TMJ Pain Research Articles

Assessment of Various Complains after Non-Surgical Treatment of Condylar Fracture

Objective: To assess various complains of patients after non-surgical treatment of condylar fracture. Methodology: A cross-sectional study was performed from October 2021 to October 2022 at the Department of Oral and Maxillofacial Surgery, Nishtar Institute of Dentistry, Multan. The sample size collected was 34 patients using a consecutive non-probability sampling. Using pertinent clinical examination, the patient was assessed for disturbed occlusion, limited mouth opening, deviation of the mouth, pain, and clicking sound. The mean follow-up period was six months. Results: The male-to-female ratio was 1.8: 1, with male predominance. The leading cause of fracture was attributed to incidents involving road traffic accidents (RTAs) (n—26, 76.5%).Twenty-three patients had a positive post-opt complaint after treatment, from which the most complaints presented were with unilateral condylar fracture n=15. The most common complaint presented was TMJ Pain with limited mouth opening n=8(23.5%). Conclusion: Conservative care for unilateral mandibular condyle fractures is a safe treatment approach. However, it can cause a few post-treatment functional complaints, the most frequent of which is TMJ pain. To further evaluate the improvement in function and discomfort, more research and consistent long-term follow-ups are required. Keyword: Temporomandibular joint movement (TMJ), TMJ Pain, Maxillomandibular Fixation (MMF)

Is the risk of chronic pain after total temporomandibular joint replacement independent of its indications? A prospective cohort study

Chronic pain is a possible long-term complication after alloplastic temporomandibular joint reconstruction (TMJR). This study was developed to evaluate various subjective and objective measurements to determine the presence and degree of TMJ pain in patients treated with TMJR regardless of the indication for the operation. A prospective, single-centre study was performed. Data on 36 patients (56 TMJR) were collected preoperatively and at follow up two to three years postoperatively. The primary outcome variable was subjective TMJ pain (none/mild, moderate/severe) at follow up. The predictor variables were objective pressure pain thresholds (PPTs) at the ipsilateral joint(s) and muscle(s), functional parameters (incisal range of motion, maximum voluntary clenching), subjective oral health-related quality of life (OHRQoL), and demographic and surgical variables. The number of patients with moderate/severe pain decreased from 17 preoperatively to 10 at follow up. Self-reported TMJ pain was significantly reduced in the entire group (p = 0.001). Patients with moderate/severe pain at follow up were more restricted in their OHRQoL but did not differ in PPT and functional parameters from the no/mild pain group. Moderate/severe TMJ pain at follow up was associated with unilateral TMJR and more preoperative pain. This study provides preliminary evidence that despite good pain reduction in most patients, persistent pain after TMJR is common and, in rare cases, may even worsen regardless of the original diagnosis. At follow up there was a close relation between OHRQoL and TMJ pain. TMJ pain after TMJR cannot be confirmed by objective measurement methods (PPTs and functional parameters).

ВОЗМОЖНОСТИ ПРИМЕНЕНИЯ МАНУАЛЬНЫХ ТЕХНИК В КОМПЛЕКСНОЙ РЕАБИЛИТАЦИИ У ПАЦИЕНТОВ С МИОФАСЦИАЛЬНЫМ БОЛЕВЫМ СИНДРОМОМ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА

Manual therapy, as a type of rehabilitation for TMJ pain, should be considered as an effective technique due to the low risk of complications at all stages of medical rehabilitation.

Efficacy of arthrocentesis with intra-articular injection of hyaluronic acid and corticosteroid in the treatment of internal derangement of temporomandibular joint.

Various techniques have been used to treat internal temporomandibular joint derangements (TMJ ID), with arthrocentesis one of the most successful in reducing symptoms and promoting function. In cases of TMJ ID, this research study compares and evaluates the efficacy of arthrocentesis with injections of corticosteroids (CS) or hyaluronic acid (HA). This prospective randomized, non-blinded study involving 91 patients with symptoms of TMJ ID treated by arthrocentesis followed by intra articular injection of 1 ml of either corticosteroid (group A) or HA (group B) . Maximum mouth opening, lateral excursive movements, TMJ pain at rest and during function, masticatory efficiency, pre-treatment functional TMJ limitation and subjective judgment of efficacy of treatment were assessed with millimeter scale. All the parameters measured before the procedure and further followed at 1st week, 1st month, 3rd month and 6th month post-procedure. Maximum mouth opening post procedure improved significantly in Group B at follow up visits (P < 0.05). Subjects in group B showed significant reduction in pain at rest (P = 0.001) at 1 week and 1 month follow up & increased masticatory efficiency at 6 months (P = 0.042) as compared to that of group A subjects. Injection of HA post-TMJ arthrocentesis is found be comparatively more effective method of treating TMD IDs with resultant decrease in pain & improved functionality of the jaw. TMJ arthrocentesis along with injection of HA could serve as a possible alternative to treat chronic TMJ pain sufferers who are unresponsive to conservative medical therapies.

Correlation of TMJ pain among patients with disc displacement with and without reduction with proton density fat suppression sequences/T2-weighted images of retrodiscal fibers using 3T MRI – Original research

Correlation of TMJ pain among patients with disc displacement with and without reduction with proton density fat suppression sequences/T2-weighted images of retrodiscal fibers using 3T MRI – Original research

Invasive carboxytherapy effectiveness in the treatment of painful temporomandibular joint dysfunction

Relevance. Today, more than 15-20% of patients suffer from chronic pain in painful temporomandibular joint disorder. Temporomandibular arthralgias are poorly treatable, excruciating, and often recurrent. Therefore, optimization of treatment is paramount in such patients.Aim: To evaluate the invasive carboxytherapy effectiveness for the treatment of pain syndrome in the temporomandibular joint.Materials and methods. The study diagnosed 33 patients (15 men and 18 women) aged 28 to 47 years old suffering from pain syndrome in the temporomandibular joint. Group 1 (control) patients (12 patients) received indomethacin tablets (25 mg/tid) for nine days [8]. The second (main) group (21 patients) had invasive carboxytherapy, which consisted of a 3 ml carbon dioxide subcutaneous injection administered five times every other day. The study evaluated the therapeutic effect persistence on the 15th day of observation.Results. The invasive carboxytherapy proved to be more effective in pain syndrome relief in painful TMJ dysfunction than indomethacin prescription. The invasive carboxytherapy was 12.02%, 9.17% and 4.29% more effective than the NSAID on the 3 rd, 9th and 15th day of observation, respectively.Conclusion. The invasive carboxytherapy is highly effective in relieving pain symptoms in pain dysfunction, which was 44.9% on the 3rd day, 83.5% – on the 9th day, and 100% – on the 15th day of observation. The advantages of carboxytherapy were noted, namely, its good tolerability with a small number of contraindications related to the general state of health, as well as the condition of the skin at the injection site. It is possible to use invasive carboxytherapy in the comprehensive treatment of patients with painful temporomandibular joint di sorder.

Conservative Therapies for TMJ Closed Lock: A Randomized Controlled Trial.

Background. Acute anterior disc displacement without reduction (ADDWoR) is characterized by permanent TMJ disc displacement, pain and functional limitations. Occlusal appliances (OA) are among the therapies of choice. Methods. A single-blind randomized study was carried out to compare the therapeutic success of two different types of splints in patients with ADDWoR. A total of 30 subjects were eligible for the study out of the 330 screened. Group I (n = 15) received RA.DI.CA splint therapy and Group II (n = 15) received stabilization splint therapy. Temporomandibular pain, headache, neck pain and functional excursions were evaluated at baseline (T0), after 4 weeks (T1) and after 6 months (T2). Descriptive and inferential statistics were performed. Results. There was a significant increase in maximum jaw opening and a reduction in pain in both groups (p < 0.05), except for neck pain in Group II. Significant differences in between- and within-subject factors emerged in all of the parameters evaluated, especially between T1 and T2 scores, with a greater trend of improvement in Group I than Group II. Conclusion. RA.DI.CA splints were found to be more effective for the considered sample, especially in the treatment of comorbidities and functional movements, probably due to the greater orthopedic action and joint mobilization.

Effects of occlusal splint and exercise therapy, respectively, for the painful temporomandibular disorder in patients seeking for orthodontic treatment: a retrospective study

ObjectiveTo evaluate the effect of hard stabilization splints (HSS), counselling and exercise therapies, respectively, for the painful temporomandibular disorder (TMD) in patients seeking for orthodontic treatment through magnetic resonance imaging (MRI) and clinical examination.Materials and methodsEighty-seven TMD patients were divided into two groups according to their therapies: the HSS group (n = 43) comprising of patients treated with HSS, counselling and masticatory muscle exercises; the control group (n = 44) comprising of patients treated with counselling and masticatory muscle exercises alone. All patients had orthodontic therapies after the first treatment phase. The joint pain and clicking of all patients were recorded via clinical examination. MRIs of HSS groups were taken before (T0), after the first phase (T1), and after the orthodontic treatment (T2). Parameters indicating the condyles and articular discs were evaluated. Clinical symptom (pain and clicking) changes among T0, T1 and T2 time point were detected in the two groups respectively. The significant differences between HSS and control groups, as well as between male and female were tested at T1 and T2. Position changes of condyles and discs in HSS group among T0, T1 and T2 were detected in male and female respectively.ResultsAfter the first treatment phase, there was no difference in the decrease of facial pain between the two group, as well as between male and female in the two groups (P > 0.05). Clicking decreasing was not statistically significant. After the whole orthodontic periods, the TMJ pain relapsed in female of the control group, and the number of female’s pain joints was more than male’s (P < 0.05). In the HSS group, the posterosuperior movements of discs and the anteroposterior movements of condyles were recorded in closing position (P < 0.05). After the whole orthodontic periods, female’s disc-condyle angles increased, the discs to HRP distance decreased and condyles to VRP distance increased when compared with the data of T1 (P < 0.05).ConclusionsFor the orthodontic patients with painful TMD, HSS combined with counselling and exercise therapies before orthodontic treatment could provide pain relief. HSS is helpful to improve the position and relation of discs and condyles. In addition, male's prognosis is better than female's in terms of stability.

Prevalence of stress and its effects on the physical and dental health of medical, dental, and engineering students in Lahore, Pakistan”

Stress can contribute to or influence the development of psychological disorders like depression and anxiety, as well as physiological issues like high blood pressure and slow wound healing. Objectives: To find out the prevalence of stress and its oral and physical manifestations in medical, dental, and engineering students of Pakistan. Methods: This cross-sectional questionnaire-based study was carried out in Rashid Latif Medical Complex and Clapp trust Lahore, Pakistan. The study included 326 male and female students from medical, dentistry, and engineering universities. Results: The majority of them were females 68.7% as compared to males 31.3%. The mean age of the students was 21.9±4.17 years. The persistent headache had the highest frequency among physical problems due to stress with 84.5% of the participants responding. In a comparative analysis, the t-test showed gender to be significant for disturbed sleep, difficulty breathing persistent headaches, and muscular pains while the ANOVA test showed a significant association of age with weight gain, pain in TMJ, and ulcers in the oral cavity. Regression analysis showed a significant relationship between weight gain and age. Conclusions: This study demonstrated that the stress of studying is making students more susceptible to problems with their physical and oral health, which is lowering their quality of life.

Retrospective analysis of the treatment of internal disorders of the temporomandibular joint and myofascial pain disorders in the conditions of adult orthodontic reception

BACKGROUND: Internal disorders of the temporomandibular joint (VN TMJ) occur at orthodontic reception no less often than with other types of dental treatment. The main clinical manifestations of VN TMJ are caused by variants of anterior displacement of the articular disc, pathology of the capsular ligamentous apparatus, hypermobility of the mandibular head, and dysfunction of the masticatory muscles. The main symptom of VN TMJ is joint pain (arthralgia) and muscle pain (myalgia). VN TMJ occupies a special place in orthodontic treatment. They can be detected at the initial treatment, and their symptoms can appear at any stage of orthodontic treatment and be a complete surprise for the doctor and the patient, arise after orthodontics, and be associated with it. Since VN TMJ significantly affects the therapeutic process, its outcomes, prognoses, and treatment problems are under the close influence of orthodontists.&#x0D; AIM: To examine the effectiveness of the treatment of VN TMJ and myofascial pain disorders in patients with dental anomalies.&#x0D; MATERIAL AND METHODS: The study retrospectively analyzed case histories of 300 adult patients with dental anomalies in need of orthodontics who underwent examination and treatment in a multidisciplinary dental clinic between 2014 and 2016. The prevalence and structure of VN TMJ were assessed, and myofascial pain disorders (MFDB) and results of their correction were analyzed.&#x0D; RESULTS: A total of 146 (71.5%) patients with myofascial pain and 58 (28.3%) with myofascial facial pain syndrome needed orthodontic treatment more often. In these patients, VN TMJ and maxillary anomalies belonging to class II according to Engle of unilateral distal occlusion, deep bite, and class I with crowding of teeth are more often detected. Internal TMJ disorders with concomitant MFDB in the form of myofascial pain were observed in 168 (82.4%) patients. Myofascial pain disorders without VN TMJ were registered in 36 (17.4%) patients. The overall effectiveness of the treatment of VN TMJ and MFBSD was 46.4% (n=78 patients). No lasting improvement was observed in 35.7% (n=60). Deterioration was registered in 17.8% (n=30). Relapses were noted in 60.7% (n=124). In the treatment of MFDB without VN TMJ, the overall effectiveness of treatment was 5.5% (n=2), stabilization in 50.0% (n=18), and deterioration in 44.4% (n=16).&#x0D; CONCLUSION: Myofascial facial pain is very difficult to treat. In combination with VN, TMJ creates significant and sometimes insurmountable difficulties in adult orthodontics. All this forces specialists to look for new approaches and develop effective ways to optimize orthodontic treatment in the case of TMJ pathology and myofascial pain disorders.

Congenital Mandibular Hypoplasia: Patient-Specific Total Joint Replacement as a Line Extension in the Treatment of Complex Craniofacial Anomalies

IntroductionCongenital mandibular hypoplasia (CMH) remains challenging because of the underlying combined hard and soft tissue deficiency. Treatment options include craniofacial distraction, orthognathic surgery, and autologous grafts, although the latter produces inadequate results after distraction and autologous grafting. Unsatisfactory long-term stability may cause relapse, necessitating reoperation.Material and MethodsWe investigated the feasibility of using alloplastic total joint replacement (TJR) in growing and young adult CMH patients. The primary outcome was long-term reconstruction stability, without implant failure. Secondary outcomes were TMJ function and pain, and jaw movements achieved during surgery.ResultsThree patients (age: 9–22 years) were treated by the same surgeon at one institution during 2018–2021. Anamnesis and clinical parameters were obtained from patient records. Preoperative 3D-scans were superimposed with postoperative 3D-scans and preoperative plans, including TJR-implant STL files, to measure jaw movement. All patients underwent prior reconstructive surgery. Mandibular movement of 16.4–20.1 mm in the sagittal direction was achieved. Post-TJR follow-up ranged from 24 to 42 months. No long-term complications occurred. At the latest follow-up, the maximal interincisal opening was between 21 and 40 mm, and all implants were functioning, without failure.ConclusionIn selected CMH cases, alloplastic TJR can deliver satisfactory medium-term results with predictable and stable outcomes, even in growing patients.

Complementary Effect of Electro Acupuncture on Refractory Head and Neck Myofascial Pain: A Retrospective Investigation of Patient-Reported Outcomes

Introduction: Acupuncture (AC) is among the complementary treatment modalities to manage chronic myofascial pain. The aim of this investigation was to assess the additive effect of AC in reducing the intensity of primary chronic myalgia/myofascial head and neck pain in patients using oral orthotic appliances (OA). Methods: A retrospective chart review was conducted for 103 patients diagnosed with primary chronic myalgia/myofascial pain and received OA with/without AC at Tufts University School of Dental Medicine (TUSDM). Subjective reporting of face/TMJ/neck pain was recorded at the initial visit and at short-term and long-term follow-ups using patient-reported pain/discomfort numeric rating scale (NRS). Results: Most subjects were females (77.7%) with the mean age of the entire study population being 53 years old. In patients with refractory response to OA, combining AC with OA showed significant improvement in NRS score compared to baseline, in TMJ pain (P=0.023), neck pain (P= 0.055), facial pain (P=0.006). The addition of AC to OA has also brought refractory pain to low levels, comparable to what OA-only respondents reported [TMJ pain (P= 0.395), neck pain (P=0.694), face pain (P=0.553)]. Conclusion: AC may provide a complementary therapeutic modality to manage refractory cases of primary chronic myofascial pain.

Arthrocentesis- An minimally invasive method for TMJ disc disorder: An original research

TMJ dysfunction is a therapeutic challenge in the oral and maxillofacial clinic. Although TMJ pain and dysfunction can be caused by many different aetiologic factors, the role played by inflammation as an underlying mechanism of pain and dysfunction of the TMJ has played a major role. TMD patients having pain and tenderness for prolonged period of time will show signs of inflammation biochemically as well as radiographically. Therefore the aim of this study was to evaluate the efficacy of arthrocentesis in patients suffering from TMJ disc disorders. Materials and Methods A Total Of 60 Subjects Suffering From Tmj Disc Disorders Were Selected And Treated By Arthrocentesis. The Subjects Were Followed Up For A Period Of Two Year. Results The mean maximal mouth opening prior to arthro-centesis was 30.10 mm and after the procedure the mean maximal mouth opening was 45.3 mm. The mean right and left lateral movements before arthrocentesis were 6.15mm and 6.59mm respectively, and the mean right and left lateral movements of 9.09 and 9.21 respectively were present after the procedure. The mean degree of pain before arthrocentesis was 7.7, and after the procedure the mean degree of pain was 1.03 as per the visual analogue scale.

Effectiveness of electromyography guided botulinum toxin injection and dextrose prolotherapy in recurrent TMJ dislocation (radiographic and clinical study)

Objectives: This study was conducted to assess effectiveness of dextrose prolotherapy, Electromyography (EMG) Guided Botulinum Toxin – A (BTX-A) Injection, and combination between them in treatment of recurrent TMJ Dislocation cases. Subjects and methods: This current study was carried out on 60 adult patients suffering from recurrent TMJ Dislocation. The patients divided equally into three groups, Group I: 20 patients were treated with EMG guided BTX-A injection. Group II: 20 patients were treated with dextrose prolotherapy. Group III: 20 patients were treated with combination of EMG guided BTX-A injection and dextrose prolotherapy. The clinical evaluation preoperatively and postoperatively (at 1week , 3 months , 6 months) included visual analog scale of TMJ pain, maximum mouth opening (MMO), and frequency of luxations . Radiographic evaluation using MRI was done preoperatively, and at 6 months. The collected data were then statistically analyzed. Results: best results were recorded in group III compared with other groups; at all intervals of study with significant reduction of pain score, and frequency of luxations beside to improvement of MMO measurements. Conclusion: the combination of EMG guided BTX-A injection and dextrose prolotherapy is a promising treatment in recurrent TMJ dislocation cases.

Repeated Intra-Articular Administration of Platelet-Rich Plasma (PRP) in Temporomandibular Disorders: A Clinical Case Series.

Background: Temporomandibular joint disorders (TMDs) are manifested, inter alia, by pain and limited scope of the mandibular abduction. Among the treatment strategies for these ailments, intra-articular injections of autologous blood preparations, including platelet-rich plasma (PRP), are administered. This prospective case series was aimed at assessing the effectiveness of repeated platelet-rich plasma (PRP) administration to the TMJ cavities in terms of reducing articular pain and increasing the mobility of the mandible. Material and methods: 40 consecutive patients diagnosed with TMJ pain qualified for the case series. The entire treatment program consisted of five PRP administrations and a summary appointment. Regression was analyzed for (1) intensity of spontaneous pain; (2) effectiveness of spontaneous pain relief; (3) mastication efficiency values; (4) painless mandibular abduction; (5) maximum mouth opening. The correlations between the abovementioned variable series were analyzed. Results: The mean spontaneous pain decreased consistently with successive PRP administrations in line with the regression model: −0.4x + 4.2 (R2 = 0.98). Articular pain improvement was reported in 71% of joints treated. Improvement in chewing quality at the end of the entire injection cycle was found in 63% of patients. The equations for the linear regression models for painless mandibular abduction (five applications of PRP) and maximum mouth opening (the first four applications of PRP) were x + 34 (R2 = 0.89) and 0.6x + 43.6 (R2 = 0.96), respectively. Improvement in these domains was found in 78% and 53% of patients, respectively. The strongest correlations were found between pain and chewing efficiency (−0.95), pain and painless mandible abduction (−0.96), and painless mandibular abduction and mastication efficiency (0.94). Conclusion: PRP injections into TMJ cavities should be considered as a low invasive, highly accessible form of treatment for various TMDs causing pain and mandible movement limitation.

An online survey of pelvic congestion support group members regarding comorbid symptoms and syndromes.

Patients with pelvic congestion syndrome (PCS) often report overlapping somatic symptoms and syndromes. The objective of this study was to explore the prevalence of co-existing symptoms and self-reported syndrome diagnoses among women with PCS and to inform future research hypotheses. A brief online survey was offered to members of a PCS support group website. Responses were assessed for self-reported co-existing symptoms and formal diagnoses, including: chronic fatigue syndrome, fibromyalgia, postural tachycardia syndrome, irritable bowel syndrome, migraines, interstitial cystitis, and temporomandibular joint dysfunction. Of a total of 6000 members, there were 398 respondents; 232 (59%) had not yet been treated for PCS. Among these, the most prevalent co-existing symptoms were as follows: severe fatigue (72%), dizziness (63%), IBS symptoms (61%), brain fog (33%), migraines (49%), polyuria or dysuria (41%), excessive sweating (31%), TMJ pain (31%), and loose skin or lax joints (18%). These are much higher than reported for the general female population. The most commonly self-reported comorbid syndrome diagnoses for the overall group of 398 were: irritable bowel syndrome (29%), fibromyalgia (13%), spinal nerve problems (18%), interstitial cystitis (10%), postural tachycardia syndrome (9%), hypertension (11%), chronic fatigue syndrome (10%), and Ehlers-Danlos syndrome (6%). Other than with hypertension, these rates are variably higher than in the general population. Several self-reported co-existing symptoms and syndromes are more prevalent in members of a PCS support group relative to the reported prevalence in the general population. More formal investigation is warranted to evaluate this finding and to investigate potential etiologic links. Ehlers-Danlos Syndrome appears to be common in self identifying PCS women.

Incidence and Clinical Presentation of Temporo-Mandibular Joint Disorders and their Association with Psychological Distress and Para-Functional Habits in a Non-Patient Population.

The study aims at finding the incidence of temporo-mandibular joint disorders (TMDs) in a non-patient population and relates their association with psychological distress and parafunctional habits. A DC/TMD questionnaire and DASS-21 scale survey were completed by selected participants followed by clinical examination of TMDs symptoms in sample population. A study sample of 855 participants revealed 36.65% population with various TMDs symptoms, while 63.5% population had no TMDs symptoms. 50.8% study participants were men, and 49.2% were women. Of all affected population, 16.2% had pain-related TMDs, 12.39% had intra-articular TMDs symptoms, and 8.07% had TMJ pain associated with pain or dysfunction. For all TMDs symptoms groups, the strongest correlations were for depression, while no significant associations were observed with parafunctional habits in all groups. Overall psychological distress and anxiety increased the prospects of TMDs symptoms. Clinical factors like muscle tenderness, crossbite and deep vertical overlap seem to be significant etiological factors, while angle molar relationship and parafunctional habits do not seem to be significant etiologic factors in TMDs.

Pattern of Temporomandibular Disorders (TMD) Among Patients Visiting Peshawar Dental College

Background and Objectives: Early diagnosis of Temporomandibular disorders (TMD) is important for prevention ofgreater damages of the parts of the maxillofacial region. This study aims to determine the pattern of TMD among patientvisiting Peshawar dental college.Methods: A cross sectional study was conducted between the periods of January 2021-dec 2022 among the patientvisiting oral medicine department of Peshawar dental hospital. Total sample size of 200 patients were assessed. TMJevaluation form’ index was used. Gender, age and all sign symptom’s like pain, TMJ click, mouth opening, deviationwere noted.Results: Out of 200 patients 110 were female and 90 were male, with age range 10- to 80 years,67 % patient presentwith TMJ click and pain both while 93% presented with TMJ click only. 15% present with limited mouth opening. Thepain and click were the most common sign and symptoms noted.Conclusion: TMD is a common problem and the severity of TMD was found higher among patient visiting Peshawardental college. Temporo-mandibular joint disorders give association with gender.

P-41648991-93 - Arthocentesis and adjuvant intraarticular steriod in the management of internal derangement of temporomandibular joint

<h3>Objectives</h3> A study was designed to compare the efficacy of arthrocentesis alone and with intraarticular steroid in treatment of TMJ internal derangements. <h3>Methods</h3> 36 patients diagnosed cases of internal derangement, aged between 17-45 years. Wilkie's second and third stage were enrolled in the study, complaining of limited mouth opening and TMJ pain. All patients were clinically evaluated before the arthocentesis, and at 1 week and 3 months after the arthocentesis after randomly distributed into two groups by lottery method. In the experimental group arthocentesisis was combined with single dose of triamecelone actonide 40mg injection into joint space. Postoperative changes were compared with the preoperative values using the Mann-Whitney U-test. <h3>Results</h3> The pre-operative mouth opening ranged from 18 to 27mm with a mean of 23.7mm with VAS pain score from 4 to 8 in control group. The post-operative MMO incresed to mean of 33.475mm and increased to a mean of 41.05mm at 3 month follow-up with decrease in pain score to a mean of 2.45 at 1 week then to a mean of 1.225 at 3 month follow-up in the control group. In the experimental group the mean MMO after steroid injection increased from 23.9 to 42.2mm, the mean pain score decreased from 6.7 to 1.11. The difference between the groups was not significant with p value of 1. <h3>Conclusion</h3> TMJ arthrocentesis is a simple, less invasive and less expensive technique with low morbidity, but addition of steroid doesn't improve the results.

The bipartite condyle: A unique rare case report

Double headed condyle or bifid mandibular condyle is rare anatomic anomaly that can result from congenital malformation, tumor, trauma or infection. This is an extremely rare disorder characterised by a duplication of the head of the mandibular condyle. We hereby report a case of double headed mandibular condyle with a separate neck which was diagnosed using computed tomography scan.Methodology: A 33 year old male patient presented with an alleged history of assault. CT faciomaxillary with 3D reconstruction revealed right coronoid process fracture and symphysis fracture and an incidental finding of a double condylar head with a separate neck on the right side. The fractures were fixed under general anaesthesia. The patient was followed up for 3 months. CT DICOM files were made followed by a stereolithographic model for the intricate understanding of this rare anomaly.Results: The shape of the main condylar head was conical with mild resorptive changes. The accessory condylar head branched from the neck of the main condylar head anteromedially with a separate neck. On regular follow up of three months, the patient had absolutely no complain of TMJ Pain and had normal TMJ movements bilaterally in all directions.Conclusion: Being one of the unique cases, this case is one of its kind since it exhibits one of the rarest morphological variant of the condylar heads. Treatment for such cases isn’t a compulsion however long term follow up is a must.