Evaluation of Intra-articular Injection of Simvastatin versus Hyaluronic Acid in Treatment of Internal Derangement of Temporomandibular Joint

Abstract

ABSTRACTIntroduction: TMJ Internal Derangement is a common form of temporomandibularjoint disorder. Almost 80% of adult symptomatic patients with TMD have some form ofID. Temporomandibular joint arthrocentesis consists of lavage of upper joint space ofTMJ done with no direct vision, aiming primarily to remove necrotic tissue, bloodand pain mediators from the joint. One of these therapeutic substances is hyaluronicacid; which is a polysaccharide of the family of glycosaminoglycans, which can befound in many extracellular tissues, including synovial fluid and cartilage. Simvastatinsare group of drugs which have good results in regeneration of degenerated TMJ.Aim: This study aimed to evaluate the intra-articular injection of simvastatin versussodium hyaluronate following arthrocentesis for management of internal derangement(ID) of the temporomandibular joint(TMJ). Patients and methods: Thirty patients withinternal TMJ derangement were included in this study. All patients were subjected topreoperative clinical examination and preoperative magnetic resonance imaging (MRI)for the affected joints. Arthrocentesis was performed firstly for the affected joints inall patients followed by intra-articular injection of 1ml. simvastatin twice a month (ingroup I) and sodium hyaluronate twice a month ( in group II).Clinical follow up weredone at 24 hours post-operatively, one week, one month,and six months. Then, after sixmonths MRI was repeated to compare with preoperative images. Results: Better resultswere recorded with simvastatin group in comparison to sodium hyaluronate group; at 1week, 1 month,and six months intervals; which was superior to arthrocentesis followedby sodium hyaluronate intra-articular injection. Patients in group I showed better MRIfindings in comparison to group II where the position of the disc was almost returnedto its normal anatomical position. Conclusion: Arthrocentesis followed by simvastatinintra-articular injection was superior to the combination of arthrocentesis and sodiumhyaluronate intra-articular injection for management of TMJ internal derangementssymptoms.