Temporomandibular joint dysfunction – sequential infiltration protocol of sodium hyaluronate at different molecular weights

Abstract

Introduction: The temporomandibular dysfunction (TMD) it’s a collective expression that encompasses clinical alterations in chewing muscles, temporomandibular joints (TMJ), and/or associated estructures. The viscosuplementation (VS) is a minimally invasive technique which consistis of intra-articular injection of sodium hyaluronate (SH) for the improvement of lubrification and joint biomechanics and elimination or decrease of pain. The aim of this study was to evaluate, through a series of cases, the efficacy of a viscosupplementation protocol with SH in different molecular weights, in the signs and syntptoms of joint TMJ and in patients’quality of life [1–3]. Materials and methods: this study was approved by the Ethics Committee of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (CAAE-24911314.3.0000.5149) and registered in the Brazilian Registry of Clinical Trials (RBR-6759yz). Is a case series that describes the efficacy of a viscosupplementation protocol in intra-articular temporomandibular disorders. Ten patients with a diagnosis of disc displacement and/or osteoarthritis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to four monthly injections of low or medium molecular weight HA. Pain, mandibular function, image analysis by tomography and magnetic resonance, and quality of life were assessed at baseline and follow-ups (1 and 6 months). Results: Pain, jaw range-of-motion, mandibular function, and quality of life improved at follow-up evaluations. Osteoarthritis changes decreased, and 20% of patients improved mandibular head excursion after treatment. Resolution of effusion and improvement in disc morphology were observed for most patients. This viscosupplementation protocol reduced pain and symptoms associated with internal derangement of temporomandibular joint, improved quality of life, and showed benefits from both low and medium molecular weight HA in alternate cycles. Discussion and conclusions: These results suggest the effectiveness of the VS protocol in the control and relief of the signs and symptoms of TMD, and the great therapeutic potential of this technique.