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Journal of Oral and Maxillofacial... Jun 2024The understanding of the causes of temporomandibular joint pain and dysfunction has evolved over 50 years. Historically, the term internal derangement has been used to... (Review)
Review
The understanding of the causes of temporomandibular joint pain and dysfunction has evolved over 50 years. Historically, the term internal derangement has been used to describe the abnormal relationship between the articular disc, condyle, and glenoid fossa, which was thought to correlate with patient symptoms. It is now known that the pathophysiology of intra-articular pain and dysfunction (IPD) involves synovitis, capsular impingement, symptomatic disc displacement, or a combination of these. Symptomatic disc displacement should only be considered to be a potential source of IPD after synovitis and capsular impingement have been treated. This philosophy provides the opportunity for most patients with IPD to be initially treated nonsurgically or with minimally invasive procedures such as arthrocentesis or arthroscopy.
Topics: Humans; Temporomandibular Joint Disorders; Arthroscopy; Facial Pain; Arthralgia; Arthrocentesis
PubMed: 38280727
DOI: 10.1016/j.joms.2024.01.003 -
Journal of Clinical Medicine Jan 2024Over recent years, temporomandibular joint (TMJ) minimally invasive procedures, such as arthrocentesis and arthroscopy, have been appointed as an initial TMJ...
Over recent years, temporomandibular joint (TMJ) minimally invasive procedures, such as arthrocentesis and arthroscopy, have been appointed as an initial TMJ intra-articular treatment. Both procedures present safe and effective clinical results in managing temporomandibular disorders (TMD) by reducing pain and improving mouth opening. The use of these techniques in adults is validated in the literature. However, data on the safety and effectiveness of minimally invasive TMJ interventions in pediatric patients are scarce. This study aims to investigate the effectiveness of TMJ arthrocentesis and arthroscopy in the pediatric population. A prospective study was conducted at Instituto Português da Face (IPF) in Lisbon, Portugal, including patients treated for TMD from 1 June 2019 to 30 June 2023. In the present study, 26 patients (17 female and 9 male) were included, representing a total of 48 joints operated. A statistically significant reduction was observed in the primary outcome, TMJ pain, from 3.93 ± 2.80 preoperatively (mean ± SD) to 0.50 ± 1.53 (mean ± SD) postoperatively ( < 0.05). An improvement in the secondary outcome, maximum mouth opening, from 36.92 ± 8.79 preoperatively to 42.96 ± 5.07 postoperatively, was observed ( < 0.05). The overall success rate was 84.62%. This prospective study showed that TMJ arthrocentesis and arthroscopy appear to benefit pediatric patients with TMD, significantly lowering pain and improving MMO without relevant postoperative complications.
PubMed: 38337365
DOI: 10.3390/jcm13030672 -
Journal of Multidisciplinary Healthcare 2024With the continuous development and progress of medicine, there are many methods for the treatment of temporomandibular disorders, among which temporomandibular joint... (Review)
Review
With the continuous development and progress of medicine, there are many methods for the treatment of temporomandibular disorders, among which temporomandibular joint lavage is also constantly developed. In the past century, through the efforts of some scholars and clinical summary, the understanding of this disease has been deepened and broadened. At present, through continuous exploration of the treatment methods, the lavage is relatively mature, and has achieved good clinical results. In this paper, the application of temporomandibular joint lavage in the treatment of temporomandibular joint disorders, its treatment methods, treatment mechanism, the auxiliary of other drugs, indications, complications and so on were discussed.
PubMed: 38736540
DOI: 10.2147/JMDH.S458227 -
The Orthopedic Clinics of North America Apr 2024Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are... (Review)
Review
Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.
Topics: Humans; Arthritis, Infectious; Debridement; Risk Factors; Wrist; Wrist Joint
PubMed: 38403373
DOI: 10.1016/j.ocl.2023.11.002 -
Pediatric Emergency Care Jan 2024Septic arthritis is one potential cause of pediatric joint effusion and pain that may lead to significant morbidity. We present a case where point-of-care ultrasound was... (Review)
Review
Septic arthritis is one potential cause of pediatric joint effusion and pain that may lead to significant morbidity. We present a case where point-of-care ultrasound was used to identify and aspirate a joint effusion in a pediatric patient with septic arthritis of the ankle, facilitating timely diagnosis and care. We review the technique for arthrocentesis of the ankle and literature on point-of-care ultrasound in the diagnosis of pediatric septic arthritis.
Topics: Humans; Child; Arthrocentesis; Ankle; Point-of-Care Systems; Arthritis, Infectious; Ultrasonography, Interventional
PubMed: 38157397
DOI: 10.1097/PEC.0000000000003105 -
Cureus Oct 2023A 54-year-old man with a history of hypertension, atrial fibrillation, chronic kidney disease, nonischemic cardiomyopathy, osteoarthritis, and gout presented to the...
A 54-year-old man with a history of hypertension, atrial fibrillation, chronic kidney disease, nonischemic cardiomyopathy, osteoarthritis, and gout presented to the emergency department (ED) with dysuria, painful scrotal swelling, severe bilateral flank pain, back pain, atraumatic right arm (elbow and distally) pain and swelling, and bilateral knee pain. His physical exam was notable for fever, tachycardia, bilateral costovertebral angle (CVA) tenderness, exquisite pain, erythema, and swelling of bilateral knees and the right arm (elbow and distally). He met Systemic Inflammatory Response Syndrome (SIRS) criteria, was placed on Ceftriaxone for presumed septic pyelonephritis, and was admitted to the medicine team. With initially unremarkable imaging studies, the differential diagnosis was broadened, and subsequent infectious workups yielded grossly normal results. At the end of hospital day one, the patient remained febrile and without symptomatic improvement. Rheumatology was consulted and empirically treated; the patient with a dose of Anakinra due to concerns about a polyarticular flare of crystalline arthropathy. Subsequent arthrocentesis confirmed a final diagnosis of a polyarticular gout flare. This case highlights the diagnostic challenges a polyarticular gout flare poses and the importance of early involvement of specialists for prompt recognition, treatment, and avoidance of unnecessary interventions.
PubMed: 38022145
DOI: 10.7759/cureus.46967 -
Journal of Cranio-maxillo-facial... Mar 2024This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump... (Randomized Controlled Trial)
Randomized Controlled Trial
This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR). A total of 48 patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 24): Group 1, TMJ arthrocentesis with the addition of catheters and a vacuum pump to the second needle; Group 2, TMJ arthrocentesis without any addition device. The following variables were registered and compared between groups: patient's pain perception (visual analogue scale [VAS; 0-10]); maximal interincisal distance [MID; mm]; joint effusion (JE, presence or absence); facial edema (FE; presence or absence); and the operation duration (OP; minutes). Patients in Group 1 presented with significantly lower VAS scores (p < 0.001) and presence of FE (p = 0.03) in the post-operative period, also an increase in MID values (p = 0.026), and a reduction in JE (p = 0.022) after 3 months. Besides that, in this group, the procedure was performed significantly faster (p < 0.001). Performing arthrocentesis with the addition of a vacuum pump makes the procedure faster and yields better results in terms of pain, facial swelling, mouth opening and joint effusion.
Topics: Humans; Arthrocentesis; Vacuum; Treatment Outcome; Punctures; Temporomandibular Joint Disorders; Catheters; Range of Motion, Articular; Temporomandibular Joint
PubMed: 38253472
DOI: 10.1016/j.jcms.2024.01.020 -
International Journal of Paediatric... Jun 2024Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, and temporomandibular joints (TMJs) are involved in 39%-78% of patients. (Review)
Review
BACKGROUND
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, and temporomandibular joints (TMJs) are involved in 39%-78% of patients.
AIM
The aim of this systematic review was to assess the effectiveness of conservative approaches in improving TMJ arthritis in children and adolescents affected by JIA.
DESIGN
PubMed, Scopus, and Web of Science were systematically searched from the inception until February 25, 2024, to identify observational studies presenting participants with a diagnosis of JIA affecting the TMJ, rehabilitative approaches for TMJ arthritis as interventions, and clinical or radiological assessment of TMJ arthritis as outcome.
RESULTS
Of 478 papers suitable for title/abstract screening, 13 studies were included. The studies evaluated the effectiveness of intra-articular (IA) corticosteroid (CS) injections, IA infliximab injections, arthrocentesis alone or in combination with IACS injections, occlusal splint, functional appliance, and physiotherapy. The effectiveness of IACS injections was shown in eight studies. IA infliximab injections did not appear to significantly improve TMJ arthritis.
CONCLUSION
Results of this systematic review suggested that conservative treatments, especially IACS injections, might be effective in improving TMJ arthritis in patients affected by JIA. Further studies with a higher level of evidence and more representative samples should be conducted.
PubMed: 38863137
DOI: 10.1111/ipd.13225 -
Journal of Stomatology, Oral and... Apr 2024We aimed to compare the clinical results of the modified double-puncture arthrocentesis technique with the results of the conventional double-puncture and...
We aimed to compare the clinical results of the modified double-puncture arthrocentesis technique with the results of the conventional double-puncture and single-puncture techniques. Patients who underwent unilateral arthrocentesis and had stage 2-4 internal irregularities according to Wilkes classification were included in the study. The outcome variables were pain, maximum mouth opening, quality of life, and duration of the procedure. Data were analysed preoperatively and 1st-day, 1st-week, and 1st-month after the procedure. A total of 52 patients (49-females, 3-males) with complete records were included in this study. The mean age of the patients was 32.7 ± 15.6 years. There was no significant difference between the three techniques in terms of outcome variables at all times (p > 0.05). There was a significant difference between the single puncture technique and the other techniques in terms of procedure time (p < 0.05). No superiority of the modified double-puncture arthrocentesis was found in terms of clinical results.
PubMed: 38580207
DOI: 10.1016/j.jormas.2024.101864 -
Journal of the College of Physicians... Jun 2024To determine the clinical applicability of the modified concentric cannula technique (CCT), focusing on the duration of the arthrocentesis, the number of reposition of...
OBJECTIVE
To determine the clinical applicability of the modified concentric cannula technique (CCT), focusing on the duration of the arthrocentesis, the number of reposition of cannula, and the occurrence of complications.
STUDY DESIGN
Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ankara Yildirim Beyazit University, Ankara, Turkiye, between September 2021 and May 2022.
METHODOLOGY
Forty patients with Wilkes III temporomandibular joints (TMJ) internal derangement were identified and 13 patients who met the inclusion criteria were reviewed. The main outcomes regarding the clinical applicability of modified CCT included the duration of arthrocentesis, the number of reposition of cannula, and the occurrence of complications.
RESULTS
The values of maximum mouth opening (MMO) without pain and MMO without assistance measured in the immediate postoperative period and at the 4th and 8th postoperative weeks were found to be significantly higher than the pre-arthrocentesis values. The values of MMO with assistance measured in the immediate postoperative period and at the 8th postoperative week were also significantly higher than the baseline values. Compared with preoperative values, notable decreases in pain scores were observed at the 4th (p = 0.003) and 8th (p = 0.002) postoperative weeks. The assessment of the jaw dysfunction also revealed significantly lower scores at the 4th (p = 0.024) and 8th (p <0.001) postoperative weeks.
CONCLUSION
Modified CCT of arthrocentesis substantially decreased pain and improved mandibular functions in patients with internal derangement of TMJ. Additionally, this technique could be performed with a reduced number of cannula relocations and required a shorter operative time even with the use of a higher irrigation volume during the lavage procedure.
KEY WORDS
Arthrocentesis, Temporomandibular joint disorder, Temporomandibular joint.
Topics: Humans; Arthrocentesis; Male; Female; Temporomandibular Joint Disorders; Adult; Middle Aged; Punctures; Needles; Treatment Outcome; Young Adult; Temporomandibular Joint; Range of Motion, Articular; Cannula
PubMed: 38840358
DOI: 10.29271/jcpsp.2024.06.717