Internal Derangement Of Temporomandibular Joint Research Articles

Efficacy of Duloxetine With Arthrocentesis in the Management of TMJ Internal Derangement.

Temporomandibular joint (TMJ) arthrocentesis is one of the most commonly used non-invasive surgical interventions in the treatment of refractory pain and dysfunction associated with internal derangement. Several adjunctive therapies have been used in combination with arthrocentesis in an attempt to increase its efficacy and long-term maintenance. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor which is used in different chronic pain conditions. This study aimed to assess the efficacy of duloxetine in combination with arthrocentesis compared with arthrocentesis alone. Twenty-eight patients with chronic TMJ pain were included and randomly allocated into 2 groups (control and study groups). The control group included patients who underwent TMJ arthrocentesis only, and the study group included patients who underwent arthrocentesis followed by giving duloxetine (30mg) orally twice daily for 3 months. Pain, maximum mouth opening, and level of anxiety and depression were assessed preoperatively and followed at regular intervals of 1 week, 1 month, 3 months, and 6 months postoperatively. Pain was significantly reduced in both groups at all postoperative intervals and was significantly lower in the study group than the control group at 6 months. Maximum mouth opening increased significantly in both groups, but the difference between them was not significant. Level of anxiety and depression was significantly decreased in both groups, with no statistically significant difference between them. The results of this study indicate that duloxetine in combination with arthrocentesis may provide effective and long-term pain control; however, its use is associated with a higher risk of adverse events.

The role of ultrasound imaging of temporomandibular joint condyle-disc complex disorders

ABSTRACT Objective This study aimed to determine the diagnostic value of ultrasonography (US) in internal derangements of temporomandibular joint (TMJ) and to compare its efficacy with magnetic resonance imaging (MRI). Methods Fifty patients with MRI indications due to a TMJ disorder were enrolled. Findings of the clinical examination, US examination and MRI examination were noted by seperate clinicians and the sensitivity, specificity and diagnostic accuracies of all examinations were compared. Results When compared with MRI, the sensitivity, specificity and diagnostic accuracy of the clinical examination for the internal derangements were 73%, 37%, and 70%, respectively and 75.7%, 33.3% and 73.0% for US examination, respectively. Conclusion US can be considered as an alternative to MRI as it can be used to detect the disc position, internal derangements, intraarticular fluid accumulations and superficial condyle changes with minimally better results than clinical examination.

Relation of Age with the Temporomandibular Joint Internal Derangement Stage and Its Improvement After Nano-fat Injection

Relation of Age with the Temporomandibular Joint Internal Derangement Stage and Its Improvement After Nano-fat Injection

The Effect of Ultrasound guided versus conventional arthrocentesis in treatment of temporomandibular joint internal derangement: A comparative study.

The Effect of Ultrasound guided versus conventional arthrocentesis in treatment of temporomandibular joint internal derangement: A comparative study.

A Three-branch Jointed Feature and Topology Decoder guided by game-theoretic interactions for temporomandibular joint segmentation

Segmentation of the temporomandibular joint (TMJ) disc and condyle from magnetic resonance imaging (MRI) is a crucial task in TMJ internal derangement research. The automatic segmentation of the disc structure presents challenges due to its intricate and variable shapes, low contrast, and unclear boundaries. Existing TMJ segmentation methods often overlook spatial and channel information in features and neglect overall topological considerations, with few studies exploring the interaction between segmentation and topology preservation. To address these challenges, we propose a Three-Branch Jointed Feature and Topology Decoder (TFTD) for the segmentation of TMJ disc and condyle in MRI. This structure effectively preserves the topological information of the disc structure and enhances features. We introduce a cross-dimensional spatial and channel attention mechanism (SCIA) to enhance features. This mechanism captures spatial, channel, and cross-dimensional information of the decoded features, leading to improved segmentation performance. Moreover, we explore the interaction between topology preservation and segmentation from the perspective of game theory. Based on this interaction, we design the Joint Loss Function (JLF) to fully leverage the features of segmentation, topology preservation, and joint interaction branches. Results on the TMJ MRI dataset demonstrate the superior performance of our TFTD compared to existing methods.

Comparative Study between Meloxicam and Piroxicam Intra-Articular Injection after arthrocentesis for Management of Temporomandibular Joint Internal Derangement

Comparative Study between Meloxicam and Piroxicam Intra-Articular Injection after arthrocentesis for Management of Temporomandibular Joint Internal Derangement

Categorizing temporomandibular joint arthroscopic procedures for a better clinical practice and teaching

ObjectiveTo provide some clarity to the confusion in the terminology used to classify arthroscopic procedures for the treatment of temporomandibular joint (TMJ) internal derangement (ID) and osteoarthrosis (OA). Material and methodsThe author introduces a new method for categorizing TMJ arthroscopic procedures more accurately, intending to establish a reference point from which further clinical series may built their analyses. ResultsSix categories are proposed for establishing a clear distinction among performed arthroscopic procedures: Level Ia, arthroscopic lavage (AL); Level Ib, arthroscopic lysis and lavage (ALL); Level Ic, ALL “needle-therapy”; Level IIa, simple operative arthroscopy (OA); Level IIb, advanced OA; and Level III, OA with discopexy. Several arthroscopic procedures, such as lysis of adherences, coblation of the retrodiscal tissue, anterior myotomy of the lateral pterigoid muscle, or discopexy, are classified in each category depending on the need (or not) to use of one or two working cannulas. ConclusionTeaching and training of maxillofacial surgeons in the acquisition of the skills to perform arthroscopy should be based on a step-by-step approach following this proposed classification. Besides, future clinical series on arthroscopy of the TMJ for the treatment of ID and/or osteoarthrosis may benefit from a clear distinction of the performed arthroscopic procedure in terms of evaluating outcomes and complications.

Evaluation Of Pterygomaxillary Disjunction with Interpositional Y-Shape Plate as An Innovative Minimally Invasive Technique in Patients with Temporomandibular Joint Internal Derangement (Clinical Trial)

Evaluation Of Pterygomaxillary Disjunction with Interpositional Y-Shape Plate as An Innovative Minimally Invasive Technique in Patients with Temporomandibular Joint Internal Derangement (Clinical Trial)

Can the Autogenous Nanofat Injection Improve the Symptoms of Patients With Temporomandibular Joint Internal Derangement? A Prospective Observational Clinical Study.

Since nanofat is considered one of the richest sources of adipose-derived stem cells with an increased need for new biological approaches for managing temporomandibular joint internal derangement (TMJ-ID) symptoms that impair a patient's lifestyle, this study evaluated the effectiveness of autogenous nanofat intra-articular injection in managing ID symptoms regarding pain, mouth opening, and joint sound. Furthermore, to assess the consequences and complications of this procedure, 20 patients with 38 TMJs with varying stages of Wilkes classification were included in the study. All involved patients were previously diagnosed with ID depending on a clinical and radiographical basis and had no previous response to conservative management for at least 4 to 6 months. Evaluation of the ID in the preoperative phase, as well as 2 weeks, 1 month, 3 months, and 6 months postoperatively. An evaluation was done depending on pain assessment using a visual analog scale (VAS), measuring maximum mouth opening (MMO) and joint noise if it was present or absent preoperatively and postoperatively. The results show improvement in the symptoms in all follow-up appointments since the VAS of pain decreased significantly with increased MMO and the absence of clicking in most cases during follow-up appointments. We conclude from this study that nanofat intra-articular injection was influential in managing ID symptoms and was safe without significant side effects.

Comparison of the efficacy of occlusal splint and botulinum toxin therapies in patients with temporomandibular disorders with sleep bruxism.

This study aims to evaluate the efficacy of occlusal splint and botulinum toxin (BTX) therapies for improving the pain scores and mouth opening in patients with temporomandibular disorders (TMD) with sleep bruxism (SB). Aretrospective cohort study was conducted based on clinical record reviews of patients with TMD symptoms (e.g., temporomandibular joint [TMJ] pain, masticatory muscle pain, TMJ internal derangements, joint sounds, and limited mouth opening) and SB. The patients were divided into two groups: occlusal splint group and BTX group. Maximum unassisted mouth opening (MMO) and pain score on avisual analogue scale (VAS) before treatment and at 1‑, 3‑, and 6‑month follow-up were analyzed to evaluate the clinical outcomes. Atotal of 60patients (49women and 11men, mean age 34.63 ± 11.85 years) were enrolled. Each group had 30patients. The comparisons of the groups at 1and 3months after treatment indicated that the BTX group had higher MMO values (P = 0.013 and 0.034, respectively) and lower VAS scores than the occlusal splint group (P = 0.000 and 0.001, respectively). No difference between the two groups was observed 6months after treatment (P > 0.05). Both occlusal splint and BTX treatment methods were successful in treating TMD with SB. BTX provided patients with rapid relief in the early period; therefore, BTX can be recommended as aprimary treatment option in patients with greater pain.

TME disk deplasmanında synovial sıvı pro-inflamatuar sitokinlerin ve klinik bulguların değerlendirilmesi

Aims: Temporomandibular disorders (TMD) are common musculoskeletal disease that affects the soft tissues and bone structures of the temporomandibular joint (TMJ). Inflammatory mediators play a critical role in the etiology of TMD by affecting various molecular mechanisms. This study aims to investigate the effect of pro-inflammatory cytokines on TMJ internal derangements and evaluate the relationship between clinical features.
 Methods: Patients who underwent arthrocentesis because of TMD were included in this study. Patients were divided into 2 groups according to anterior disc displacement with reduction (Group 1) and without reduction ( Group 2). Clinical findings before and after the arthrocentesis were evaluated retrospectively. Synovial fluid TNF-α, IL-1β, and IL-6 levels were analyzed with the ELISA method. 
 Results: A total of 28 patients were included, with 15 patients in Group 1 and 13 patients in Group 2. All patients were female with an average age of 30.75±14.9. The average pre-operative pain score was 6.6±1.95 in all patients. After the arthrocentesis, the average pain score was 2.0 ( 1.0 - 2.5) and the difference was significant (p

The Auriculotemporal Nerve and TMJ region: anatomy and function

The studies on the auriculotemporal nerve in humans are limited. However, we considered crucial to investigate the topographic relation between the auriculotemporal nerve and the TMJ region that can explain some of the symptoms in TMDs. The results derived from our experience in the anatomic dissection on 16 adult cadaveric heads were compared with what literature describes from 1971 to 2023. The results confirm the existence of a particular anatomic position of the ATN within the infratemporal fossa in direct contact with the lateral pterygoid muscle and the TMJ capsular region. Therefore, there is evidence of a potential entrapment mechanism involving the ATN caused by an internal derangement of TMJ or a spastic condition of the lateral pterygoid muscle. Through a detailed anatomical description of the ATN the present study aims to offer an explanation to the main sensory and otological symptoms that patients with TMJ disorders often complaint, from facial pain and paresthesias to external ear pruritus.

Integrated bioinformatics analysis of differentially expressed genes in the temporomandibular joint internal derangement.

This study aimed to identify significant mechanisms and potential treatments for temporomandibular joint internal derangement (TMJD) through integrated bioinformatics analysis. Gene expression data sets (GSE66864) from the Gene Expression Omnibus (GEO) database were downloaded. Differentially expressed genes (DEGs) were identified both in the treatment groups and in controls by R packages. Network analysis of protein-protein interaction (PPI) and Human Protein Atlas was used to explore DEGs' potential function. DGIdb database was utilized to gain potential drug targets. In conclusion, 126 DEGs were selected for TMJD through bioinformatics analysis. Both GO and Kyoto Encyclopedia of Genes and Genomes analyses combined showed the pathways involved in TMJD. A PPI network was constructed to select the top 10 hub genes, of which five hub genes were chosen for further investigation. Moreover, the microenvironment of immune cells related to hub genes was evaluated by R packages. Macrophages play an important role in inflammation and oral-related tumors. The Human Protein Atlas analysis indicated that the five hub genes are highly related to head and neck cancer. Finally, eight potential drugs were selected for two genes using the DGIdb database. Our integrated bioinformatics analysis identified DEGs in TMJD and provided potential ideas for further research and treatment approaches. However, experimental validation of the hub genes and potential drug targets is still needed. The key mechanisms of the identified genes and their potential roles as biomarkers or drug targets in TMJD require further investigation.

A novel conservative modality in the management of internal derangement of temporomandibular joint- A case report

A novel conservative modality in the management of internal derangement of temporomandibular joint- A case report

Efficacy of Arthrocentesis with and Without Sodium Hyaluronate Injection for Temporomandibular Joint Disorders: A Comparative Study.

To evaluate the efficacy of arthrocentesis with and without sodium hyaluronate injection for internal derangement of temporomandibular joint. Patients with clinically and radiographically confirmed cases of temporomandibular joint disorders were enrolled for this study. 20 patients were randomly allocated into two groups for arthrocentesis of TMJ with 10 patients in each group. In group 1, patients were treated with TMJ arthrocentesis followed by sodium hyaluronate injection, and in group 2, patients were treated with arthrocentesis alone. All the patients were treated under local anaesthesia. The patients were followed up at 1st week, 2nd week, 4th week and 12th week post operatively for maximum mouth opening, lateral mandibular movements, pain at rest and on mastication and the subjective efficacy of the treatment. By the end of twelfth week follow up, the mean mouth opening showed significant improvement in group 1, the right and left lateral movements showed better results in group 1 than in group 2, pain at rest and pain on mastication were mild in both the groups with subjective efficacy good in group 1 and moderate in group 2. This study suggested that TMJ arthrocentesis with sodium hyaluronate injection had better clinical outcome compared to TMJ arthrocentesis alone for TMJ disorders.

Efficacy of Arthrocentesis and Anterior Repositioning Splints in Treatment of Internal Derangement of TMJ: A Prospective Clinical Study.

The aim of this study is to assess the efficacy of double puncture arthrocentesis and anterior repositioning splints in the treatment of internal derangement of temporomandibular joint. 35 patients with mean age of 36.6 years±10.2 years diagnosed with unilateral TMD who fell into Wilkes stage 2 and disc displacement with reduction with intermittent locking described by RDC/TMD were treated with Nitzan's double puncture arthrocentesis and were given a anterior repositioning hard splint. The parameters following parameters were assessed at intervals of 1 week, 2 weeks, 1 month, 3 months and 6 months: pain, maximum inter-incisal mouth opening, Joint noise/click. Statistically significant (p < 0.001) improvements were seen at all recorded intervals in all observed parameters. Simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.

Effect of dextrose prolotherapy on internal derangement of the temporomandibular joint.

This study aimed to evaluate the effect of dextrose prolotherapy in treating internal derangement of the temporomandibular joint. A total of 20 patients with temporomandibular joint internal derangement were enrolled in the study. The diagnosis of internal derangement was confirmed by magnetic resonance imaging (MRI). The posterior and anterior disc attachment, as well as the most tender part of the masseter muscle, were injected with 12.5% dextrose. Pain, maximum mouth opening, clicking, and deviation were assessed immediately before treatment, as well as at 2-, 4-, and 12- weeks post-treatment. There was a significant improvement in the four clinical variables at the three-time intervals. Pain at two weeks was reduced by 60% (6 vs. 3.75) and by 200% (6 vs. 1.9) at 4 weeks. The maximum mouth opening was increased by 6.4 mm at 2 weeks and 7.85 mm at 4 weeks. The percentage of patients with clicking decreased from 70%, preoperatively- to 50% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks. The ratio of patients with deviation was decreased from 80% preoperatively to 35% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks. Prolotherapy is a safe and effective treatment for alleviating the symptoms of internal derangement of the temporomandibular joint.

Does Temporomandibular Joint Pain have a Predictive Value for Temporomandibular Joint Internal Derangement in Fibromyalgia Patients? Magnetic Resonance Imaging Role in Diagnosis

Does Temporomandibular Joint Pain have a Predictive Value for Temporomandibular Joint Internal Derangement in Fibromyalgia Patients? Magnetic Resonance Imaging Role in Diagnosis

Is dextrose prolotherapy beneficial in the management of temporomandibular joint internal derangement? A systematic review

ABSTRACT Objective To highlight the current knowledge of the efficacy of dextrose as a prolotherapy agent in managing temporomandibular joint internal derangement (TMJ-ID). Methods A “Population, Intervention, Comparison, Outcome” (PICO) strategy was executed using an electronic search through PubMed/MEDLINE, Cochrane databases, and Google Scholar from their inception to August 2022. Only randomized clinical trials investigating the treatment of TMJ-ID with hypertonic dextrose prolotherapy (HDPT) were included. Two independent reviewers assessed the eligibility of the studies with subsequent data extraction. Results The systematic search identified 392 studies, and only 8 articles were considered eligible for selection, with a total of 286 patients; 72% were females, and 28% were males. The extracted data showed positive effects of dextrose on joint pain and maximum mouth opening (MMO) with high patient satisfaction. Conclusion HDPT can be effective in relieving TMD symptoms as it reduces pain, improves joint dysfunction, and increases MMO up to 12 months.

Arthroscopic assisted release of lateral pterygoid versus scarification of retrodiscal tissue in management of internal derangement of temporomandibular joint-A randomized clinical trial

The purpose of this study was to compare the effectiveness of arthroscopic-assisted lateral pterygoid muscle release versus scarification of retrodiscal tissues in the treatment of temporomandibular joint internal derangement.A prospective, comparative, randomized clinical trial involved 16 patients with TMJ internal derangement. Arthroscopic assisted release of lateral pterygoid muscle was assigned to one group of patients (Group I). Group II patients received arthroscopic assisted scarification of retrodiscal tissues. Data collected through functional examination including visual analogue scale (VAS), maximum mouth opening, lateral excursion, and clicking sound immediately and after 3, 6, and 12 months. Pre- and post-operative MRI was used to assess disc position.The VAS scores decreased in both groups at the end of the follow-up period (0.45 vs 6.75, and 1.13 vs 6.50 in group I and II respectively; P<0.001). The maximum mouth opening improved to 32.9.50 ± 1.69 mm in group I, and 30.49 ± 0.93 in group II (P<0.001). Lateral excursion improved in both groups (P<0.001). Clicking sounds disappeared in all patients.Within the limitations of the study, it seems that arthroscopic assisted release of lateral pterygoid and scarification of retrodiscal tissues may be beneficial in management of anteriorly displaced discs that don't respond to conservative treatments.