|Baltic Dental and Maxillofacial Journal|
December, 2015, Vol. 17, No. 4
Upper airway obstuction in class II patients. Effects of Andresen activator on the anatomy of pharingeal airway passage. Cone beam evalution
© 2015 Stomatologija
Stomatologija 2015; 17 (4): 113-17 145 KB
Temporomandibular joint arthrocentesis for the treatment of osteoarthritis
Edvitar Leibur, Oksana Jagur, Ülle Voog-Oras
The aim of the study was to estimate the effect of arthrocentesis in the treatment of osteoarthritis of the temporomandibular joint (TMJ), evaluate and compare cytological and biochemical findings in the synovial fluid (SF) as well in venous blood samples and to determine the effectiveness of arthrocentesis with regard to TMJ pain intensity and mandibular movement.
Patients and Methods. Twenty three consecutive patients with a diagnosis of TMJ osteoarthritis (Wilkes´ stages III, IV) after noneffective conservative treatment were treated with arthrocentesis using push and pull technique (Alstergren et al. 1995). Preoperative radiographs and the scores pre- and posttreatment (after 6 months), maximal interincisal opening (MIO) and visual analogue scale (VAS) for pain estimation were performed. Blocking the auriculotemporal nerve with a 2 mL of 2% lidocaine solution, the needle was inserted into the upper joint compartment and connected with the three-way stopcock for infusion therapy (Discofix® Braun) and 2-3 mL of saline solution was pushed slowly to the upper compartment and then aspirated back. The first SF aspirate was allocated for the following analysis: SF viscosity, presence of crystals, SF rheumatoid factor (RF) compared to blood plasma RF. The washing was repeated 3-4 times until the aspirate was clear.
Results. After 6 months MIO improved significantly (p<0.05) and pain according to VAS had substantially decreased (p<0.01). Viscosity of the aspirate was 0.78 (medium), crystals were found in 5 patients (21.7%). There was not statistical significant difference between SF RF and plasma RF values (p>0.05).The effectiveness of arthrocentesis may be explained by the joint space expansion achieved with the introduction fluid, washing out inflammatory mediators, the particles of adhesions, fibrillations, crystals etc.
Conclusions. Arthrocentesis with this technique for the treatment of TMJ osteoarthritis offer favourable results with regard to increasing MIO, reducing pain and dysfunction. The presence of crystals or chondromatosis granules in the synovial fluid and increased viscosity of the synovial fluid indicates a pathological condition of an inflammatory nature.
Key words: temporomandibular joint, osteoarthritis, arthrocentesis, synovial fluid.
Received: 10 12 2014
Accepted for publishing: 28 12 2015
1Department of Stomatology, Faculty of Medicine, Tartu University, Tartu, Estonia
2Department of Internal Medicine, Faculty of Medicine ,Tartu University, Tartu, Estonia
Edvitar Leibur1, 2 – M.D., PhD, Dr. med. Sc, Dr.h.c, prof.emeritus
Oksana Jagur1 – D.D.S., PhD
Ülle Voog-Oras1 – M.D., PhD, assoc. prof.
Address correspondence to prof. Edvitar Leibur, Department of Stomatology, Faculty of Medicine, Tartu University, L. Puusepa str. 8, 51014 Tartu, Estonia. E-mail address: Edvitar.Leibur@kliinikum.ee