変形性顎関節症に対する１次治療―第３報 ２回顎関節腔洗浄療法（ステロイド注入），消炎鎮痛剤投与および開口練習併用療法―

Abstract

Arthrocentesis is the surgical treatment of choice for TMJ disorders. Many studies of arthrocentesis have been performed, with excellent clinical outcomes. No previous study has used multiple arthrocenteses to treat the dysfunctional TMJ. This study evaluated the efficacy of two consecutive arthrocenteses (steroid injection) followed by mouth-opening exercises during non-steroidal anti-inflammatory drug (NSAID) administration as a primary treatment for TMJ osteoarthritis.Subjects in this study were selected from a consecutive series of new patients with unilateral moderate to severe TMJ dysfunction at TMD Clinic, Aichi-Gakuin University Hospital during a year. Twenty-eight patients with MRI documentation of osteoarthritis underwent two consecutive arthrocenteses with steroid injection at a 2-week interval followed by mouth-opening exercises and treatment with the NSAID, Etodolac. The patients were postoperatively examined every 2weeks for 12weeks. The patients were clinically evaluated on the basis of visual analog scales (0-100) and the range of motion. Factors that affected the clinical outcome of TMJ function were assessed.Of the 28 patients who underwent two consecutive arthrocenteses, 21 (75%) showed substantial improvement on follow-up at 12weeks. The range of motion (median) increased from 28mm to 41mm. Visual analog scale pain-scores on mouth opening and chewing significantly decreased from 50 and 60 to 24 and 22, respectively. The disturbance score for activities of daily life also decreased from 55 to 18. A longer duration of TMJ symptoms before the procedure was found to affect outcome.This combination therapy is an effective primary treatment for TMJ osteoarthritis.