Clinical and radiological outcome of arthrocentesis followed by autologous blood injection for treatment of chronic recurrent temporomandibular joint dislocation.

J Patel,A Vaghasiya,K Nilesh,Mi Parkar

doi:10.4317/jced.53812

Abstract

BackgroundThis study was conducted to evaluate the functional outcome and MRI findings of arthrocentsis followed by autologous blood injection (ABI) into the joint space for management of chronic recurrent TMJ dislocation.Material and MethodsTotal ten patients with bilateral chronic recurrent condylar dislocation were included in the study. Arthrocentesis of both TMJ was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included; thorough history, clinical examination of TMJ, maximal mouth opening, frequency of dislocation, TMJ radiographs (open and closed mouth position), MRI, recurrence and presence of facial nerve paralysis.ResultsAt the end of 3 months follow-up 8 patients (80%) had successful outcome with no further episodes of dislocation, whereas two patients reported with recurrence. Post-operative MRI showed significant improvement after ABI, compared to pre-operative MRI. There were no degenerative changes to the bony and soft tissue components of TMJ.ConclusionsABI is a simple, safe, minimally invasive and cost-effective technique for treatment of chronic recurrent TMJ dislocation. MRI evaluation showed an improvement in the anatomical and spatial relationship of the osseous and soft tissue components of the TMJ. Key words:TMJ lavage, luxation, fibrosis, magnetic resonance imaging.

Highlights

Dislocation of the Temporomandibular Joint (TMJ) is a pathophysiologic condition that is challenging to manage in clinical practice
TMJ dislocation is a distressing condition as it causes disability to close the mouth and is often associated with pain and muscle spasm
Structural defects resulting in TMJ dislocation includes arthritic changes in the condyle, decrease in the height of the articular eminence, morphological changes of the glenoid fossa, zygomatic arch, and squamotympanic fissure [11,12]

Summary

Introduction

Dislocation of the Temporomandibular Joint (TMJ) is a pathophysiologic condition that is challenging to manage in clinical practice. In TMJ dislocation, the condyle reaches a position in front of the articular eminence, on wide mouth opening It can be caused by abnormalities in the osseous architecture of the joint, laxity of TMJ ligament or due to reduced muscle tension [1]. Surgical interventions include capsular plication, reduction or augmentation of the articular eminence, temporalis tendon scarification, lateral pterygoid myotomy, and condylectomy [5] These procedures require hospitalization, general anesthesia and surgical access to TMJ area. The principle behind ABI is to restrict mandibular movements by inducing fibrosis in upper joint space, pericapsular tissues or both by injecting blood into TMJ In this conservative method patient’s own blood is injected in TMJ, thereby avoiding any chance of allergic reaction and postoperative infection. Quantifiable parameters, including linear and angular measurements were carried on pre and post injection MRI to standardise the treatment outcome

Material and Methods

Results

Discussion