Temporomandibular Joint Lavage Research Articles

Temporomandibular joint arthrocentesis videos on YouTube: Are they a good source of information?

BackgroundYouTube has been increasingly used as a source of information by patients in the field of health, but many studies revealed poor information quality. This study evaluated the content and quality of YouTube videos on Temporomandibular Joint Arthrocentesis (TMJA) as an information resource for patients. Material and methodsYouTube search with the two keywords “temporomandibular joint arthrocentesis” and “temporomandibular joint lavage” was performed. The first 160 videos were listed for each term according to relevancy. Results were assessed for inclusion and categorized for source, purpose, target, arthrocentesis method described, and the narrator of the videos. An evaluation was performed independently by two oral and maxillofacial surgeons. The quality of videos was analyzed for the content and defined as poor, moderate, and excellent. DISCERN was also performed by scoring between 0 and 5. ResultsA total of 43 videos were evaluated. The most upload source was individual users (46.5%) and the most video upload purpose was information for professionals (37.2%). The method with the most information about was the two-needle technic, which had a rate of 44.2 percent. The average usefulness score of the videos was 3.00 and 57.1% of the videos resulted in poor quality. A statistically significant positive high correlation was found between DISCERN and usefulness scoring (r = 0.793; p < 0.001). ConclusionThe majority of YouTube videos are of poor quality and this situation affects the patients' decisions about treatment. Health professionals should be aware of the content on YouTube and produce high-quality, accurate, and up-to-date information for patient education.

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

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.

Результати застосування артроцентезу при лікуванні скронево-нижньощелепних розладів, асоційованих з переломами виросткового відростка нижньої щелепи

The purpose of the work was to study the effectiveness of arthrocentesis in the complex treatment of post-traumatic temporomandibular disorders. Materials and methods. The clinical part of the study included 24 patients, who had a history of fractures of the mandibular articular process. Patients underwent radiological examination – orthopantomography, computer tomography, ultrasound and magnetic resonance. Patients with titanium mini-plates after osteosynthesis were subjected to ultrasound, and since the reposition and fixation of fragments was performed using intermaxillary fixation they were subjected to magnetic resonance imaging. Pain assessment was performed according to visual analogue scale. Temporomandibular joint arthrocentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia. Results and discussion. All patients complained of the temporomandibular joint pain, which was rated from 1 to 6 points. All patients noted pain on palpation of the temporomandibular joint. Limited mouth opening ranging from 30 to 38 mm was found in 11 patients. Lower jaw deviation was observed in 18 patients. All patients had articulatory noises – clicking, and 11 had blocked movement of the joint head. Orthopantomograms or computer tomography revealed satisfactory restoration of the anatomical shape of the mandible after fractures and complete consolidation of the fracture. Ultrasound and magnetic resonance revealed signs of unabsorbed hematoma as consequences of hemarthrosis; in 18 patients – deformity of the capsule, in 17 – a slight thickening of the posterior edge of the articular disc, in 18 patients – disc adhesion, in 13 people – forward disc displacement with reduction, in 11 patients – disc protrusion without reduction. According to clinical and radiological signs after traumatic temporomandibular disorders, patients were divided into two groups according to Wilkes classification: 13 patients with stage II (early-middle) and 11 – with stage III (middle). We also found that after surgical treatment – osteosynthesis, the number of patients with stage III according to Wilkes makes up 58.33% (7 people), while those after splinting – 33.33% (4 people). The control ultrasound and MRI carried out 3-6 months after arthrocentesis showed no signs of hemarthrosis in 11 (84.61%) patients with intra-articular disorders of the second degree, and in 8 (72.72%) patients with internal disorders of the third degree, the position and function of the articular disc were restored. Conclusion. Arthrocentesis with temporomandibular joint lavage is a minimally invasive surgical manipulation that has proven itself in temporomandibular disorders of traumatic origin, in particular after fractures of the articular process of the mandible. Arthrocentesis is recommended to be used after ineffective conservative treatment, as well as to prevent post-traumatic intra-articular disorders in the early post-treatment fractures (intermaxillary fixation or osteosynthesis) with the attenuation of acute post-traumatic events, which is our goal of further work

Efficacy of arthrocentesis and lavage for treatment of post-traumatic arthritis in temporomandibular joints.

ObjectivesJoint injuries frequently lead to progressive joint degeneration that causes articular disc derangement, joint inflammation, and osteoarthritis. Such arthropathies that arise after trauma are defined as post-traumatic arthritis (PTA). Although PTA is well recognized in knee and elbow joints, PTA in the temporomandibular joint (TMJ) has not been clearly defined. Interestingly, patients experiencing head and neck trauma without direct jaw fracture have displayed TMJ disease symptoms; however, definitive diagnosis and treatment options are not available. This study will analyze clinical aspects of PTA in TMJ and their treatment outcomes after joint arthrocentesis and lavage.Materials and MethodsTwenty patients with history of trauma to the head and neck especially without jaw fracture were retrospectively studied. Those patients developed TMJ disease symptoms and were diagnosed by computed tomography or magnetic resonance imaging. To decrease TMJ discomfort, arthrocentesis and lavage with or without conservative therapy were applied, and efficacy was evaluated by amount of mouth opening and pain scale. Statistical differences between pre- and post-treatment values were evaluated by Wilcoxon signed-rank test.ResultsPatient age varied widely between 20 and 80 years, and causes of trauma were diverse. Duration of disease onset was measured as 508 posttrauma days, and 85% of the patients sought clinic visit within 2 years after trauma. In addition, 85% of the patients showed TMJ disc derangement without reduction, and osteoarthritis was accompanied at the traumatized side or at both sides in 40% of the patients. After arthrocentesis or lavage, maximal mouth opening was significantly increased (28-44 mm on average, P<0.001) and pain scale was dramatically decreased (7.8-3.5 of 10, P<0.001); however, concomitant conservative therapy showed no difference in treatment outcome.ConclusionThe results of this study clarify the disease identity of PTA in TMJ and suggest early diagnosis and treatment options to manage PTA in TMJ.

Benefit of Temporomandibular Joint Lavage With Intra-Articular Steroids Versus Lavage Alone in the Management of Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis

The aim of the present investigation was to evaluate, in patients with juvenile idiopathic arthritis, the effect of lavage with or without intra-articular corticosteroid (IACS) injection on clinical temporomandibular joint (TMJ) signs and symptoms of inflammation and changes in acute inflammation as assessed using magnetic resonance imaging (MRI). Forty-one patients (mean age, 13.6±4.0yr) with juvenile idiopathic arthritis participating in a large prospective juvenile inflammatory rheumatism cohort study (JIRcohorte) were included in this study. Clinical history, examination, and MRI were carried out at baseline and 6months after intervention, if any. Twenty-one patients underwent lavage and IACS injection in at least 1 TMJ, 8patients underwent lavage of at least 1 TMJ, and 12 patients were followed with no intervention. Outcomes measured were maximal mouth opening, Helkimo dysfunction index scores, pain intensity, and acute inflammation as assessed using MRI. All groups showed a mean increase in mouth opening and mean decrease in pain intensity. The mean Helkimo clinical dysfunction score decreased for the 2 intervention groups but not for the control group. The mean Helkimo anamnestic dysfunction score decreased for the lavage with IACS group but not for the lavage-only group. The only statistically relevant difference was found for the Helkimo anamnestic dysfunction score comparing the lavage-only with the lavage with IACS group, with a more positive effect found in the lavage with IACS group. More than 50% of joints in each group showed no change at MRI examination. Joints with lavage and ICAS injection showed better improvement than joints that had lavage only or no intervention. TMJ lavage with or without IACS injection cannot be claimed to systematically decrease pain, increase mouth opening, or resolve acute inflammation. Despite a tendency for improvement, response to this treatment is very patient dependent and can be determined by an array of other variables.

Outcomes of office-based temporomandibular joint arthroscopy: a 5-year retrospective study

Temporomandibular joint (TMJ) arthroscopy is a minimally invasive surgical approach for intra-articular TMJ diseases. Office-based arthroscopy using the smallest TMJ scope allows for good visualization, as well as the ability to lavage the joint in an office setting. This study aimed to assess the efficacy of an office-based TMJ arthroscopic technique. A retrospective evaluation of 363 patients with a TMJ disorder was performed. These patients underwent office-based arthroscopy using the OnPoint 1.2mm Scope System (Biomet Microfixation, Jacksonville, FL, USA) in Florida, USA, from July 2007. The following outcomes of the procedure were assessed: improvement in painless range of mandibular motion, pain on loading, and functional jaw pain; these were evaluated using a visual analog scale (VAS) over an average follow-up period of 263.81±142.1 days. The statistical analysis was performed using IBM SPSS Statistics version 20. Statistically significant improvements in TMJ pain and function, and other variables (P=0.001) were shown following TMJ arthroscopic lysis and lavage. Office-based arthroscopy using the OnPoint System was demonstrated to be a safe and efficient procedure for the treatment of patients with TMJ disorders as the first level of the algorithm of care.

OUTCOME OF ARTHROSCOPIC LYSIS AND LAVAGE FOR INTERNAL DERANGEMENT OF THE TEMPOROMANDIBULAR JOINT

Background: Temporomandibular Joint (TMJ) diseases have been established to be differentiated between intra-articular and extra-articular problems. TMJ internal derangement categories are the diseases with orthopedic obstacles that require management which might require surgical intervention. Among different surgical interventions, TMJ arthroscopy has been proven to be one of the minimally invasive surgical approaches to tackle TMJ internal derangement. Arthroscopic surgery appears to be a safe, minimally invasive and effective method for treating internal derangements (ID) of the temporomandibular joint (TMJ). Aim: the purpose of this study is to assess the outcome of using arthroscopic lysis and lavage for TMJ ID. Patient and Method: This is a prospective, cohort (27-52y), single institutional clinical study. TMJ ID subjects who failed conservative treatment for two months were presented and treated at the oral and maxillofacial surgery department, faculty of oral and dental medicine, Cairo University. The primary outcome variable was the absence of joint pain at 6 months postoperatively. Secondary outcome variables included joint function and maximum inter-incisal opening (MIO). Patients were followed up for six months postoperatively. Statistical analyses included paired t test and Chi square test. Results: 28 subjects (45;11 unilateral & 34 bilateral), with a mean age of 38.3 years. 24 (85.7%) were females. Successful outcome was seen in 64.4% of the studied subjects. Maximum painless inter-incisal opening as well as visual analog scale for joint pain and function showed a statistical significant improvement at the end of the follow up period.Conclusion: This study showed that TMJ arthroscopic lysis and lavage is an effective and predictable treatment for TMJ ID patients who failed conservative treatment.

Temporomandibular joint (TMJ) arthroscopic lysis and lavage: Outcomes and rate of progression to open surgery

Arthroscopic lysis and lavage has been shown to be effective in the management of a variety of TMJ (Temporomandibular joint) diseases. The purpose of this study was to evaluate the medium to long-term outcomes of TMJ arthroscopic lysis and lavage and determine factors associated with progression to open surgery. A retrospective cohort study of a single operator series was performed over a 6-year period from 2006 to 2012. The variables of gender, age and category (Dimitroulis classification) were compared to evaluate factors associated with success of arthroscopy and progression to open surgery. The data were analysed via Kaplan Meier method for time-to event analyses and Chi-squared tests for trend analyses. Pre-operative and post-operative Visual analogue scores and maximum inter-incisal opening results were analysed with the Student's t-test. A total of 167 patients and 216 joints underwent arthroscopy with a mean follow up of 6.9 years. Overall 77.7% of joints had a successful result and required no further surgery. There was no gender difference with respect to progression to surgery. Males underwent open surgery after a mean of 6.2 months from arthroscopy and Females after a mean of 15.6 months from arthroscopy (p<0.005). The highest failure rate between age groups was in the 21-30 year age group (p<0.04). There was a statistically significant rate of progression to open surgery depending on the classification at the time of arthroscopy, with all patients with category 4 and 5 disease progressing to open surgery (p<0.0001). Arthroscopic lysis and lavage of the TMJ is a reliable and effective operation for patients with early stage (i.e., Categories 1, 2 and 3) disorders of the TMJ. Patients with more advanced joint disease (i.e., Categories 4 & 5) gained only temporary relief from TMJ arthroscopy and often progress to open TMJ surgery.

Dynamic Evaluation of Lavage Efficacy in Upper Compartment of the Temporomandibular Joint

The aim of this study was to determine the most efficient temporomandibular joint (TMJ) lavage technique for complete irrigation and removal of synovial fluid. The corresponding total lavage fluid volume needed also was investigated. Three-dimensional TMJ lavage models of the classic double- and single-needle techniques with modified cannula sizes (diameters, 2.4 and 0.8mm) were generated based on a constructed upper compartment model. Models were integrated with 2-phase flow models to predict fractional fluid volume (α value) changes of lavage saline and synovial fluid within the upper compartment of the TMJ. Fluid flow diagrams, velocity vectors, and intra-articular pressure data were collected and compared among the models. Models were validated by clinical synovial fluid concentration analyses, with vitamin B12 used as an internal standard. In all 8 models, lavage fluid initially gathered around the inflow portal, with a stable mixture of synovial and lavage fluids eventually being established in the compartment. Use of the double-needle technique with a large inflow portal resulted in thorough lavage (α= 100%). When the single-needle or Shepard cannula technique was used, some areas within the upper compartment remained devoid of brisk flow. The 2.4-mm inflow model coupled with a 0.8-mm outflow portal resulted in a stably and persistently high intra-articular pressure (>2.7 × 104Pa). A minimum volume of 109mL of lavage fluid was necessary for complete replacement of synovial fluid by saline. When a 2.4-mm inflow portal needle was applied, a lavage rate of 100% was obtained with a minimum lavage volume of 109mL. Using a small inflow portal could lead to inadequate flow, residual synovial fluid, and, ultimately, treatment failure.

Outcome of Otologic Symptoms after Temporomandibular Joint Arthrocentesis.

The objectives of this study were to determine the prevalence of otologic complaints in patients with temporomandibular joint (TMJ) closed lock (CL), and to evaluate the efficacy of arthrocentesis in temporomandibular disorder (TMD) patients with otologic symptoms. Fifty-seven patients with TMJ CL were included in this study. The pre-treatment evaluations included assessment of the maximum mouth opening (MMO); pain level in palpation of the affected TMJ; pain level with function; and otologic complaints, including otalgia, tinnitus, vertigo, and hearing loss. Arthrocentesis treatment was performed for all the patients, and post-treatment data were recorded 1 month later. Before arthrocentesis and lavage, the mean MMO was 24.67 ± 4.61 mm; the mean tenderness score was 7.02 ± 1.09; and the mean score for pain in function was 6.86 ± 1.31. Following TMJ arthrocentesis and lavage, the mean MMO was 39.81 mm ± 4.56 mm; the mean tenderness score was 2.37 ± 0.65; and the mean score for pain in function was 2.45 ± 0.69. Seventeen (29.82%) patients reported at least 1 otologic complaint, 17 (29.82%) patients reported otalgia, and 8 (14.04%) patients reported tinnitus. Vertigo was noted in 5 (8.77%) patients. Complaints of hearing loss were not noted in any of the patients. After treatment, 14 patients no longer complained of otalgia, 5 patients no longer complained of tinnitus, and 2 patients no longer complained of vertigo. This represented a significant improvement in the patients' condition, especially in patients with otalgia (P < 0.0006). As evident from the results of this study, arthrocentesis procedures reduce both TMD symptoms and otologic complaints.

The Disc Positioning after Arthroscopic Lysis and Lavage of the Temporomandibular Joint

The symptomatic disc displacement of the temporomandibular joint (TMJ) can be treated by many ways, like oclusal splints, physiotherapy, arthrocentesis, arthroscopy and open surgery. TMJ Arthroscopic Lysis and Lavage (ALL) has showed good results in these cases. The aimed of this study were to observe the disc positioning after the procedure and the improvement of pain and mouth opening. 38 (6 men and 32 women) with 54 symptomatic disc displacement were included in this study. The results showed improvement of the disc positioning in 37 TMJ (68.51%), mouth opening in 33 patients (86.84%) and pain 35 in patients 35 patients (92.7%). In conclusion ALL can improve the disc positioning, mouth opening and pain in patients with symptomatic TMJ disc displacement.

Cytopathologic diagnosis on joint lavage fluid for patients with temporomandibular joint disorders

Temporomandibular joint (TMJ) disorders (TMD) are usually diagnosed based on the patient's clinical findings and the results of image investigations; however, understanding of the inflammatory process in TMJ is difficult. In addition, many of the TMJ disease types share common principal symptoms. Therefore, TMJ diseases in the early stage can be misdiagnosed with TMD. It is hypothesized that cytopathologic examination of the joint lavage fluids is useful in interpreting the TMD-associated inflammatory process from a cellular aspect. The aim of this study was to assess the TMJ lavage fluid cytopathologically in TMD patients. Thirty-nine patients, clinically diagnosed as TMD, were included in the present study. Clinical symptoms of the patients were recorded. Forty-four samples of TMJ lavage fluid were collected and paraffin-embedded cell sections were made by cell block tissue array method. Cytologic conditions in upper articular cavity of TMJ were cytopathologically diagnosed and were compared with the clinical symptoms of each patient. Cell components were detected in 22 of the 44 analyzed joint lavage fluids. There was a correlation between cytopathologic findings and clinical symptoms. Variety of cytopathology and inflammatory conditions in patients with similar clinical symptoms were also found. The results suggested that cytopathologic examination of the joint lavage fluids from TMD patients is helpful for gaining an understanding of the inner local conditions of TMJ at the cellular level.

Lavage Therapy Versus Nonsurgical Therapy for the Treatment of Arthralgia of the Temporomandibular Joint: A Systematic Review of Randomized Controlled Trials

To carry out a systematic review of randomized controlled trials (RCTs) to investigate in patients with arthralgia of the temporomandibular joint (TMJ) the effectiveness of TMJ lavage compared to nonsurgical treatment with regard to pain intensity and mandibular range of motion. The electronic databases Cochrane Controlled Trials Register (1960-2012), PubMed÷Medline (1966-2012), and Embase (1966-2012) were systematically searched for relevant RCTs. References of relevant articles were searched for additional studies, as well as citing reports. Two authors independently performed data extraction by using predefined quality indicators. Relevant outcome data included reduction in pain, as assessed by a visual analog scale (VAS) or a pain score, and maximal mouth opening (MMO) before and 6 months after treatment. Included trials were combined using fixed and random effects meta-analysis. Three RCTs (222 patients) were included for meta-analysis. The statistically significant overall standardized mean difference (SMD) (P < .001) with regard to pain intensity was -1.07 (95% CI = -1.38, - 0.76) in favor of TMJ lavage. The MMO did not change significantly (P > .05, SMD = .05 [95% CI = -0.33, 0.23]). The results suggest that lavage of the TMJ may be slightly more effective than nonsurgical treatment for pain reduction. However, this difference is not likely to be clinically relevant.

Concentric-Needle Cannula Method for Single-Puncture Arthrocentesis in Temporomandibular Joint Disease: An Inexpensive and Feasible Technique

Management of temporomandibular joint (TMJ) disorders presenting with pain, restricted mouth opening, or simply asymptomatic clicking can be challenging even to the experienced surgeon. Many conservative and invasive techniques are available, but most cases can be treated by arthrocentesis of the joint locally. A simple process of joint irrigation enables lysis of intra-articular adhesions, change in the joint viscosity, and clearance of various substances in the joint fluid. Classically, arthrocentesis of the TMJ has been performed with 2 needles: an infusion needle and an aspiration needle. Various devices and techniques have been described in the literature, each with its own benefits and drawbacks. We introduce our technique of TMJ lavage using 2 different gauge needles placed in a concentric manner; hence, besides a less traumatic and easier puncture of the joint capsule, the lavage and aspiration of the joint space can be performed efficiently, with minimal morbidity. The use of a concentric-needle cannula system is the least traumatic and perhaps the most cost-effective method for TMJ lavage described to date. We believe that this technique is applicable and can be performed by even the inexperienced surgeon.

A new approach to arthrocentesis of the temporomandibular joint

We describe a new temporomandibular joint (TMJ) arthrocentesis technique using the irrigation pump from a surgical and dental implant motor, providing the highest hydraulic pressure reported in the literature for TMJ lavage.

The Use of Double- Needle Canula Method for Temporomandibular Joint Arthrocentesis: Clinical Report

The purpose of this study is to demonstrate a temporomandibular lavage instrument with double needles in a single canula that make the procedure easier for surgeons. 38 year old woman was referred to our department with pain on the right temporomandibular joint (TMJ) region and restricted mouth opening. Magnetic resonance imaging reveals anterior disc displacement without reduction of the right TMJ. TMJ lysis and lavage was performed with double needle canula method. The upper joint space was successfully lavaged with 50 mL of 0.9% saline solution. Maximal mouth opening and lateral jaw movement increased and jaw functions improved immediately after the procedure. It is recommended as a simple alternative to classical arthrocentesis with two needles that it is easy to use and enables to perform lysis and lavage with a single puncture.

Iron-dependent generation of free radicals: Plausible mechanisms in the progressive deterioration of the temporomandibular joint

Purpose: The purposes of this study were 1) to determine whether iron concentrations detected in temporomandibular joint (TMJ) lavage fluid samples obtained from symptomatic patients are sufficient to catalyze the degradation of specific extracellular matrix (ECM) molecules in vitro, and 2) to provide evidence of oxidative stress in symptomatic TMJs by the detection of protein carbonyls in lavage fluids.Patients and Methods: Iron concentrations in TMJ lavage samples (19 joints in 14 patients) were determined colorimetrically, and the ability of the sample to produce free radicals in the presence of hydrogen peroxide was determined with the chromogen 2,2′-azinobis (3-ethylbenzothizoline-6-sulfonic acid), diammonium salt (ABTS). The presence of oxidized proteins was measured fluorimetrically using Bodipy FL hydrazide (Molecular Probes, Eugene, OR). Degradation of fibronectin was visualized by Western blot. Relative susceptibilities of fibronectin and collagen I to free radical cleavage were measured with the Fenton reaction.Results: Redox-active iron concentration in lavage samples was found to be as high as 3.66 μmol/L. A 70-kd protein band, presumed to be albumin, was found to contain higher levels of carbonyls than peripheral serum albumin, which correlated with a greater degree of oxidative damage. Fibronectin was found to be more susceptible than collagen I to free radical degradation, and fragments of the former were found in the lavage. The TMJ lavage fluid was capable of producing free radicals in the presence of peroxide.Conclusion: Circumstantial evidence is provided that the presence of modified and cleaved proteins isolated from lavage of symptomatic TMJs may have been subjected to oxidative stress.

Detection and preliminary characterization of matrix metalloproteinase activity in temporomandibular joint lavage fluid

In this study, lavage fluid was fractionated from the superior joint space in patients with temporomandibular joint (TMJ) dysfunction. A hide powder azure protease assay was used to assess protease activity in lavage fluid. No correlation between a patients's pain and the level of protease activity was demonstrated. Latent as well as active proteases were detected in the sample lavage fluid. Latent matrix metalloproteinases (MMPs) were activated using trypsin. Stromelysin-1 was detected in an active form in lavage fluid by immunozymography. The presence of high molecular weight species with protease activity was also demonstrated. This study validates the presence of stromelysin-1 as well as other MMPs in TMJ lavage fluid and proposes a mechanism for their physiologic activation.

Temporomandibular joint arthrocentesis and lavage for the treatment of closed lock: a follow-up study

Objectives: Temporomandibular joint (TMJ) arthrocentesis and lavage, first described in the North American literature in 1991, is a simplified method used for the treatment of severe, limited mouth opening. The purpose of this study is to evaluate the efficacy of this technique as a treatment for closed lock of the TMJ. Design: Forty-six patients with persistent closed lock of the TMJ of acute onset were treated by TMJ arthrocentesis and lavage with manipulation in an out-patient setting. Clinical data was collected in the form of visual analogue scales for pain and chewing ability, and measurements of maximum mandibular opening before and after treatment. Results: On follow-up ranging from 6 to 30 months, jaw opening and mandibular function had significantly improved (p < 0.001), and pain had substantially decreased in all but one patient as a result of this procedure. Conclusion: TMJ arthrocentesis and lavage is recommended as a simple alternative to more invasive TMJ procedures as an effective technique for the treatment of acute persistent closed lock of the TMJ.