変形性顎関節症に対する１次治康―第２報 ２回顎関節腔洗浄療法，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 temporomandibular joint (TMJ) disorders. Many studies of arthrocentesis have reported an excellent clinical outcome. No previous report, however, has described the use of multiple arthrocenteses to treat TMJ dysfunction. We evaluated the efficacy of two consecutive arthrocenteses followed by mouth opening exercises during treatment with non-steroidal anti-inflammatory drugs (NSAID) as a primary treatment for TMJ osteoarthritis.The subjects of this study were selected from a consecutive series of patients with unilateral moderate-to-severe TMJ dysfunction newly diagnosed at the TMD Clinic, Aichi-Gakuin University Hospital during a 1-year period. Thirty-six patients with osteoarthritis as documented by magnetic resonance imaging underwent two consecutive arthrocenteses at a 2-week interval followed by mouth opening exercises and NSAID administration. The patients were postoperatively examined every 2 weeks for 12 weeks. Clinical evaluations included pain-related measures on visual analog scales (VAS, 0-100) and range of motion. At the completion of treatment, patients had sustained pain relief and improved mouth opening. Factors that affected clinical outcome of TMJ function were assessed.Of the 36 patients who underwent two consecutive arthrocenteses, 28 showed substantially improvement on follow-up at 12 weeks. The range of motion (median) increased from 28 mm to 39.5 mm. VAS pain-scores on mouth opening and chewing significantly decreased from 54 and 53 to 10 and 7, respectively. The interference score for activities of daily life also decreased from 33.5 to 9. A longer duration of TMJ symptoms before the procedure was found to affect the outcome.Two consecutive arthrocenteses were apparently markedly superior to a single arthrocentesis in alleviating TMJ dysfunction. Pain-free TMJ function was restored in 78% of the patients with this treatment within 12 weeks.