More Related Content
Similar to JOURNAL CONDYLE.pptx oral and maxillofacial surgery (20)
More from DivuuJain (18)
Recently uploaded (20)
JOURNAL CONDYLE.pptx oral and maxillofacial surgery
- 1. JOURNAL CLUB PRESENTATION GUIDED BY- DR.VIKAS KUNWAR SINGH SIR HOD AND PROFESSOR DEPT. OF ORAL AND MAXILLOFACIAL SURGERY MGDCH , JAIPUR. PRESENTED BY- DR.DIVESH JAIN PG 1ST YEAR DEPT. OF ORAL AND MAXILLOFACIAL SURGERY MGDCH , JAIPUR.
- 3. INTRODUCTION Temporomandibular joint disorders (TMD) - common disease and interfere with normal life activities due to pain, clicking and limited mouth opening. Management starts with conservative methods including analgesics, muscle relaxants, soft diet, hot fomentations and occlusal splints. Simple and minimally invasive surgical procedures such as arthrocentesis or prolotherapy should be considered if the symptoms persist after conservative management. Arthrocentesis - Minimally invasive surgical procedure that results in breaking up the joint adhesions and washing away the inflammatory mediators and necrotic tissues from the joint. Prolotherapy - Based on injection of an irritant solution which stimulates the tissues to proliferate and promotes healing. Solutions used is Hypertonic dextrose.
- 4. AIM To compare the clinical outcomes of three different techniques for the management of internal derangement of the temporomandibular joint including arthrocentesis, prolotherapy and combination of both.
- 5. MATERIALS AND METHODS Thirty patients (18 females and 12 males) with a mean age of 27.4 (賊6.6) years suffering from TMD with pain and limited mouth opening were included in this study. Inclusion criteria Patients with an age range between 20 and 60 years old with chronic unilateral TMJ pain persisting for at least 3 months and indicated by a score of 7 and above. Patients with limited mouth opening less than 40 mm were included in the study. Those represented with anterior disc displacement were included in the study.
- 6. Exclusion Criteria Patients with previous TMJ surgeries, rheumatoid disease, ankylosis, tumors, condylar fractures, coagulation disorders, pregnancy or lactation and those patients with previous TMJ injections were excluded from the study Patients were divided randomly into three equal groups. Group I - Arthrocentesis was carried out Group II - Prolotherapy was carried out Group III - Arthrocentesis followed by injection of dextrose was carried
- 7. GROUP I Straight line was drawn from the outer canthus of the eye till the middle of the tragus of the ear. First point (Point A) - Marked at 10 mm anterior to the tragus and 2 mm below the line Second point (Point B) - Marked at 20 mm anterior to the tragus and 10 mm below the same line. Articaine 4% with epinephrine 1:100000 was injected through the entrance points before starting arthrocentesis. 18-gauge needle was inserted into the posterior entrance point in the superior joint space and 5ml of lactated Ringers solution was injected into the joint before inserting the second needle. This was performed to distend the superior joint space and release the joint adhesions.
- 9. Following this, the second needle was inserted through the anterior entrance point allowing the lactated Ringers solution to flow freely through the superior joint space. 400 ml of Ringers lactate solution was injected simultaneously from both needles. During the injection procedure the patients were asked to open, close, protrude and perform lateral excursions of the mandible to facilitate the lysis of any adhesions.
- 10. GROUP II Straight line was drawn on the patients face from the outer canthus of the eye till the middle of the tragus of the ear. Point was marked 10 mm anterior to the tragus and 10 mm inferior and perpendicular to the canthotragal line Prolotherapy was started after achieving auriculotemporal nerve block. A 30 gauge needle was inserted through the marked point and directed towards the condylar neck to a depth of 25 mm followed by a single injection of 2 ml of 25% dextrose solution.
- 12. GROUP III Arthrocentesis was performed as in group A and at the end of the procedure the anterior needle was removed and 2 ml of 25% dextrose solution was injected through the posterior needle .
- 13. DISCUSSION There was a significant decrease in pain and an increase in the Maximum Mouth Opening (MMO) at the end of the follow up period in the three groups. In Group I, there was a statistically significant decrease in pain scores and increase in MMO at the end of the follow up period. This is in agreement with the studies performed by Kim et al , Alpaslan et al and Polat et al who reported a significant decrease in pain scores and increase in MMO after performing arthrocentesis. In group II, there was a statistically significant decrease in pain scores and increase in MMO after 3 months of follow up period. This coincides with the studies of Zhou et al , Ungor et al , Majumdar et al and C旦mert et al who reported favorable outcomes concerning a subjective decrease in joint pain and increase in MMO following dextrose injection.
- 14. Our results showed no statistically significant difference in pain scores after 3 months between Group I and Group II. However both groups showed statistically significant higher pain scores than group III. Concerning the MMO, Group III showed the highest statistically significant mean MMO. This result can be attributed to combining of the advantages of both procedures of arthrocentesis and prolotherapy in the form of breaking up joint adhesions and washing away the inflammatory mediators achieved by arthrocentesis together with induction of proliferation of cells, healing of tissues and the chondrogenic effect on joints reported after dextrose injection
- 15. RESULTS Pain (VAS) scores : Group I showed the statistically significantly highest pain score. Group II showed statistically significantly lower pain score. Group III showed the statistically significantly lowest pain score
- 16. Maximum Mouth Opening (MMO) : Pre-operatively - No statistically significant difference between maximum mouth opening in the three groups Group I showed statistically significantly lower mean MMO. Group II showed the statistically significantly lowest mean MMO. Group III showed the statistically significantly highest mean MMO.
- 18. CONCLUSION Arthocentesis followed by prolotherapy resulted in better clinical outcomes concerning pain and MMO when compared to arthrocentesis alone or prolotherapy alone. It is a safe and simple procedure.
- 22. THANK YOU