Single Puncture Arthrocentesis Research Articles

Does Articular Pressure Change Vital Signs During Temporomandibular Joint Arthrocentesis?

Objective: The aim of this study was to compare the vital signs as mean arterial pressure and heart rate of patients undergoing two different temporomandibular joint (TMJ) arthrocentesis techniques.
 Methods: Thirty patients received TMJ arthrocentesis with either double puncture arthrocentesis (DPA) or single puncture arthrocentesis (SPA). Blood pressure and heart rate were assessed preoperatively, during the application of local anesthesia, and at needle insertion into the joint cavity, the 5th and 10th minute of the procedure, and the end of the procedure. 
 Results: The heart rate and mean arterial pressure were highest during anesthesia and needle insertion (P

Investigation of the clinician satisfaction for the single-puncture and double-puncture arthrocentesis of temporomandibular joint

Aim: The aim of this study was to evaluate the clinician satisfaction of single-puncture arthrocentesis and double-puncture arthrocentesis in cadavers. Material and Method: The study was conducted on 10 fresh cadaver temporomandibular joints bilaterally. Single-puncture arthrocentesis was randomly conducted on one side chosen by coin toss and double-puncture arthrocentesis on the other side. The main outcome variable was clinician satisfaction and measured using 0-10 point Likert scale. Results: Twenty arthrocentesis procedures were completed. The mean clinical satisfaction scores for single-puncture arthrocentesis and double-puncture arthrocentesis were 8.1 and 4.8, respectively. A statistically significant difference was found between the techniques in terms of main outcome variable, and it was significantly lower in double-puncture arthrocentesis (p=0.001). Conclusion: Single-puncture arthrocentesis showed higher clinician satisfaction compared to double-puncture arthrocentesis.

Is Single Puncture Superior to Double Puncture Arthrocentesis in Patients With Wilkes III Internal Derangement?

Arthrocentesis is a minimally invasive procedure with reported efficacy when used for lysis and lavage of the joint for symptomatic internal derangement, irrespective of the technique utilized. The purpose of the study was to determine if the single puncture arthrocentesis (SPA) is superior to double puncture arthrocentesis (DPA) with respect to pain reduction and improved maximal mouth opening (MMO) for subjects with acute disc displacement without reduction. A single-blinded randomized prospective clinical trial was conducted at the tertiary referral center for temporomandibular joint disorders. All subjects were diagnosed with acute onset disc displacement without reduction based on history and magnetic resonance imaging findings. Subjects were randomized to SPA or DPA. The primary predictor variable was arthrocentesis technique (SPA vs DPA). The primary outcome variables were pain and MMO, measured at 4weeks. The duration for the procedure was recorded at the time of the surgery. Age, sex, and the side affected were recorded. Data were analyzed using analysis of variance to compare the primary outcome variables. Levene's, post hoc, and Bonferroni-Holm tests were used for intergroup comparisons with a P value of <0.05 being significant. Forty subjects completed the study. The mean age for the SPA and DPA groups was 28.3 (±3.9) and 29.1 (±4.1), respectively (P=.52). The sex distribution was 60 and 55% female in the SPA and DPA groups, respectively. The mean pain reduction in the SPA and DPA groups was from 8.30 (±0.86) to 0.90 (±0.78) and from 8.00 (±0.79) to 0.95 (±0.82), respectively (P<.0001). There was no difference in pain reduction between the groups (P=.05). The mean increase in MMO was 34.6 (±2.34) and 33.4 (±2.35) in the SPA and DPA groups, respectively (P<.0001). The difference between the groups was not significant (P=.12). The procedural time in the SPA and DPA groups was 14.15±1.72 and 17.55±1.66, respectively (P<.0001). SPA and DPA arthrocentesis appear to be equally efficacious for pain reduction and increasing MMO. SPA can be completed in less time than DPA and should be considered as a viable alternative to the conventional DPA technique.

State of the Art in Temporomandibular Joint Arthrocentesis-A Systematic Review.

Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the temporomandibular joint has become a widely approved method for non-invasive treatment, bridging the gap between conservative and surgical approaches. Regardless of technique, treatment is based upon joint lavage and lysis of the inflammatory fibrous tissue adhesions, which, in turn, improves joint mobility and reduces pain and closed lock. Recently, approaches for intra-articular injections have been proposed as adjuvant or replacement therapy. The aim of this study was to assess the most efficient technique of arthrocentesis. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, a reference list search and a manual search, was performed. Relevant articles were selected after three search rounds for final review. The studies pulled for the analysis presented information about the relevant predictors, including the technique of arthrocentesis (single- or two-needle method), fluid used for lavage (Ringer lactate or saline), volume of the fluid, application of the injectable, number of interventions, pain (VAS) and mouth opening scores (MMO) and follow-up. All cohorts showed improvement in mouth opening, but significant pain reduction was observed only in cohorts treated either by arthrocentesis alone or arthrocentesis followed by intra-articular injectables. Intra-articular injectables used alone failed to reduce pain post-operatively when compared to other cohorts. We concluded that both double-needle and single-puncture arthrocentesis techniques are equally efficient. Application of the adjuvant injectable did not improve the outcomes of arthrocentesis performed alone. The volume of the fluid used for joint lavage and its chemical composition were not significant in clinical outcomes. However, due to the lack of homogeneity in the study settings, a meta-analysis could not be applied and a systematic review was conducted. We still, however, state that there is a knowledge gap in the current literature regarding the use of injectables alone, as well as a longitudinal follow-up, which provides information about treatment efficiency. More high-quality and randomized controlled trials are required to shed light on this subject.

Intra-articular injection of hyaluronic acid versus platelet-rich plasma following single puncture arthrocentesis for the management of internal derangement of TMJ: A double-blinded randomised controlled trial

The present study aimed to compare the efficacies of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) following single needle arthrocentesis in patients with TMJ internal derangement.This double-blinded randomised controlled trial involved the enrolment of patients diagnosed with unilateral TMD, falling into either Wilkes' stages II or III. In Group A, single needle arthrocentesis was performed using Ringer's lactate serving as a control group; in Group B, intra-articular injection of 1 ml hyaluronic acid injection was given following arthrocentesis; and in Group C, autologous intraarticular injections of 1 ml of PRP was given after arthrocentesis, twice in two weeks' interval. The primary outcome variables were maximum mouth opening and pain, while TMJ clicking sounds formed the secondary outcome variable. All the outcome variables were assessed preoperatively (T0) and postoperatively after the second dose of injection at one month (T1), three months (T2), and six months (T3). The alpha level was set to p < 0.05.Ninety patients (N = 90) comprised the final sample size of the study with thirty patients(n = 30) in each treatment group. A statistically significant decrease in the management in mean pain scores was noted between T0 [mean scores were 7.30 ± 1.05 (Group A), 7.63 ± 1.12 (Group B), and 7.56 ± 1.04(Group C)] and T3 [mean scores were 2.66 ± 0.88 (Group A), 2.4 ± 0.72 (Group B), and 1.66 ± 0.66 (Group C)] time intervals between Group A and C(p < 0.001). Significant improvement was noted in preoperative maximum mouth opening (MMO) of Group A, B, and C which was 22.83 ± 3.58, 22.17 ± 4.07, and 21.37 ± 3.69, respectively to 28.90 ± 2.72, 32.17 ± 3.97, and 34.10 ± 3.80 mm, respectively at six months postoperatively (p < 0.001). A significant decrease in joint sounds was evident for all three groups(p = 0.003 for Group A, p < 0.001 for Group B, and p < 0.001 for Group C) across the time intervals. Moreover, Group C showed a significant decrease in the prevalence of joint sound compared to the other two groups at all-time intervals postoperatively when equated to baseline (p = 0.02 at T1, p = 0.009 at T2, and p = 0.002 at T3).Within the limitations of the present study, it can be concluded that intra-articular PRP may be preferable over HA whenever appropriate, following single needle arthrocentesis in the treatment of TMJ internal derangement.

Double-Puncture Versus Single-Puncture Arthrocentesis: A Randomized Controlled Trial with 3 Years of Follow-Up.

To compare the clinical effectiveness of conventional double-puncture vs single-puncture type 2 arthrocentesis for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR) after 3 years of follow-up. A total of 26 patients with DDWOR were randomly and blindly allocated into two treatment groups (n = 13 each): group 1 = conventional double-puncture arthrocentesis; group 2 = single-puncture type 2 arthrocentesis. Data on gender, side of painful joint complaint, age (years), duration of joint pain (months), maximum interincisal distance (MID, mm), and pain intensity (self-reported with a 0-10 visual analog scale [VAS]) were collected. VAS scores and MID were measured before (baseline) and 3 years after (final) the arthrocentesis. Twenty-three patients completed the study (group 1, n = 11; group 2, n = 12). Both techniques resulted in significantly reduced VAS scores and increased MID (P = .001) after the 3 years of follow-up; however, there were no statistically significant differences between techniques (P > 0.05). The two arthrocentesis methods tested were both effective in reducing VAS scores and increasing MID in patients with DDWOR.

Is single puncture arthrocentesis superior to double puncture arthrocentesis in TMJ disc displacement without reduction?

Purpose: The aim of the study was to compare the effectiveness of single puncture arthrocentesis type-1 (SPA Type-1) and double puncture arthrocentesis (DPA) in patients with disc displacement without reduction (DDwoR) of the temporomandibular joint (TMJ). Materials and Methods: This randomized prospective study included 36 consecutive patients who had TMJ arthrocentesis either with DPA or SPA Type-1. Several outcome parameters, such as pain on function, maximum mouth opening, and chewing efficiency were recorded at baseline and multiple follow-up assessments. Additionally, treatment tolerability, easiness and duration of the procedures and analgesics required postoperatively were also evaluated. The difference between the groups at each time point and percentages of sixth month-baseline changes were determined by the Mann-Whitney U test. Wilcoxon test was used for intra-group evaluation of variables according to baseline. Statistical significance level was accepted as p <0.05. Results: The rates of improvement of the outcome variables were not significantly different between the two groups (𝑝>0.05). However, the duration of the DPA technique was significantly shorter than the SPA Type-1 (p˂0.0001). The ease of the procedure was statistically significantly higher in SPA Type-1 (p<0.001). Treatment tolerability was statistically higher in DPA than SPA Type-1 in one day and one-week period however was similar in the one-month period. Conclusion: Both SPA Type-1 and DPA techniques are similarly effective in DDwoR. SPA Type-1 may be considered the first treatment modality in DDwoR due to its advantages over DPA as low morbidity and easiness.

Comparison of outcomes with the single-puncture and double-puncture techniques of arthrocentesis of the temporomandibular joint: An updated systematic review and meta-analysis.

To compare intra-operative and postoperative outcomes between the single-puncture and the standard double-puncture techniques of arthrocentesis. PubMed, Embase, ScienceDirect and CENTRAL databases were searched from inception up to 31st August 2020. Randomised controlled trials (RCTs), prospective and retrospective studies conducted on patients with temporomandibular joint disorders comparing any type of single-puncture arthrocentesis with standard double-puncture arthrocentesis and reporting intra-operative/postoperative outcomes were included. Assessment of the risk of bias was done with the Cochrane Collaboration risk assessment tool. Thirteen studies were included (12 were RCTs). Analysis of a limited number of studies indicated no difference in pain or maximal mouth opening (MMO) between the single-puncture type-1 or type-2 and the double-puncture technique at various follow-up intervals. Pooled analysis (four studies) demonstrated that the single-puncture type-2 technique requires significantly less operating time as compared to the double-puncture method. No such difference was noted between single-puncture type-1 and double-puncture techniques. Analysis of two studies indicated significantly reduced intra-operative needle relocations with the single-puncture techniques. Studies were not of high quality with concerns of bias in randomisation, allocation concealment and blinding. Limited data indicate no difference in pain or MMO with single- or double-puncture techniques of arthrocentesis. Amongst the three techniques, the single-puncture type-2 technique has the advantages of significantly lower operating time and reduced intra-operative needle relocations and it may be the preferred method of TMJ arthrocentesis in clinical practice.

Clinical and ultrasonographic evaluation of ultrasound-guided single puncture temporomandibular joint arthrocentesis

ABSTRACT Objective To evaluate the effects of successful TMJ treatment on relief of pain, improvement of mandibular movement and capsular width with clinical and ultrasonography (US) findings. In this study, TMJ changes were evaluated by clinical and US examination after US-guided single-puncture arthrocentesis, which represents a novel approach. Methods Clinical measurements were obtained before each procedure and at 1 day, 7 days, and 3 months thereafter. Capsular width was measured via the US at the 3-month follow-up. Results Significant improvements were evident at the short term of 3 months post-arthrocentesis with supportive treatment, including splint therapy and jaw exercises. Conclusion Arthrocentesis in conjunction with splint therapy and jaw exercises demonstrated significant clinical improvement at the short-term follow-up of 3 months. US imaging can be helpful for follow-up evaluation of the pre- and post-treatment capsule width. Longer follow-up studies are necessary to validate the effectiveness of this treatment protocol.

Comparison of single- and double-puncture arthrocentesis for the treatment of temporomandibular joint disorders: A six-month, prospective study

ABSTRACT Objective: To compare the efficacies of single- and double-puncture arthrocentesis in patients with temporomandibular joint (TMJ) with closed lock (CL). Methods: Arthrocentesis procedures were performed in 32 joints from 32 patients with magnetic resonance imaging-based diagnoses of anterior disc displacement without reduction. The patients were randomly divided into two groups according to the surgical procedure received (single-puncture arthrocentesis Type 1 or double-puncture). Maximum mouth opening, pain at rest, pain while chewing, pain at maximum mouth opening, tenderness level, and treatment tolerability were measured. Procedure duration and analgesic required were also considered. Results: The rates of improvement of the outcome variables were not significantly different between the two groups. However, the duration of the single-puncture arthrocentesis technique was significantly longer than the double-puncture (p ˂ 0.0001). Conclusion: Both the single- and double-puncture technique are similarly tolerated and efficacious for the treatment of temporomandibular joint disorders.

Ultrasound-guided arthrocentesis using single-puncture, double-lumen, single-barrel needle for patients with temporomandibular joint acute closed lock internal derangement.

Temporomandibular joint (TMJ) disc derangement is defined as a malpositioning of the articular disc relative to the condyle and eminence. Arthrocentesis of the TMJ is considered by many as the first-line surgical treatment for patients who do not respond to conservative treatment. The aim of this study is to assist needle insertion for temporomandibular joint arthrocentesis using ultrasonography. Twenty patients who required arthrocentesis of the TMJ were randomly assigned to two groups A and B undergoing single-puncture arthrocentesis with modified double-lumen single-barrel needle and ultrasound-guided single-puncture arthrocentesis using modified double-lumen single-barrel needle (n = 10 in each group). The number of attempts of needle manipulation, duration of the operative procedural time, and visual analog (VAS) scale score for pain to assess surgical discomfort were the main outcome variables. None of the patients in either group developed any complication with no significant difference in VAS score for pain between the two study groups. The number of attempts for needle manipulation (mean ± SD) for group A was 2.20 ± 0.789, and for group B, it was 1.10 ± 0.316 (p value, 0.0007); operative procedural time (mean ± SD) for group A was 18.5 ± 3.171min, and for group B, it was 13.1 ± 1.663 (p value, 0.0002) which was significantly lesser in group A than in group B. The sentence signifies that the number of attempts that was required to re-insert the needle to enter the joint space in Ultrasound guided and conventional method of arthrocentesis. Ultrasound-guided single-puncture arthrocentesis using a customized needle is a promising method to perform joint lavage with minimal trauma and in a precise manner.

Double puncture versus single puncture arthrocentesis for the management of unilateral temporomandibular joint disc displacement without reduction: A randomized controlled trial

PurposeTo compare the clinical efficacy of the conventional double puncture versus single puncture type 2 arthrocentesis for management of temporomandibular joint disc displacement without reduction (DDWOR). Materials and methodsTwenty-six patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 13): Group 1, conventional double puncture arthrocentesis; Group 2, single puncture type 2 arthrocentesis. Data on gender, side of painful joint complaint, age (years), duration of joint pain (months), maximum interincisal distance (MID – mm), and pain intensity self-reported with a visual analog scale (VAS; 0–10) were collected. VAS scores and MID were measured before (baseline) and 6 months after arthrocentesis (final). ResultsBoth techniques resulted in significantly reduced VAS scores and increased MID (p = 0.001) after 180 days. However, there were no statistically significant differences between techniques (p > 0.05). ConclusionsThe two arthrocentesis methods tested were effective in reducing VAS scores and increasing MID in patients with DDWOR.

Single puncture versus standard double needle arthrocentesis for the management of temporomandibular joint disorders: A systematic review

The aim of this systematic review was to investigate the current evidence in order to assess the efficacy of single puncture arthrocentesis vs standard double needle arthrocentesis in the management of temporomandibular joint(TMJ) disorders. An electronic search of the PubMed, Scopus, Cochrane CENTRAL and Google Scholar databases was performed to identify English studies published up until October 2017. Eligible studies were selected based on inclusion criteria and included randomised controlled trials(RCTs) comparing single puncture arthrocentesis and standard double needle arthrocentesis for the management TMJ disorders. The initial screening identified 984 records, of which only 5 fulfilled the inclusion criteria. A high degree of heterogeneity was found in the 5 studies with each reporting different sample selection and arthrocentesis protocol. All 5 studies reported no difference in reduction in pain intensity and improvement in maximal mouth opening between the single puncture technique and standard double needle technique. This review provides some evidence that single puncture arthrocentesis is clinically as efficacious as standard double needle arthrocentesis. There is a need of well-designed RCT with standard protocol of arthrocentesis comparing different single puncture techniques and standard double needle technique for the management of TMJ disorders.

Intraoperative comparison of single- and double-puncture techniques in temporomandibular joint arthrocentesis

The objective of this study was to compare techniques for temporomandibular joint (TMJ) arthrocentesis intraoperatively and to determine the ease of performance of these techniques for the physician. A total of 33 TMJ treatments were done using single-puncture arthrocentesis (SPA) type 1, SPA type 2, and double-puncture arthrocentesis (DPA) (n=11 in each treatment group) between December 2013 and December 2017. A retrospective analysis of the duration of the procedure (minutes), occurrence of complications, number of cannula relocations, and ease of the procedure was performed. Ease of the procedure was measured using a Likert-type visual analogue scale (VAS; 0–10). All measurement variables were recorded intraoperatively, and related data were analyzed statistically. Significant differences were found between SPA type 2 and the other techniques in terms of procedure duration and ease of the procedure (P<0.05). No significant differences were found in the occurrence of complications or number of cannula relocations between the techniques (P>0.05). Compared to the other TMJ arthrocentesis techniques, SPA type 2 is easier, and physicians can perform it in a shorter time.

Efficacy of Sodium Hyaluronate for Temporomandibular Joint Disorder by Single-Puncture Arthrocentesis.

The term temporomandibular joint internal derangement has characteristic clinical findings such as restricted mouth opening, pain, irregular deviated jaw function and clicking sounds. The technique of TMJ arthrocentesis has gained widespread acceptance as a simple and effective technique for the treatment of acute persistent closed lock of the TMJ. Arthrocentesis is known as the lavage and lysis of upper joint compartment. To evaluate the efficacy of sodium hyaluronate followed by single-puncture arthrocentesis. Sodium hyaluronate is the sodium salt of hyaluronic acid which is a polysaccharide of the glycosaminoglycans family, found in many extracellular tissues, including synovial fluid and cartilage. Exogenous hyaluronate can stimulate the synthesis of endogenous hyaluronic acid. In our study, a sample of 10 patients (7 females and 3 males) with TMJ disorder was selected. Arthrocentesis was done followed by sodium hyaluronate injection for all the patients. On follow-up ranging from 1 to 3 months, pain at rest and pain on mastication had substantially decreased in all patients and mandibular function and mouth opening had significantly improved. Our study shows that single-puncture Ringer's lactate arthrocentesis followed by sodium hyaluronate injection is effective in the management of the internal derangement of the temporomandibular joint.

Evaluation of ultrasonography guidance for single-puncture temporomandibular joint arthrocentesis: A randomized clinical study

Objective To evaluate ultrasonography (US) guidance on the single-puncture temporomandibular joint (TMJ) arthrocentesis technique.Methods Twenty-four patients were randomly divided into two groups (n = 12 in each group), and single puncture arthrocentesis (SPA) was performed with and without US guidance in groups 1 and 2. During the one-year follow-up period, the groups were statistically evaluated by the visual analog scale for pain, maximum mouth opening, lateral excursion, and protrusion within each group and between the two groups.Results Both treatment groups showed significant improvement, compared to the baseline levels for almost all outcome variables. However, there were no statistically significant differences between groups 1 and 2 (p > 0.05).Conclusion US guidance can be used for cannula placement in SPA. However, the outcome results are the same with or without its use.

The Double Intravenous Catheter Technique for Single-Puncture Arthrocentesis.

Traditionally, arthrocentesis involves insertion of 2 needles into the joint space of which one acts as an inflow port and the other as the outflow port. These 2 needles must triangulate and be exactly placed in the upper joint space for the procedure to be effective. Due to the difficulty in maintaining the needle position, single-puncture arthrocentesis is gaining popularity. It is relatively easier to perform and less traumatic to the joint. The authors describe a simple technique of single-puncture arthrocentesis using parts of 2 peripheral intravenous catheters of different gauges. The outflow port is formed by the catheter tube of 1 cannula while the inflow port is formed by the needle of the second cannula. Besides beings easy to perform and cost-effective, our technique provides predictable joint lavage of the joint with minimal trauma to the tissues.

Long-term evaluation of single-puncture temporomandibular joint arthrocentesis in patients with unilateral temporomandibular disorders

The purpose of this study was to evaluate the long-term effects of the single-puncture arthrocentesis (SPA) technique. Forty-two patients with unilateral temporomandibular joint disorders (TMDs) were treated by SPA. Thirty-eight of these patients completed 1–24 months of follow-up (short-term group) and 21 completed 11 months or longer of follow-up (long-term group). The two groups were evaluated statistically for pain (visual analogue scale), maximum mouth opening, lateral excursion, and protrusion. Both follow-up duration groups showed significant improvements when compared to baseline levels for almost all of the outcome variables (P<0.05). Single puncture temporomandibular joint arthrocentesis is an effective treatment method over both the short and long term.

Techniques and modifications for TMJ arthrocentesis: A literature review

Objectives: To discuss advantages and disadvantages of TMJ arthrocentesis techniques, identifying modifications as reported in the literature.Methods: A PubMed web-based search was carried out, using the terms TMJ and arthrocentesis, to determine the scope of coverage in well-documented articles in English.Results: Among 237 articles, 12 distinct techniques were described for TMJ arthrocentesis in 12 articles. Among 12 techniques, 5 were classified as double puncture arthrocentesis (DPA) and 7 as single puncture arthrocentesis (SPA). In total, 17 well documented articles about SPA were found in literature.Discussion: Arthrocentesis of the temporomandibular joint (TMJ) was first described in 1991. To make the traditional procedure even less invasive, many arthrocentesis methods have been described. However, in 2015, TMJ arthrocentesis techniques were divided into two groups to limit the complexities surrounding the concepts related to TMJ arthrocentesis techniques.

Effectiveness of single puncture arthrocentesis in temporomandibular joint disturbances

Effectiveness of single puncture arthrocentesis in temporomandibular joint disturbances