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Journal of Oral Rehabilitation Jun 2024Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform... (Review)
Review
BACKGROUND
Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet.
OBJECTIVE
The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD?
METHODS
The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases.
RESULTS
The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I = 22%; TMJ pain: p = .0003, I = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I = 0%; TMJ pain: p = .28, I = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence.
CONCLUSION
Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.
Topics: Humans; Temporomandibular Joint Disorders; Minimally Invasive Surgical Procedures; Joint Dislocations; Temporomandibular Joint Disc; Treatment Outcome; Arthrocentesis; Range of Motion, Articular; Hyaluronic Acid; Injections, Intra-Articular
PubMed: 38400536
DOI: 10.1111/joor.13661 -
Journal of Stomatology, Oral and... Apr 2024We aimed to find out if there is any difference in outcomes with the use of platelet-rich plasma (PRP) or hyaluronic acid (HA) intra-articular injections after... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We aimed to find out if there is any difference in outcomes with the use of platelet-rich plasma (PRP) or hyaluronic acid (HA) intra-articular injections after temporomandibular joint arthrocentesis.
METHODS
A systematic search of the electronic databases of PubMed, Embase, and Scopus was undertaken up to 5th May 2023. Randomized controlled trials (RCTs) comparing PRP with HA after TMJ arthrocentesis were included.
RESULTS
Seven RCTs were eligible. Pooled analysis failed to demonstrate any significant difference in MMO between PRP and HA groups at 1 month (MD: 0.21 95 % CI: -1.29, 1.70), 3 months (MD: 0.92 95 % CI: -2.96, 4.80), and 6 months (MD: -0.05 95 % CI: -2.08, 1.97). The inter-study heterogeneity was high with I values of 85 %, 98 %, and 81 % respectively. Similarly, there was no statistically significant difference in pain scores between the PRP and HA groups at 1 month (MD: 0.42 95 % CI: -2.25, 3.10), 3 months (MD: 0.90 95 % CI: -1.60, 3.41), and 6 months (MD: 0.06 95 % CI: -0.92, 1.04) with inter-study heterogeneity of 99 %, 99 %, and 92 % respectively.
CONCLUSION
Intra-articular use of PRP or HA after TMJ arthrocentesis may lead to comparable clinical outcomes. The current evidence is low-quality and fraught with high heterogeneity.
Topics: Humans; Hyaluronic Acid; Arthrocentesis; Treatment Outcome; Injections, Intra-Articular; Platelet-Rich Plasma
PubMed: 37923134
DOI: 10.1016/j.jormas.2023.101676 -
Pulmonary Medicine 2024Bilothorax is defined as the presence of bile in the pleural space. It is a rare condition, and diagnosis is confirmed with a pleural fluid-to-serum bilirubin ratio of...
BACKGROUND
Bilothorax is defined as the presence of bile in the pleural space. It is a rare condition, and diagnosis is confirmed with a pleural fluid-to-serum bilirubin ratio of >1.
METHODS
The PubMed, Embase, Google Scholar, and CINAHL databases were searched using predetermined Boolean parameters. The systematic literature review was done per PRISMA guidelines. Retrospective studies, case series, case reports, and conference abstracts were included. The patients with reported pleural fluid analyses were pooled for fluid parameter data analysis.
RESULTS
Of 838 articles identified through the inclusion criteria and removing 105 duplicates, 732 articles were screened with abstracts, and 285 were screened for full article review. After this, 123 studies qualified for further detailed review, and of these, 115 were pooled for data analysis. The mean pleural fluid and serum bilirubin levels were 72 mg/dL and 61 mg/dL, respectively, with a mean pleural fluid-to-serum bilirubin ratio of 3.47. In most cases, the bilothorax was reported as a subacute or remote complication of hepatobiliary surgery or procedure, and traumatic injury to the chest or abdomen was the second most common cause. Tube thoracostomy was the main treatment modality (73.83%), followed by serial thoracentesis. Fifty-two patients (51.30%) had associated bronchopleural fistulas. The mortality was considerable, with 18/115 (15.65%) reported death. Most of the patients with mortality had advanced hepatobiliary cancer and were noted to die of complications not related to bilothorax.
CONCLUSION
Bilothorax should be suspected in patients presenting with pleural effusion following surgical manipulation of hepatobiliary structures or a traumatic injury to the chest. This review is registered with CRD42023438426.
Topics: Female; Humans; Bile; Bilirubin; Pleural Effusion; Thoracentesis; Thoracostomy; Aged
PubMed: 38947176
DOI: 10.1155/2024/3973056 -
Cranio : the Journal of... Mar 2024To evaluate the benefits of hyaluronic acid intraarticular injection (HA IAI), in conjunction with minimally invasive surgery (arthrocentesis or arthroscopy), as a...
OBJECTIVE
To evaluate the benefits of hyaluronic acid intraarticular injection (HA IAI), in conjunction with minimally invasive surgery (arthrocentesis or arthroscopy), as a therapeutic option for temporomandibular joint disorders.
METHODS
An electronic search in PubMed, Cochrane Library, and Scopus databases was conducted in order to answer the following PICOS question: "In clinical trials with patients treated with arthroscopy or arthrocentesis, did the subsequent use of HA IAI provide a better control of postoperative pain and temporomandibular joint function compared to those patients who did not receive it?"
RESULTS
Following PRISMA criteria, six randomized controlled clinical trials were selected. HA IAI showed significant differences in terms of pain reduction in three of them and improvement of mandibular function in two, compared to the control group.
CONCLUSION
Based on scientific evidence, the level of recommendation found regarding this type of intervention is type B (recommendation based on inconsistent or limited-quality patient-oriented evidence).
Topics: Humans; Arthrocentesis; Hyaluronic Acid; Arthroscopy; Temporomandibular Joint Disorders; Temporomandibular Joint; Injections, Intra-Articular; Treatment Outcome
PubMed: 34027829
DOI: 10.1080/08869634.2021.1925029