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International Journal of Oral and... Jun 2024The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint... (Meta-Analysis)
Meta-Analysis Review
Arthroscopy versus arthrocentesis and versus conservative treatments for temporomandibular joint disorders: a systematic review with meta-analysis and trial sequential analysis.
The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint disorders. Thirteen controlled studies on various patient outcomes were included after a systematic search in seven electronic databases. Meta-analyses were conducted separately for arthroscopic surgery (AS) and arthroscopic lysis and lavage (ALL), and short-term (<6 months), intermediate-term (6 months to 5 years), and long-term (≥5 years) follow-up periods were considered. No significant differences in pain reduction and complication rates were found between AS or ALL and arthrocentesis. Regarding improvement in maximum mouth opening (MMO), both AS at intermediate-term and ALL at short-term follow-up were equally efficient when compared to arthrocentesis. However, at intermediate-term follow-up, ALL was superior to arthrocentesis for MMO improvement (mean difference 4.9 mm, 95% confidence interval 2.7-7.1 mm). Trial sequential analysis supported the conclusion of the meta-analysis for MMO improvement for ALL versus arthrocentesis studies at intermediate-term follow-up, but not for the other meta-analyses. Insufficient evidence exists to draw conclusions regarding other patient outcomes or about comparisons between arthroscopy and conservative treatments. Due to the low quality of the primary studies, further research is warranted before final conclusions can be drawn regarding the management of temporomandibular joint disorders.
Topics: Humans; Arthroscopy; Temporomandibular Joint Disorders; Arthrocentesis; Conservative Treatment
PubMed: 38286713
DOI: 10.1016/j.ijom.2024.01.006 -
Cureus Sep 2023Temporomandibular joint (TMJ) disorders present complex challenges in pain management and functional restoration. This review delves into the innovative approach of... (Review)
Review
Temporomandibular joint (TMJ) disorders present complex challenges in pain management and functional restoration. This review delves into the innovative approach of using platelet-rich plasma (PRP) and hyaluronic acid (HA) combination therapy in TMJ arthrocentesis to address these issues. The potential benefits of this approach are highlighted through an exploration of mechanisms, clinical studies, safety considerations, and future directions. PRP's regenerative properties and HA's lubrication and anti-inflammatory effects offer a comprehensive solution to multifactorial TMJ pain and dysfunction. Clinical studies reveal significant pain reduction, improved mobility, and enhanced satisfaction in patients treated with PRP and HA. Although mild and transient adverse effects have been reported, the safety profile remains favorable. While the evidence is promising, more extensive randomized controlled trials are needed to establish sustained efficacy and safety. As research evolves, collaborative efforts among clinicians and researchers are crucial in realizing the potential of PRP and HA combination therapy, ultimately providing a novel pathway to alleviate TMJ-related pain and enhance patient well-being.
PubMed: 37868393
DOI: 10.7759/cureus.45646 -
Journal of Maxillofacial and Oral... Dec 2023To evaluate the efficacy of arthrocentesis with and without sodium hyaluronate injection for internal derangement of temporomandibular joint.
AIM
To evaluate the efficacy of arthrocentesis with and without sodium hyaluronate injection for internal derangement of temporomandibular joint.
MATERIALS AND METHODS
Patients with clinically and radiographically confirmed cases of temporomandibular joint disorders were enrolled for this study. 20 patients were randomly allocated into two groups for arthrocentesis of TMJ with 10 patients in each group. In group 1, patients were treated with TMJ arthrocentesis followed by sodium hyaluronate injection, and in group 2, patients were treated with arthrocentesis alone. All the patients were treated under local anaesthesia. The patients were followed up at 1st week, 2nd week, 4th week and 12th week post operatively for maximum mouth opening, lateral mandibular movements, pain at rest and on mastication and the subjective efficacy of the treatment.
RESULTS
By the end of twelfth week follow up, the mean mouth opening showed significant improvement in group 1, the right and left lateral movements showed better results in group 1 than in group 2, pain at rest and pain on mastication were mild in both the groups with subjective efficacy good in group 1 and moderate in group 2.
CONCLUSION
This study suggested that TMJ arthrocentesis with sodium hyaluronate injection had better clinical outcome compared to TMJ arthrocentesis alone for TMJ disorders.
PubMed: 38105822
DOI: 10.1007/s12663-023-01936-1 -
Scientific Reports Oct 2023Irrespective of the exceptional adaptation of dromedaries to harsh environmental conditions, they remain highly susceptible to joint lameness resulting from a range of...
Irrespective of the exceptional adaptation of dromedaries to harsh environmental conditions, they remain highly susceptible to joint lameness resulting from a range of diverse factors and conditions. The joints most often affected by traumatic osteoarthritis in dromedaries are the metacarpophalangeal and metatarsophalangeal joints. A comprehensive understanding of joint anatomy and topography of the dromedary is required to perform arthrocentesis correctly on affected joints. Forty-two distal limbs were taken from 28 camels and studied by gross dissection, casting, ultrasonography, and computed tomography (CT). Representative three-dimensional models of the joint cavities, recesses, and pouches were obtained using different casting agents. This study provides a detailed description of dorsally, axially, and abaxially positioned joint recesses, as well as palmar/plantar positioned joint pouches. The safety and feasibility of the different arthrocentesis approaches were evaluated. The traditional dorsal arthrocentesis approach of the metacarpophalangeal, metatarsophalangeal, proximal interphalangeal, and distal interphalangeal joints, has limitations due to the risk of damaging the tendon structures and articular cartilage, which can lead to joint degeneration. A lateral arthrocentesis approach via the proximal palmar/plantar pouches of the metacarpophalangeal/metatarsophalangeal and proximal interphalangeal joints is recommended. This approach eliminates the potential needle injury to the articulating joint cartilage and other surrounding joint structures, such as tendons, blood vessels, and nerves.
Topics: Animals; Camelus; Arthrocentesis; Forelimb; Joints; Cartilage, Articular; Metatarsophalangeal Joint
PubMed: 37833397
DOI: 10.1038/s41598-023-44391-1 -
Journal of General Internal Medicine Oct 2023Lack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS).
BACKGROUND
Lack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS).
AIM
Describe the development and 10-year outcomes of an MPS led by IM chief residents.
SETTING
University-based IM residency program affiliated with a county and Veterans Affairs hospital.
PARTICIPANTS
Categorical IM interns (n=320) and 4-year IM chief residents (n=48) from 2011 to 2022.
PROGRAM DESCRIPTION
The MPS operated on weekdays, 8 am-5 pm. After training and sign-off by the MPS director, chief residents trained and supervised interns in ultrasound-guided procedures during a 4-week rotation.
PROGRAM EVALUATION
From 2011 to 2022, our MPS received 5967 consults and 4465 (75%) procedures were attempted. Overall procedure success, complication, and major complication rates were 94%, 2.6%, and 0.6%, respectively. Success and complication rates for paracentesis (n=2285) were 99% and 1.1%, respectively; 99% and 4.2% for thoracentesis (n=1167); 76% and 4.5% for lumbar puncture (n=883); 83% and 1.2% for knee arthrocentesis (n=85); and 76% and 0% for central venous catheterization (n=45). The rotation was rated 4.6 out of 5 for overall learning quality.
DISCUSSION
A chief resident-led MPS is a practical and safe approach for IM residency programs to establish an MPS when experienced attending physicians are unavailable.
Topics: Humans; Internship and Residency; Clinical Competence; Education, Medical, Graduate; Paracentesis; Spinal Puncture; Internal Medicine
PubMed: 37237120
DOI: 10.1007/s11606-023-08234-z -
Journal of the American Veterinary... Apr 2024Synovial extramedullary hematopoiesis is a rarely reported condition in humans and, to date, has never been reported in canines. This case report describes the clinical...
OBJECTIVE
Synovial extramedullary hematopoiesis is a rarely reported condition in humans and, to date, has never been reported in canines. This case report describes the clinical presentation, diagnostic work-up, treatment, and outcome of a canine case confirmed to have hematopoietic tissue within multiple joints.
ANIMAL
A client-owned canine.
CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES
The clinical presentation was most consistent with immune-mediated polyarthritis, and arthrocentesis was performed in multiple joints for cytological evaluation and culture. Cytology revealed evidence of extramedullary hematopoiesis, and shortly thereafter the dog was diagnosed with immune-mediated hemolytic anemia and thrombocytopenia.
TREATMENT AND OUTCOME
Pregabalin, prednisolone, clopidogrel, and cyclosporine were started, and after several recheck appointments and dose adjustments, the dog's clinical signs resolved for all conditions.
CLINICAL RELEVANCE
Unusual sites of extramedullary hematopoietic tissue may result in a clinical presentation for which more traditional etiologies and differentials are not applicable.
Topics: Humans; Dogs; Animals; Hematopoiesis, Extramedullary; Bone Marrow; Anemia; Dog Diseases
PubMed: 38266389
DOI: 10.2460/javma.23.11.0617 -
Medicina (Kaunas, Lithuania) Oct 2023: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular diseases involving the temporomandibular joint complex and the...
The Effect of Arthrocentesis Treatment for Maximum Mouth Opening and Pain in Temporomandibular Joint Diseases and the Effect of Splint, Drug, and Physical Therapy on This Treatment.
: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular diseases involving the temporomandibular joint complex and the surrounding muscle and osseous structure. TMD can be classified as intra-articular or extra-articular. The aim of this study was to evaluate the effect of arthrocentesis in terms of maximum mouth opening (MMO) and pain in patients with TMD of intra-articular origin. In addition to this treatment, the effects of factors such as splints, medication, and physical therapy on arthrocentesis were examined. : This retrospectively designed study was conducted with 79 patients who had previously undergone arthrocentesis. These patients were divided into three groups according to the Research Diagnostic Criteria for temporomandibular disorder: disc displacement (DD) with locking (Group 1), DD without locking (Group 2), and degenerative joint diseases (Group 3) groups. The maximum mouth opening (MMO) and visual analog score (VAS) values of the groups were recorded before arthrocentesis (Baseline: T0), on the third day after arthrocentesis (T1), and at the sixth month (T2) after arthrocentesis. Information about whether the patients received concurrent medical treatment, splint treatment, and physical therapy was also recorded. These data were compared between groups. : It was observed that the VAS scores in all three groups decreased from T1 compared to T0 ( < 0.05). Likewise, the MMO value increased in all groups at T1 compared to T0. ( < 0.05). It was observed that splint treatment, pain killer and muscle relaxant treatment, and physical therapy made no additional contribution to arthrocentesis in terms of reducing pain or increasing MMO value ( > 0.05). : Arthrocentesis was observed to be effective in terms of pain and function in TMJ patients in this study. It was observed that splint therapy, physical therapy, and medical therapy made no additional contribution to arthrocentesis in terms of MMO or pain.
Topics: Humans; Arthrocentesis; Splints; Retrospective Studies; Treatment Outcome; Range of Motion, Articular; Temporomandibular Joint Disorders; Pain; Physical Therapy Modalities; Mouth
PubMed: 37893485
DOI: 10.3390/medicina59101767 -
Cranio : the Journal of... Jul 2024To compare the comfort and anxiety levels of patients undergoing two different temporomandibular joint (TMJ) arthrocentesis techniques. (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
OBJECTIVE
To compare the comfort and anxiety levels of patients undergoing two different temporomandibular joint (TMJ) arthrocentesis techniques.
METHODS
Fifty female patients were randomly assigned into two groups of 25 based on the treatment modality: Group 1, single-puncture Type-1 arthrocentesis (SPA); Group 2, conventional double-puncture arthrocentesis (DPA). Preoperative and postoperative anxiety was scored with the State-Trait Anxiety Inventory-S (STAI-S) questionnaire. Blood pressure and heart rate were assessed preoperatively during the application of local anesthesia and at needle insertion into the joint cavity, the 5th and 10th minute of the procedure, and end of the procedure.
RESULTS
STAI-S scores were lower postoperative than preoperative in both groups. Heart rate and mean arterial pressure were highest during anesthesia and needle insertion ( < 0.005). Changes in heart rate, mean arterial pressure, and STAI-S scores were statistically similar between the groups.
CONCLUSION
DPA and SPA were tolerated similarly by the patients.
Topics: Humans; Female; Arthrocentesis; Adult; Heart Rate; Patient Comfort; Anxiety; Punctures; Blood Pressure; Middle Aged; Young Adult; Temporomandibular Joint Disorders; Anesthesia, Local
PubMed: 34719355
DOI: 10.1080/08869634.2021.1992211 -
The Journal of Craniofacial Surgery Jun 2024Temporomandibular joint (TMJ) arthrocentesis is one of the most commonly used non-invasive surgical interventions in the treatment of refractory pain and dysfunction... (Randomized Controlled Trial)
Randomized Controlled Trial
Temporomandibular joint (TMJ) arthrocentesis is one of the most commonly used non-invasive surgical interventions in the treatment of refractory pain and dysfunction associated with internal derangement. Several adjunctive therapies have been used in combination with arthrocentesis in an attempt to increase its efficacy and long-term maintenance. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor which is used in different chronic pain conditions. This study aimed to assess the efficacy of duloxetine in combination with arthrocentesis compared with arthrocentesis alone. Twenty-eight patients with chronic TMJ pain were included and randomly allocated into 2 groups (control and study groups). The control group included patients who underwent TMJ arthrocentesis only, and the study group included patients who underwent arthrocentesis followed by giving duloxetine (30 mg) orally twice daily for 3 months. Pain, maximum mouth opening, and level of anxiety and depression were assessed preoperatively and followed at regular intervals of 1 week, 1 month, 3 months, and 6 months postoperatively. Pain was significantly reduced in both groups at all postoperative intervals and was significantly lower in the study group than the control group at 6 months. Maximum mouth opening increased significantly in both groups, but the difference between them was not significant. Level of anxiety and depression was significantly decreased in both groups, with no statistically significant difference between them. The results of this study indicate that duloxetine in combination with arthrocentesis may provide effective and long-term pain control; however, its use is associated with a higher risk of adverse events.
Topics: Humans; Duloxetine Hydrochloride; Female; Male; Adult; Temporomandibular Joint Disorders; Arthrocentesis; Treatment Outcome; Pain Measurement; Combined Modality Therapy; Middle Aged; Anxiety; Depression; Chronic Pain; Serotonin and Noradrenaline Reuptake Inhibitors
PubMed: 38727210
DOI: 10.1097/SCS.0000000000010266 -
Quintessence International (Berlin,... Jul 2023The technique of lysis and lavage has shown excellent success rates in treating internal derangement of the temporomandibular joint (TMJ). This procedure has been shown... (Randomized Controlled Trial)
Randomized Controlled Trial
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.
Topics: Humans; Arthrocentesis; Temporomandibular Joint Disorders; Temporomandibular Joint; Facial Pain; Arthroscopy; Range of Motion, Articular; Treatment Outcome
PubMed: 37010440
DOI: 10.3290/j.qi.b4007423