resting opening, mastication

90.0%

66.4%

10.0%

33.6%

Improved Not Improved

Retrospective Study about Treatment Effect

of Temporomandibular Joint Arthrocentesis performed by a Single Surgeon

TMJ arthrocentesis may be used to reduce the pain in arthralgia with pain in

resting state and increase mouth opening in short term effectively. There is no

difference between treatment effect by injection medications after TMJ arthrocentesis,

and TMJ arthrocentesis had little effect to improve in joint noise.

Jin-woo Kim*, Jin-yong CHO, Sung-beom KIM

Materials and Methods

Conclusion

Department of Oral & Maxillofacial Surgery, Gachon University Gil Medical Center

Table 1. Demographic of patients

Introduction

Variables DD Myalgia DJD Arthralgia

Age, years 45.1±22.2 49.5±23.5 57.5±17.6 54.8±19.3

Gender, n(%) Men 11 (19.6) 1 (50.0) 4 (20.0) 24 (44.4)

Women 45 (80.4) 1 (50.0) 16 (80.0) 30 (55.6)

Total, n 56 2 20 54

132

129 patients complained of pain at first visit, and pain was reduced in 88 patients

after TMJ arthrocentesis. In 41 patients, pain were not relieved, or even worse.

Temporomandibular joint arthrocentesis is used for surgical treatment of several

kinds of temporomandibular disorder. The aim of study is to evaluate the treatment

effect of temporomandibular joint (TMJ) arthrocentesis and investigate the factors

affected treatment result.

Two-needle technique is commonly used for TMJ arthrocentesis. This technique

inserts two separate needles to upper joint space of TMJ. Two points on the

Holmlund-Hellsing line (H-H line) are widely used for needle insertion during TMJ

arthrocentesis. But, needle was not inserted into upper joint cavity of TMJ properly,

when using two points on H-H line, in most cases of this study.

Figure 1. Clinical image of

Two needle technique procedure.

○ Inclusion criteria

· Dept. of OMFS, Gachon University Gil Medical Center

· 2013 – 2019.06

· 132 patients diagnosed as Temporomandibular disorder (TMD)

- Disc Displacement (DD)

- Myalgia

- Degenerative Joint Disease (DJD)

- Arthralgia

Results

Difference in pain reduction by diagnosis, characteristic of pain at first visit, and

injection medication were not significant.

Low proportion (24.4%) of patients who had joint noise got improvement in

symptoms after TMJ arthrocentesis.

The reduction of pain was observed in 62.6% (57 out of 91) of women, and

81.6% (31 out of 38) of men. Treatment effect was significantly higher in men than

women. (p = 0.035)

Figure 2. Pain improvement by gender. (* p < 0.05 )

Figure 4. Pain improvement by diagnosis

In 74.1% of arthralgia patient, pain was reduced after TMJ arthrocentesis and its

proportion was higher than disc displacement (64.1%) and DJD patients (60%).

Figure 5. Pain improvement by characteristic of pain

The reduction of pain was observed in 90% of patients who had pain in resting

state, 66.4% of patients who had pain during mouth opening or mastication.

Figure 3. Pain improvement by injection medication

Steroid and hyaluronic acid were used for injection to joint cavity, and

improvement of pain was 62.5% and 73.6%, respectively.

p = 0.161

p = 0.421

p = 0.123

p = 0.035

Hyaluronic acid Steroid none

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

Improved Not Improved

Men Women

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

Improved Not Improved

DD Myalgia DJD Arthralgia

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

[CELLRANGE]

Improved Not Improved

*

Therefore, in this study, needles were

inserted with palpation of condyle and

mandibular fossa with patient’s mouth

open. It was confirmed that needles were

inserted into TMJ upper joint cavity by

aspiration and saline pumping. After joint

lavage using saline, medication was

injected.

Improvement of pain was investigated

using patient’s subjective evaluation on

the pain before and after treatment. The

age, gender, injection after

arthrocentesis(hyaluronic acid or steroid),

change of mouth opening, change of joint

noise were assessed and statistical

analysis was performed.

Pearson＇s chi-square test were used

for statistical analysis. The results were

considered significant at p <0.05.