TMJ pain, significant decrease in both MMO and joint sound. Besides that, TMJ locking was not observed in any patient during the follow-up period. There were no statistically significant differences throughout the study intervals between the groups. CONCLUSION: It was concluded that there was no significant difference between control group and dextrose groups and there is no superiority of any concentration of dextrose over the others in TMJ prolotherapy, and all treatment procedures were efficient in improvement of clinical symptoms related to TMJ hypermobility. If dextrose is used as a proliferant, it can be said that 10% dextrose can be sufficient in TMJ hypermobility treatment.


Assuntos
Glucose/administração & dosagem , Luxações Articulares/tratamento farmacológico , Proloterapia/métodos , Síndrome da Disfunção da Articulação Temporomandibular/tratamento farmacológico , Articulação Temporomandibular/efeitos dos fármacos , Adolescente , Adulto , Relação Dose-Resposta a Droga , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
6.
J Emerg Med ; 53(2): 232-235, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28651954

RESUMO

BACKGROUND: The interest in regional anesthesia procedures for the management of upper-extremity emergencies has increased. Toward that end, supraclavicular, interscalene, or infraclavicular approaches, with or without ultrasound guidance, are used for brachial plexus nerve blocks. Although many studies have reported on the use of ultrasound-guided supraclavicular and interscalene brachial plexus blocks for upper-extremity dislocations, very few studies have reported on the use of ultrasound-guided infraclavicular brachial plexus blocks. CASE REPORT: We present an adult patient with posterior elbow dislocation that is treated with reduction after applying an ultrasound-guided infraclavicular brachial plexus block. Additionally, we describe the infraclavicular block in detail and demonstrate the technique using images. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Based on our experience, the ultrasound-guided infraclavicular block is a fast, safe, and efficient anesthesia technique that can be an excellent alternative to sedoanalgesia and other brachial plexus blocks for the management of elbow dislocations in the emergency department.


Assuntos
Plexo Braquial/patologia , Cotovelo/lesões , Luxações Articulares/tratamento farmacológico , Bloqueio Nervoso/métodos , Ultrassonografia/métodos , Anestésicos Locais/farmacologia , Anestésicos Locais/uso terapêutico , Cotovelo/fisiopatologia , Humanos , Masculino , Mepivacaína/farmacologia , Mepivacaína/uso terapêutico , Bloqueio Nervoso/instrumentação , Adulto Jovem
7.
Br J Oral Maxillofac Surg ; 55(5): 465-470, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28460873

RESUMO

The aim was to analyse the short-term and long-term therapeutic efficacy of dextrose prolotherapy for dislocation or subluxation (hypermobility) of the temporomandibular joint (TMJ). Sixty-one patients with symptomatic hypermobility of the TMJ were included in this single-arm prospective study, in which they were each given four sessions of intra-articular and pericapsular injections six weeks apart. Each injection comprised 10% dextrose/mepivacaine solution 3ml. Clinical outcomes including severity of pain on movement according to the numerical rating scale (NRS), maximal interincisal opening, clicking, and frequency of locking were measured before treatment (T1), during treatment (T2) (just before the third session of injections), at the short-term follow-up (T3) (three months after treatment), and at the long-term follow-up (T4) (1-4 years after treatment). Condylar translation and osseous changes of each joint were evaluated at T1 and T4 using tomography. There was significant reduction in all variables by T2 (p<0.001, p<0.001, p=0.006, and p<0.001). The pain scores (p<0.001) and clicking (p<0.001) had decreased significantly by T3. Linear tomograms of each joint at T1 and T4 showed no alteration in the morphology of the bony components of the joint, and at T4, tomographic open views of all joints showed condylar hypertranslation. Dextrose prolotherapy provided significant and sustained reduction of pain and recovery of constitutional symptoms associated with symptomatic hypermobility of the TMJ without changing either the position of the condyle or the morphology of the bony components of the joint.


Assuntos
Anestésicos Locais/uso terapêutico , Glucose/uso terapêutico , Luxações Articulares/tratamento farmacológico , Instabilidade Articular/tratamento farmacológico , Mepivacaína/uso terapêutico , Proloterapia/métodos , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Adolescente , Adulto , Anestésicos Locais/administração & dosagem , Feminino , Seguimentos , Glucose/administração & dosagem , Humanos , Injeções Intra-Articulares , Masculino , Mepivacaína/administração & dosagem , Medição da Dor , Estudos Prospectivos , Resultado do Tratamento
8.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 52(3): 161-165, 2017 Mar 09.
Artigo em Chinês | MEDLINE | ID: mdl-28279053

RESUMO

Anterior disc displacement (ADD) of temporomandibular joint (TMJ) is regarded as one of the major findings in temporomandibular disorders (TMD). It is related to joint noise, pain, mandibular dysfunction, degenerative change and osteoarthritis. In the mean time, the pathological changes were found in synovial membrane and synovial fluid. Hyaluronic acid is a principal component of the synovial fluid which plays an important role in nutrition, lubrication, anti-inflammation and cartilage repair. The synthesis, molecule weight, and concentration of hyaluronic acid are decreased during TMD and cause TMJ degenerative changes. The clinical conditions, pathological changes, the mechanism of action for hyaluronic acid and the treatment of anterior disc displacement of TMJ are discussed in this article.


Assuntos
Ácido Hialurônico/administração & dosagem , Luxações Articulares/tratamento farmacológico , Síndrome da Disfunção da Articulação Temporomandibular/tratamento farmacológico , Articulação Temporomandibular/lesões , Viscossuplementos/administração & dosagem , Humanos , Ácido Hialurônico/química , Injeções Intra-Articulares , Osteoartrite/tratamento farmacológico , Osteoartrite/etiologia , Líquido Sinovial/química , Membrana Sinovial/química , Síndrome da Disfunção da Articulação Temporomandibular/etiologia
9.
Br J Oral Maxillofac Surg ; 55(1): e1-e2, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27256802

RESUMO

Recurrent dislocations of the temporomandibular joint (TMJ) can be debilitating. We describe a patient with osteoporosis who presented to our regional centre where we have limited resources. We injected botulinum toxin into both of her lateral pterygoid muscles, and six months later she has not required further injections and has had no issues with tolerance of the procedure. Botulinum toxin is a safe, conservative approach to recurrent dislocations of the TMJ and can be given accurately by an experienced surgeon without the use of an electromyogram.


Assuntos
Toxinas Botulínicas/uso terapêutico , Luxações Articulares/tratamento farmacológico , Osteoporose/complicações , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Idoso de 80 Anos ou mais , Feminino , Humanos , Luxações Articulares/etiologia , Osteoporose/tratamento farmacológico , Recidiva , Articulação Temporomandibular
10.
BMC Ophthalmol ; 16: 21, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26931792

RESUMO

BACKGROUND: Anomalous head posture (AHP) or torticollis is a relatively common condition in children. Torticollis is not a diagnosis, but it is a sign of underlying disease. Grisel's syndrome (GS) is a rare condition of uncertain etiology characterized by a nontraumatic atlanto-axial subluxation (AAS), secondary to an infection in the head and neck region. It has not been considered, in ophthalmological papers, as a possible cause of AHP. CASE PRESENTATION: A case of AAS secondary to an otitis media is studied. The children showed neck pain, head tilt, and reduction in neck mobility. The patient had complete remission with antibiotic and anti-inflammatory therapy and muscle relaxants. Signs of GS should always be taken into account during ophthalmological examination (recent history of upper airway infections and/or head and neck surgeries associated to a new onset of sudden, painful AHP with normal ocular exam). In such cases it is necessary to require quick execution of radiological examinations (computer tomography and/or nuclear magnetic resonance), which are essential to confirm the diagnosis. CONCLUSION: GS is a multidisciplinary disease. We underline the importance of an accurate orthoptic and ophthalmological examination. Indeed, early detection and diagnosis are fundamental to achieve proper management, avoid neurological complications and lead to a good prognosis.


Assuntos
Articulação Atlantoaxial/patologia , Artropatias/complicações , Luxações Articulares/complicações , Transtornos da Motilidade Ocular/etiologia , Postura , Torcicolo/etiologia , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Articulação Atlantoaxial/diagnóstico por imagem , Humanos , Imagem Tridimensional , Lactente , Artropatias/diagnóstico , Artropatias/tratamento farmacológico , Luxações Articulares/diagnóstico , Luxações Articulares/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Relaxantes Musculares Centrais/uso terapêutico , Cervicalgia/diagnóstico , Cervicalgia/tratamento farmacológico , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/tratamento farmacológico , Braquetes Ortodônticos , Faringite/diagnóstico , Faringite/tratamento farmacológico , Tomografia Computadorizada por Raios X , Torcicolo/diagnóstico , Torcicolo/tratamento farmacológico
11.
Pediatr Dent ; 37(1): 65-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25685976

RESUMO

Chronic recurrent temporomandibular joint (TMJ) dislocation is an uncommon condition that is painful and distressing to patients and uniquely challenging for clinicians. Sustained TMJ dislocation is not amenable to manual reduction alone when the etiology is muscular in nature. The purpose of this report was to describe the case of a child presenting with recurring temporomandibular joint dislocation secondary to muscle hyperactivity of unknown etiology that was managed with injections of botulinum toxin type A into the inferior lateral pterygoid muscles. The use of this peripheral antispasmoic neurotoxin is a reasonable, safe, and conservative, palliative treatment option for pediatric patients suffering from chronic recurring TMJ dislocation.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Luxações Articulares/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Artralgia/tratamento farmacológico , Toxinas Botulínicas Tipo A/administração & dosagem , Criança , Tratamento Conservador , Distonia/tratamento farmacológico , Feminino , Seguimentos , Humanos , Injeções Intramusculares , Fármacos Neuromusculares/administração & dosagem , Cuidados Paliativos , Parassimpatolíticos/administração & dosagem , Parassimpatolíticos/uso terapêutico , Músculos Pterigoides/efeitos dos fármacos , Recidiva
12.
J Craniofac Surg ; 25(6): e571-5, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25376140

RESUMO

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.


Assuntos
Dexametasona/uso terapêutico , Dor Facial/cirurgia , Glucocorticoides/uso terapêutico , Luxações Articulares/cirurgia , Paracentese/métodos , Transtornos da Articulação Temporomandibular/cirurgia , Adulto , Dexametasona/administração & dosagem , Dor Facial/tratamento farmacológico , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Injeções Intra-Articulares , Soluções Isotônicas/uso terapêutico , Luxações Articulares/tratamento farmacológico , Masculino , Má Oclusão de Angle Classe I/diagnóstico , Má Oclusão de Angle Classe II/diagnóstico , Má Oclusão de Angle Classe III/diagnóstico , Medição da Dor , Amplitude de Movimento Articular/efeitos dos fármacos , Amplitude de Movimento Articular/fisiologia , Solução de Ringer , Método Simples-Cego , Som , Disco da Articulação Temporomandibular/efeitos dos fármacos , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
13.
J Calif Dent Assoc ; 42(8): 537-47; discussion 545-8, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25174212

RESUMO

TMD orthopedics is the assessment, diagnosis and management of orthopedic disorders of the temporomandibular joint (TMJ). Anterior repositioning appliance (ARA) therapy for TMJ internal derangements is successful in long-term recapturing of disks in reducing and nonreducing joints at a rate of 64 percent and in regenerating degenerated condyles in some cases. ARA therapy for TMJ internal derangements is subjectively successful in relieving symptoms in reducing and nonreducing disk displacement TMJs in this study at an average rate of 94.5 percent.


Assuntos
Anestésicos Locais/uso terapêutico , Aparelhos Ortodônticos , Transtornos da Articulação Temporomandibular/terapia , Regeneração Óssea/fisiologia , Humanos , Injeções Intra-Articulares , Luxações Articulares/tratamento farmacológico , Luxações Articulares/terapia , Côndilo Mandibular/patologia , Desenho de Aparelho Ortodôntico , Disco da Articulação Temporomandibular/efeitos dos fármacos , Disco da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/tratamento farmacológico
15.
Br J Oral Maxillofac Surg ; 52(1): 63-6, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24064304

RESUMO

Conservative interventions with simple procedures and predictable benefits are expected by patients with recurrent dislocation of the temporomandibular joint (TMJ). We have introduced a modified technique of prolotherapy that comprises injection of lignocaine and 50% dextrose at a single site in the posterior periarticular tissues. We studied the effects in 45 younger patients (age range 17-59 years) with non-neurogenic recurrent dislocation of the TMJ, and confirmed the therapeutic effect after more than a year's follow-up. There were appreciable improvements in the number of episodes of dislocation and clicking after the injection. The overall success rate, defined as the absence of any further dislocation or subluxation for more than 6 months, was 41/45 (91%). Of the 41 rehabilitated patients, 26 (63%) required a single injection, 11 (27%) had 2 treatments, and 4 (10%) needed a third injection. All patients tolerated the injections well. The modified dextrose prolotherapy is simple, safe, and cost-effective for the treatment of recurrent dislocation of the TMJ.


Assuntos
Anestésicos Locais/administração & dosagem , Solução Hipertônica de Glucose/uso terapêutico , Luxações Articulares/tratamento farmacológico , Lidocaína/administração & dosagem , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Adolescente , Adulto , Feminino , Seguimentos , Solução Hipertônica de Glucose/administração & dosagem , Humanos , Injeções Intra-Articulares , Irritantes/administração & dosagem , Irritantes/uso terapêutico , Instabilidade Articular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Recidiva , Medicina Regenerativa , Segurança , Resultado do Tratamento , Adulto Jovem
16.
Dental Press J Orthod ; 18(5): 128-33, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24352399

RESUMO

INTRODUCTION: In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ) is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve function in patients who present arthrogenic temporomandibular disorders. OBJECTIVE: This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. METHODS: Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. RESULTS: After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. CONCLUSION: After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.


Assuntos
Corticosteroides/administração & dosagem , Ácido Hialurônico/administração & dosagem , Injeções Intra-Articulares , Luxações Articulares/tratamento farmacológico , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Viscossuplementos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Método Duplo-Cego , Combinação de Medicamentos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego
17.
Spine (Phila Pa 1976) ; 38(26): 2258-63, 2013 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-24150439

RESUMO

STUDY DESIGN: Retrospective cohort analysis. OBJECTIVE: To clarify the effect of biological agents (BAs) on the development and progression of cervical lesions in patients with rheumatoid arthritis (RA) and to identify biomarkers that accurately predict disease progression. SUMMARY OF BACKGROUND DATA: The introduction of BAs changed the paradigm of RA treatment. However, their effects on cervical lesions in patients with RA have not been studied. METHODS: Ninety-one subjects who had received BAs for 2 years or more were enrolled. Mean radiographical interval was 3.9 years. Disease activity was evaluated by disease activity score-C-reactive protein levels, and matrix metalloproteinase-3 levels. Cervical lesions were defined as an atlantodental interval more than 3 mm for atlantoaxial subluxation (AAS), Ranawat value less than 13 mm for vertical subluxation (VS), and anterior or posterior listhesis more than 2 mm for subaxial subluxation. Disease progression was defined radiographically as an increase in the atlantodental interval more than 2 mm for AAS, a decrease in both Ranawat and Redlund-Johnell values more than 2 mm for VS, and an increase in listhesis more than 2 mm for subaxial subluxation. We used multivariate regression techniques to assess predictors of disease progression. RESULTS: Baseline radiographical evaluation showed no pre-existing cervical lesion in 44 patients, AAS in 29, and VS in 18. Radiological progression occurred in 7% patients without baseline lesions, 79% in the AAS group, and 72% in the VS group. The incidence of progression was significantly lower in patients without lesions at baseline. Multivariate regression analysis demonstrated pre-existing cervical lesions, disease activity score-C-reactive protein levels at baseline and metalloproteinase-3 levels at final visit as good predictors of RA progression. CONCLUSION: BAs prevented de novo cervical lesions in patients with RA but failed to control progression in patients with pre-existing cervical lesions. Disease activity score-C-reactive protein levels at baseline were related to pre-existing joint destruction, and metalloproteinase-3 levels accurately predicted ongoing bone destruction during BA treatment. LEVEL OF EVIDENCE: 3.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Fatores Biológicos/uso terapêutico , Biomarcadores/metabolismo , Vértebras Cervicais/efeitos dos fármacos , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/metabolismo , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/efeitos dos fármacos , Articulação Atlantoaxial/patologia , Proteína C-Reativa/metabolismo , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Luxações Articulares/tratamento farmacológico , Instabilidade Articular/tratamento farmacológico , Modelos Logísticos , Masculino , Metaloproteinase 3 da Matriz/metabolismo , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Radiografia , Estudos Retrospectivos , Resultado do Tratamento
18.
Dental press j. orthod. (Impr.) ; 18(5): 128-133, Sept.-Oct. 2013. graf, tab
Artigo em Inglês | LILACS | ID: lil-697056

RESUMO

INTRODUCTION: In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ) is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve patients' functions who present arthrogenic temporomandibular disorders. OBJECTIVE: This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. METHODS: Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October of 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. RESULTS: After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. CONCLUSION: After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.


INTRODUÇÃO: em algumas situações, o tratamento conservador das alterações internas da articulação temporomandibular apresenta-se pouco responsivo. Nessas condições, torna-se necessária a realização de tratamentos que visem reduzir a dor e melhorar a função dos pacientes frente a disfunções temporomandibulares articulares. OBJETIVO: esse trabalho, por meio de uma revisão sistemática de literatura, teve como objetivo analisar a efetividade de infiltrações intra-articulares com corticosteroides e com hialuronato de sódio no tratamento para as alterações internas da ATM. MÉTODOS: foi feito levantamento nas bases de pesquisa MEDLINE, Cochrane, EMBASE, PubMed, Lilacs e BBO, abrangendo os anos de 1966 a outubro de 2010, com enfoque em estudos clínicos controlados randomizados ou quase-randomizados, cegos ou duplo-cegos. RESULTADOS: após a aplicação dos critérios de inclusão, chegou-se a nove artigos, sendo que sete eram estudos clínicos controlados randomizados duplo-cego e dois eram estudos clínicos controlados randomizados apenas cegos. CONCLUSÕES: pela análise da literatura, verifica-se que a infiltração intra-articular com corticosteroides e hialuronato de sódio parece ser um método efetivo no tratamento das alterações internas da ATM. Porém, são necessários mais estudos clínicos controlados randomizados, com amostras representativas e tempo de acompanhamento longo, para avaliar a real efetividade da técnica.


Assuntos
Humanos , Corticosteroides/administração & dosagem , Luxações Articulares/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Injeções Intra-Articulares , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Viscossuplementos/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Método Duplo-Cego , Combinação de Medicamentos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego
19.
Cranio ; 31(3): 211-25, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23971162

RESUMO

The aim of this study was to evaluate the efficacy of self-care combined with anti-inflammatory medications in the treatment of temporomandibular joint (TMJ) pain associated with disc displacement without reduction (DDWOR). A systematic review of randomized clinical trials was done by the authors. The databases searched were Medline (1966 to July 2012); EMBASE (1980 to July 2012); and LILACS (from 1982 to July 2012). The review authors independently assessed trials for eligibility and methodological quality and also extracted all data. The data was double-checked for accuracy. There was no language restriction in the searches of EMBASE, PubMed, and LILACS databases, or in the manual search. The risk of bias and the heterogeneity of the studies taken into consideration were assessed. Two studies, randomizing 175 patients, were included in this review. The first study (n = 106) compared the following interventions: medical treatment, rehabilitation, arthroscopic surgery with postoperative rehabilitation, or arthroplastic surgery with post-operative rehabilitation. The second study (n = 69) compared the use of nonsteroidal anti-inflammatory medications and self-care instructions, nonsteroidal anti-inflammatory medications, occlusal splint, and mobilization therapy. The third group received no treatment; patients were only informed of their prognosis. There is no sufficient evidence regarding efficacy and safety of the palliative treatments associated with anti-inflammatory versus other treatments, or absence of treatment on pain reduction in patients with TMJ DDWOR.


Assuntos
Anti-Inflamatórios/uso terapêutico , Luxações Articulares/terapia , Cuidados Paliativos , Disco da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/terapia , Humanos , Luxações Articulares/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Autocuidado , Transtornos da Articulação Temporomandibular/tratamento farmacológico
20.
Arch Dis Child ; 98(9): 721-4, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23702435

RESUMO

OBJECTIVES: To assess the effectiveness of sublingual ketorolac versus sublingual tramadol in reducing the pain associated with fracture or dislocation of extremities in children. PATIENTS AND METHODS: A double-blind, randomised, controlled, non-inferiority trial was conducted in the paediatric emergency department of a research institute. One hundred and thirty-one children aged 4-17 years with suspected bone fracture or dislocation were enrolled. Eligible children were randomised to ketorolac (0.5 mg/kg) and placebo, or to tramadol (2 mg/kg) and placebo by sublingual administration, using a double-dummy technique. Pain was assessed by the patients every 20 min, for a maximum period of 2 h, using the McGrath scale for patients up to 6 years of age, and the Visual Analogue Scale for those older than 6 years of age. RESULTS: The mean pain scores fell significantly from eight to four and five in the ketorolac and tramadol groups, respectively, by 100 min (Wilcoxon sign rank test, p<0.001). The mean pain scores for ketorolac were lower than those for tramadol, but these differences were not significant at any time point (Mann-Whitney U Test, p values: 0-20 min: 0.167; 20-40 min: 0.314; 40-60 min: 0.223; 60-80 min: 0.348; 80-100 min: 0.166; 100-120 min: 0.08). The rescue dose of paracetamol-codeine was administered in 2/60 children in the ketorolac group versus 8/65 in the tramadol group (Fisher exact test, p=0.098). There were no statistically significant differences between the two groups in the frequency of adverse effects. CONCLUSIONS: Both sublingual ketorolac and tramadol were equally effective for pain management in children with suspected fractures or dislocations.


Assuntos
Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Fraturas Ósseas/tratamento farmacológico , Luxações Articulares/tratamento farmacológico , Cetorolaco/uso terapêutico , Manejo da Dor/métodos , Tramadol/uso terapêutico , Administração Sublingual , Adolescente , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Criança , Pré-Escolar , Método Duplo-Cego , Serviço Hospitalar de Emergência , Feminino , Humanos , Cetorolaco/administração & dosagem , Cetorolaco/efeitos adversos , Masculino , Medição da Dor , Tramadol/administração & dosagem , Tramadol/efeitos adversos , Resultado do Tratamento
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