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International Dental Journal Jun 2024The aim of this superiority trial was to investigate the clinical outcomes of arthrocentesis as an early treatment supported by use of an occlusal splint vs use of an...
OBJECTIVES
The aim of this superiority trial was to investigate the clinical outcomes of arthrocentesis as an early treatment supported by use of an occlusal splint vs use of an occlusal splint only in the management of temporomandibular joint (TMJ) arthralgia.
METHODS
Ninety-five adults presenting with TMJ arthralgia were recruited into the study and randomised into 2 groups: Group 1 received arthrocentesis as an early treatment supported by use of an occlusal splint, whereas group 2 received treatment with an occlusal splint only. Seventy-four patients (group 1: n = 37; group 2: n = 37) completed the 1-year follow-up schedule and were included in the final analysis. Reduction of pain intensity measured by a numeric rating scale and increase in mouth opening distance (unassisted maximal, assisted maximal, and pain-free) was seen in both treatment groups.
RESULTS
In group 1, pain intensity significantly decreased at 6 weeks and all subsequent time points compared with group 2. In terms of mouth opening distance, a significant improvement was observed in both groups during the course of treatment, but statistical significance was not seen between the 2 treatment groups.
CONCLUSIONS
Early arthrocentesis supported by use of an occlusal splint is superior to use of an occlusal splint alone in the treatment of TMJ arthralgia. Arthrocentesis with occlusal splint support could be discussed as first-line treatment for arthralgia of the TMJ, which may co-occur with various painful and nonpainful conditions of TMJ disorders.
PubMed: 38851933
DOI: 10.1016/j.identj.2024.04.015 -
National Journal of Maxillofacial... 2022The aim of the study is to compare the efficacy of platelet-rich plasma (PRP) for the management of internal derangement of temporomandibular joint (TMJ).
Comparison of intraarticular injection of platelet-rich plasma following arthrocentesis, with sodium hyaluronate and conventional arthrocentesis for management of internal derangement of temporomandibular joint.
AIM
The aim of the study is to compare the efficacy of platelet-rich plasma (PRP) for the management of internal derangement of temporomandibular joint (TMJ).
SETTINGS AND DESIGN
Thirty-three patients were selected from the pool of patients visiting the department of oral and maxillofacial surgery. Simple randomization was done.
SUBJECTS AND METHODS
Patients with anterior disc displacement without reduction (DDWOR) were indicated for arthrocentesis. Group A patients are treated with PRP, Group B patients with sodium hyaluronate following arthrocentesis, and Group C patients were treated with arthrocentesis alone. Postoperative pain and maximal incisal opening are the primary outcomes evaluated.
STATISTICAL ANALYSIS USED
The collected data were analyzed with IBM. SPSS statistics software 23.0 version and the one-way ANOVA with Tukey's test were used.
RESULTS
The mean age is 33 years, with female predominance. The statistical significant differences ( < 0.05) in pain and MIO between the 3 groups at the end of 3week, 4week, and 3 month postoperatively are seen in PRP group comparative to other groups.
CONCLUSIONS
Our study has concluded that the intraarticular injection of PRP is an effective management for anterior DDWOR of TMJ than intraarticular injection of sodium hyaluronate and arthrocentesis in, reducing the pain and improving the interincisal distance in patients with DDWOR, thus providing a rapid recovery and improved quality of life.
PubMed: 36051804
DOI: 10.4103/njms.NJMS_94_20 -
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 Maxillofacial and Oral... Jun 2022Temporomandibular disorders may be influenced by a lot of factors. Most patients with joint problems and especially in the facial muscles present some level of...
INTRODUCTION
Temporomandibular disorders may be influenced by a lot of factors. Most patients with joint problems and especially in the facial muscles present some level of psychological pathology.
MATERIALS AND METHODS
A prospective study was carried out to evaluate whether depression and anxiety influence the prognosis of 108 arthrocentesis in patients with temporomandibular disorders after 6-months follow-up.
RESULTS
Patients with depression and anxiety were worse than patients without psychological comorbidities, after six months postarthrocentesis. Both factors: anxiety and depression were significantly related to presenting degenerative joint pathology before and after arthrocentesis.
CONCLUSIONS
Diagnosis and treatment of psychological factors are important to improve the results in the treatment of temporomandibular disorders.
PubMed: 35712382
DOI: 10.1007/s12663-020-01504-x -
Journal of the Korean Association of... Jun 2020Joint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that...
OBJECTIVES
Joint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that arise after trauma are defined as post-traumatic arthritis (PTA). Although PTA is well recognized in knee and elbow joints, PTA in the temporomandibular joint (TMJ) has not been clearly defined. Interestingly, patients experiencing head and neck trauma without direct jaw fracture have displayed TMJ disease symptoms; however, definitive diagnosis and treatment options are not available. This study will analyze clinical aspects of PTA in TMJ and their treatment outcomes after joint arthrocentesis and lavage.
MATERIALS AND METHODS
Twenty patients with history of trauma to the head and neck especially without jaw fracture were retrospectively studied. Those patients developed TMJ disease symptoms and were diagnosed by computed tomography or magnetic resonance imaging. To decrease TMJ discomfort, arthrocentesis and lavage with or without conservative therapy were applied, and efficacy was evaluated by amount of mouth opening and pain scale. Statistical differences between pre- and post-treatment values were evaluated by Wilcoxon signed-rank test.
RESULTS
Patient age varied widely between 20 and 80 years, and causes of trauma were diverse. Duration of disease onset was measured as 508 posttrauma days, and 85% of the patients sought clinic visit within 2 years after trauma. In addition, 85% of the patients showed TMJ disc derangement without reduction, and osteoarthritis was accompanied at the traumatized side or at both sides in 40% of the patients. After arthrocentesis or lavage, maximal mouth opening was significantly increased (28-44 mm on average, <0.001) and pain scale was dramatically decreased (7.8-3.5 of 10, <0.001); however, concomitant conservative therapy showed no difference in treatment outcome.
CONCLUSION
The results of this study clarify the disease identity of PTA in TMJ and suggest early diagnosis and treatment options to manage PTA in TMJ.
PubMed: 32606278
DOI: 10.5125/jkaoms.2020.46.3.174 -
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 -
Cureus Sep 2021Novel oral anticoagulants (NOACs) are increasingly prescribed blood-thinning medication. Surpassing Warfarin, NOACs are more favored and extensively used in paroxysmal... (Review)
Review
Novel oral anticoagulants (NOACs) are increasingly prescribed blood-thinning medication. Surpassing Warfarin, NOACs are more favored and extensively used in paroxysmal atrial fibrillation, acute coronary syndrome, and in elderly patients. Well-known benefits of novel oral anticoagulants include predictable pharmacokinetics, pharmacodynamics, and shorter half-life. However, as with any anticoagulant, there are bleeding risks with NOACs. There is a lack of evidence and consensus on the management of novel anticoagulants for intraarticular injections and arthrocentesis. This systematic review aims to analyze the risk of bleeding complications in patients on novel oral anticoagulants who underwent joint injections and arthrocentesis to help physicians in the decision-making and consenting process. A literature search of three online databases was completed using the Cochrane methodology for systematic reviews. Eligibility criteria included any study that reported bleeding complication rates in adult patients on novel oral anticoagulants that had a joint injection or aspiration whilst continuing their regular oral anticoagulation. All studies with any number of patients and published in any language were included. Review articles and systematic reviews were excluded. The search of databases resulted in a total of 310 articles. After screening, a total of four articles were deemed suitable to be included in the analysis. These described a total of 668 patients undergoing injections/aspiration procedures with patients on three different novel oral anticoagulants namely Rivaroxaban, Apixaban, and Dabigatran. Only one patient joint had a bleeding complication and the patient was on Dabigatran. The results of this systematic review show that it is relatively safe to perform joint injections and arthrocentesis whilst continuing on Novel oral anticoagulation.
PubMed: 34659968
DOI: 10.7759/cureus.17755 -
Cureus Nov 2022Introduction Osteoarthritis is one of the most common disorders of the temporomandibular joint (TMJ). The complex etiopathogenesis of the temporomandibular disorders...
Arthrocentesis, Injectable Platelet-Rich Plasma and Combination of Both Protocols of Temporomandibular Joint Disorders Management: A Single-Blinded Randomized Clinical Trial.
Introduction Osteoarthritis is one of the most common disorders of the temporomandibular joint (TMJ). The complex etiopathogenesis of the temporomandibular disorders (TMDs), and the variability of symptoms make it difficult to adopt standardized therapeutic protocols. Recently, platelet-rich plasma (PRP) injections have been applied into the TMJ in patients with TMJ osteoarthritis. On the other hand, arthrocentesis has received a widespread acceptance, as a minimally-invasive surgical procedure for TMDs. This study aimed to assess and compare the effect of each of these protocols (arthrocentesis, PRP injection, combination of them) in the management of TMJ osteoarthritis. Methods A single-blinded randomized clinical trial was conducted on a sample of 33 participants with limited mouth opening, pain on function and joint sounds due to TMJ osteoarthritis. Participants were assigned randomly into three groups: Arthrocentesis with PRP group; PRP group; Arthrocentesis group. Maximum mouth opening (MMO), pain and joint sounds were re-evaluated during a six-month observation period. Intra- and inter-group comparisons regarding these variables were performed. Results Participants in all study groups showed statistically significant improvement in terms of MMO and pain during the six-month postoperative period (p<0.05), and showed no significant improvements regarding joint sounds (p>0.05). Pain evaluations showed better outcomes in arthrocentesis with PRP group in comparison to arthrocentesis or injectable PRP alone after six months of follow-up (p<0.05). There were no significant differences in the outcomes of MMO and joint sounds evaluations between the three groups after six months. Conclusions Within the limitations of this study, it can be concluded that the three assessed treatment protocols were effective in improving limited mouth opening and pain in patients with TMJ osteoarthritis. A combination of TMJ arthrocentesis and PRP intra-articular injections showed the best outcomes regarding pain symptoms. None of the tested treatment protocols showed improvement in terms of articular sounds.
PubMed: 36523721
DOI: 10.7759/cureus.31396 -
Journal of Clinical Medicine Apr 2022Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular... (Review)
Review
INTRODUCTION
Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains.
MATERIAL AND METHODS
The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis.
RESULTS
The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas.
DISCUSSION
Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis.
CONCLUSIONS
The most promising substances appear to be bone marrow and adipose tissue.
PubMed: 35566431
DOI: 10.3390/jcm11092305 -
Cartilage Dec 2021The knee joint is one of the most frequently injured joints in the body, and the resulting injury may often lead to the presence of a bloody effusion, or hemarthrosis.... (Review)
Review
The knee joint is one of the most frequently injured joints in the body, and the resulting injury may often lead to the presence of a bloody effusion, or hemarthrosis. The acute management of this condition can have long-lasting implications, and may ultimately result in the early onset of osteoarthritis in this population. Heme, a breakdown product of erythrocytes, and associated pro-inflammatory mediators, are known to have deleterious interactions with cartilage and synovium. The presence of blood in a joint following injury can precipitate these effects and accelerate the degenerative changes in the joint. Currently, there is no consensus on the optimal management of a traumatic knee joint injury with a hemarthrosis. Nontraumatic hemarthosis, seen most commonly in hemophilia patients, has a set of established guidelines that does not routinely recommend drainage of the joint. This article presents a rationale for joint aspiration to minimize the harmful effects of blood following traumatic hemarthrosis.
Topics: Arthrocentesis; Hemarthrosis; Hemophilia A; Humans; Knee Injuries; Knee Joint; Synovial Membrane
PubMed: 32698601
DOI: 10.1177/1947603520942937