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Stomatologija 2015; 17 (4): 113-17 145 KB

Temporomandibular joint arthrocentesis for the treatment of osteoarthritis

Edvitar Leibur, Oksana Jagur, Ülle Voog-Oras

Summary

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



	Baltic Dental and Maxillofacial Journal

December, 2015, Vol. 17, No. 4 CONTENTS REVIEWS Biological approach of dental caries management Rūta Grigalauskienė, Eglė Slabšinskienė, Ingrida Vasiliauskienė 107-112 SCIENTIFIC ARTICLES Temporomandibular joint arthrocentesis for the treatment of osteoarthritis Edvitar Leibur, Oksana Jagur, Ülle Voog-Oras 113-117 Connection of functional quality of partial removable dentures and the degree of patients’ phonetic adaptation Victoria Artjomenko, Aldis Vidzis, Guntis Zigurs 118-123 Upper airway obstuction in class II patients. Effects of Andresen activator on the anatomy of pharingeal airway passage. Cone beam evalution Cinzia Maspero, Lucia Giannini, Guido Galbiati, Laima Kairyte, Giampietro Farronato 124-130 CASE REPORTS A rare variant of calcifying odontogenic cyst with ameloblastoma presentation Supriya Bhat, Shishir Ram Shetty, Subhas G. Babu, Pushparaja Shetty, Fazil Ka 131-134 An unusual complication of genioglossus advancement surgery Metin Sencimen, Aydin Gulses, Gurkan Rasit Bayar, Timur Akcam 135-136 © 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 Summary 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