USE OF ARTHROCENTESIS FOR СOMPLEX TREATMENT OF POST-TRAUMATIC TEMPOROMANDIBULAR DISORDERS, WHICH ARE NOT CAUSED BY MANDIBULAR FRACTURES

Abstract

Introduction. Injury to the temporomandibular joint (TMJ) in patients without condylar fractures may cause more damage to the joint tissues than a fracture. Intra-articular changes are more often caused by intraarticular localization of the fracture, but extra-articular fractures of the mandible can also cause damage to the structural elements of the joint. Unfortunately, the use of conservative therapy after TMJ traumatic injuries is of little effectiveness, therefore, the next step in the treatment of TMJ post-traumatic disorders implies the use of minimally invasive surgery, including arthrocentesis. The aim of this work is to investigate the effectiveness of arthrocentesis in the treatment of post-traumatic internal temporomandibular disorders. Materials and methods. The study included 24 patients who had a history of head injury without bone fractures, namely TMJ contusions. Arthrocentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia. Results. According to clinical and radiological findings obtained after TMJ traumatic disorders, patients were divided into two groups according to the Wilkes classification (1989): 13 patients with stage II (early-medium) derangement and 11 patients with stage III (medium) derangement. Control radiological studies performed in 3-6 months after arthrocentesis did not show signs of hemarthrosis in 11 (84.61%) patients with intra-articular disorders of II degree and in 8 (72.72%) patients with internal disorders of III degree, position and function articular disc restored. Conclusions. Arthrocentesis with TMJ lavage is a minimally invasive surgical manipulation that has been proven as an effective mote to treat TMJ disorders of traumatic origin, and in particular, after TMJ contusion.