Treatment Of Temporomandibular Joint Dysfunction Research Articles

Клінічне та патофізіологічне обґрунтування доцільності застосування функціональної терапії при лікуванні больової дисфункції скронево-нижньощелепних суглобів

Summary: Our study made it possible to trace and analyze the changes in the masticatory muscles of patients that occur during the treatment of temporomandibular joint dysfunction (TMJ) and testify to its effectiveness. In patients with TMJ dysfunction, the qualitative and quantitative indicators of electromyography are closely correlated with the stages of development of the pathology and correspond to its clinical manifestations. In this study, for the first time, the relationship between the change in the parameters of the frequency of muscle contractions and the subjective feeling of pain in the area of the specified masticatory muscle in patients was analyzed. The aim of this study is to study and compare the nature and degree of changes in the electromyographic activity of the main and auxiliary masticatory muscles in patients with TMJ dysfunction before and after the use of myorelaxing splints. Research materials and methods. A five-year study of patients with TMJ dysfunction (92 people). A total of 342 electromyograms before and during the stages of patient treatment were submitted to the overall analysis. The results of the analysis of the effectiveness of the use of myorelaxation splints in the treatment of TMJ dysfunction allow to improve the quality of treatment of this pathology in patients. The results obtained after 6 months indicate that the effectiveness of the treatment of CG I patients (with the lowest intensity of TMJ dysfunction symptoms) reached 89.1±1.3%; CG II - up to 78.3±1.3%; CG III – 77.3±1.3%. Key words: electromyography, dysfunction, temporomandibular joint, masticatory muscles, bioelectric activity, bioelectric rest, myorelaxation splint, occlusion

Therapeutic challenges in temporomandibular disorders

Background and aims. This study aimed at evaluating the etiology and treatment challenges of temporomandibular disorders (TMDs). 
 Methods. 160 subjects with TMDs, 38 males (23.8%) and 122 females (76.3%) were studied. A personalized coefficient was designated, which included the resolution of the main symptom, correction of secondary symptoms, patient collaboration (emotional parameter), treatment duration, and cost. 
 Results. The most frequent cause for consultation was muscle impairment (42.5%), or limitation of mouth opening, followed by joint impairment (23.1%). Muscle pain was noticed, particularly in the masseter (57.5%) and lateral pterygoid muscles (51.9%). Tooth pain or gingival retraction was frequently associated with tooth wear (48.1%) and dental abfraction (31.3%). Remote symptomatology was dominated by otologic symptomatology. Iatrogenic etiology was highest (69.4%), followed by untreated missing teeth (66.9%). Treatment options included muscle relaxation, occlusal balancing (equilibration), kinesitherapy, medication, and swallowing re-education. Most patients benefited from four to seven different types of therapy, which resulted in a higher cost and a longer and more uncomfortable treatment. The primary symptom was relieved in 82.3% of cases, with recurrence occurring in 15.7%. 
 Conclusion. The treatment of temporomandibular joint dysfunction is time-consuming, demanding, and intricate. Most patients required four to seven different types of therapy, which increased the expense, treatment duration, and suffering. 
  
  

Results of diagnosis and treatment of temporomandibular joint dysfunction in patients with malocclusion

Temporomandibular joint dysfunction in patients with malocclusion is quite a widespread problem in modern dentistry. The study included: identification of patients with signs of TMJ dysfunction and malocclusion by pre-selection; diagnosis of dysfunctions in the main group of patients; preparation of the treatment plan using splint therapy and kinesiotherapy; assessment of the effectiveness of these treatment methods. Most of the subjects had a decrease in the tone of the masticatory muscles, pain sensitivity in the masticatory muscles and the TMJ area. Splint therapy, as well as kinesiotherapy, is the best choice in the treatment of these patients.

Effectiveness of Physiotherapy in the Treatment of Temporomandibular Joint Dysfunction and the Relationship with Cervical Spine.

Temporomandibular dysfunctions are a heterogeneous group of conditions involving the temporomandibular joints (TMJs) and periarticular musculoskeletal structures. This study aimed to evaluate the effectiveness of a physiotherapy program for TMJ dysfunctions and the relationship with cervical spine. The study design was a non-randomized clinical trial with two parallel treatment groups: 33 subjects in the experimental group that underwent conservative drug treatment and physiotherapy treatment, and 31 subjects in the control group that underwent only conservative drug treatment. The participants were examined at baseline and re-examined after 3 months. In this study there was a higher incidence of female subjects. After 3 months of treatment of the TMJs and cervical spine, pain decreased in both groups (p = 0001). Muscle testing at the cervical spine and temporomandibular level showed a decrease in pain and muscles spasms. The average percentage values of the Neck Disability Index (NDI) and the Jaw Functional Limitation Scale 8 (JFLS 8) decreased significantly in both groups, but especially in the experimental group (p = 0.001). Physiotherapy treatments could maintain the functional state at the temporomandibular and cervical levels, thus contributing to increasing the quality of daily life.

Efficacy of the use of chondroitin sulphate and glucosamine for the treatment of temporomandibular joint dysfunction: A systematic review and meta-analysis

ABSTRACT Objective To evaluate the efficacy of chondroitin sulfate (CS) and glucosamine (GS), the most relevant drugs of “Symptomatic Slow Acting Drug for Osteoarthritis” (SYSADOA), in the functional and symptomatic improvement of temporomandibular dysfunction. Although, controversy exists regarding their benefit. Methods An electronic search was conducted to retrieve randomized controlled clinical trials (RCTs). The risk of bias assessment was evaluated using the Cochrane Collaboration’s tool. Data were meta-analyzed with a random effect model whenever possible. Results Three RCTs were included. Qualitative results showed a decrease in pain, joint noise, and inflammatory biomarkers in synovial fluid and an improvement in maximum mouth opening without significant adverse effects. Meta-analysis showed a significant increase in maximum mouth opening with the use of CS-GS (p = 0.19). No statistically significant differences were found in pain reduction compared to tramadol. Conclusion CS-GS is effective and safe in the symptomatic and functional improvement of patients with TMD.

Електроміографічне обгрунтування доцільності застосування міорелаксуючих шин технології EXOCAD при лікуванні дисфункції скронево-нижньощелепних суглобів

The purpose of the study was to study and comparatively analyze the nature and degree of changes in electromyographic activity of the main and auxiliary chewing muscles in patients with temporomandibular joint dysfunction before and after the use of treatment with myorelaxant splints. Materials and methods. Five-year study on the basis of Stomatological Medical Center of Bogomolets National Medical University of patients with temporomandibular joint dysfunction (274 people) was conduscted. The general analysis provided 1024 detailed electromyograms before, after and at the stages of treatment of patients with temporomandibular joint dysfunction. Results and discussion. The results and conclusions of the analysis of the effectiveness of the treatment with the use of myorelaxant splints in the treatment of temporomandibular joint dysfunction indicate an increase in the quality of treatment of this pathology in patients and a reduction in the period of achievement of the result. The results obtained after 12 months indicate that the effectiveness of treatment of patients of control group I (with the lowest intensity of symptoms of temporomandibular joint dysfunction) reached 89.1±1.3%; control group II – up to 78.3±1.3%; control group III – 77.3±1.3%. In general, a study of the state of temporomandibular joint, complex clinical and paraclinic diagnosis, modern orthopedic treatment and prevention of musculoskeletal dysfunction of the temporomandibular joints were carried out. Based on the obtained data, the effectiveness of this algorithm of complex diagnosis, treatment and prevention of musculoskeletal dysfunction of temporomandibular joint was developed, clinically implemented and evaluated. Also, the data obtained as a result of the study by the authors were the basis for finding and correcting new methods and algorithms for diagnosing and treating pathology. The original author's concept of the pathogenesis of muscular-articular dysfunction of temporomandibular joint, used in the study and scientifically substantiated by the authors, united all existing theories of the development of this disease. The multifactorial analysis revealed an increase (p <0.001) of the risk of not achieving the effect of treatment by reducing pain syndrome with an increase in scores on the Bayers scale before treatment, odds ratio = 1.6 (95% of BI 1.4–1.9) for each point of growth score (when standardizing on three other risk factors). An increase (p=0.002) of the risk of not achieving the effect of treatment by reducing pain syndrome with an increase in the asymmetry of the indicator J_MM_A_max, Index Bayers (visual analogue scale) = 1.08 (95% BI 1.03–1.12) for each point exceeding the value of the indicator for the left half above the right (when standardizing on three other risk factors). Also, an increase (p= 0.049) of the risk of not achieving the effect of treatment for a decrease in pain syndrome with an increase in the asymmetry of the J_MM_A_mean indicator, odds ratio = 1.28 (95% of BI 1.00–1.65) for each point exceeding the value of the indicator for the left side above the right side (when standardizing on three other risk factors) was found. Conclusion. Such a thorough approach to the implemented model of diagnosis and treatment of patients with temporomandibular joint dysfunction and a synchronized complex of studies and treatment of this pathology, developed in accordance with it, provided an opportunity to assess qualitative and quantitative changes in the link of the chewing apparatus and the central link of the corresponding functional biosystem that ensure the formation and implementation of the main functions of the temporomandibular joint

Сплинт-терапия как отдельный подход в рамках комплексного лечения дисфункции височно-нижнечелюстного сустава с точки зрения физиологических понятий

BACKGROUND: Among the adult socially active population, one of the most common pathologies of the maxillary system is musculoskeletal dysfunction of the temporomandibular joint (TMJ). One of the modern methods of correction and treatment of TMJ dysfunction is splint therapy, which involves the use of splints and permits to consistently and selectively act on a particular level of disorders: occlusive, muscular, articular. This ultimately forms a new myostatic reflex of holding the jaw, builds physiological biomechanics and neuromuscular activity of the speech apparatus and the stomatognathic system as a whole. AIM: To prove the positive effectiveness of the use of splint therapy from the point of view of physiological concepts in optimizing the neuro- and myofunctional state of the stomatognathic system with an analysis of the effectiveness of the mode of using occlusal splints in patients with TMJ dysfunction. MATERIALS AND METHODS: The treatment was carried out in 34 patients with diagnosed TMJ dysfunction at the age from 17 to 40 years. For the treatment of patients, a relaxing therapeutic and diagnostic articular splint was used. The patients were divided into 2 groups of 17 people each: for the first group of patients, a round-the-clock mode of wearing a splint was set, for the second group, a 16-hour mode was set. The total observation period was 6 months. The criteria for achieving therapeutic goals were considered: absence/reduction of pain in the TMJ and orofacial pain, absence of pain on palpation of the masticatory muscles and in the TMJ, stable position of the lower jaw in the central occlusion, stability and uniformity of movements of the lower jaw at various functional positions, comfort when chewing and at rest, absence/reduction of hypertonicity of the masticatory muscles. RESULTS: The treatment results were evaluated 3 and 6 months after the primary stabilization of the mandible position. At the same time, among the patients of the first group, primary stabilization was achieved on average at the third visit (after 1.5 months from the start of splint therapy), in the second group of patients only at the fourth or fifth visit (after 2–2.5 months). Three months later, all patients of the first group and 8 patients from the second group noted a decrease in pain and orofacial pain, as well as the absence of pain on palpation of muscles and TMJ. Chewing discomfort was observed in 4 patients from the first group and 7 from the second. According to the results after 6 months, all patients were satisfied according to all criteria, all established objective criteria for treatment goals were achieved. CONCLUSIONS: With the correct selection of patients with symptoms indicative of muscle or occlusive dysfunction, splint therapy shows itself as an effective method that allows, with a full understanding of the biomechanics and functional physiology of the occlusal-muscular-articular complex, to effectively correct the neuromuscular state of the stomatognathic system towards it full balance.

Morphological changes in temporomandibular joint dysfunction and effectiveness of different treatment methods

Objectives: Temporomandibular joint dysfunction (TMD) results in changes in anatomical structures. The aim of this study was to examine the morphological changes using magnetic resonance imaging (MRI) and evaluate the effectiveness of different treatment methods in patients with TMD. Methods: 34 TMD patients (18–62 years of age) were randomly divided into two treatment groups. Group A (n=18) was subjected to dry needling (DN) and mobilization for 10 sessions, Group B (n=16) was instructed to use occlusal splint with home exercises for one month. The control group included MRIs of 17 healthy adults that were randomly selected from the archives of Radiology Department of Mustafa Kemal University. The length and width of the masseter, lateral and medial pterygoid muscles and the depth of the mandibular fossa were measured and mandibular condyle types were recorded. Range of motion of each temporomandibular joint was evaluated in pre- and post-treatment periods to test the effectiveness of the treatment methods. Results: The size of the masticatory muscles in TMD group was significantly smaller than the control group (p<0.05). The depth of the mandibular fossa was significantly shallower in the TMD group (p<0.05). The most commonly encountered condylar shape was convex in the TMD group (63.6%), but flat (58.8%) in the control group. No statistically significant relationship was observed between condyle type and fossa depth (p>0.05). However, the fossa depth showed a significant correlation with muscle size (p<0.05) and this correlation decreased with dysfunction. Dry needling and mobilization significantly decreased pain and increased mandibular movements (p<0.05); however, there was no significant change for Group B. Conclusion: The anatomical structures associated with the temporomandibular joint seems to be affected in patients with TMD. We suggest that the limited movement of the temporomandibular joint may cause atrophy of the masticatory muscles, affecting the range of motion of the joint. Dry needling and mobilization techniques might be a more effective alternative than occlusal splint in the treatment of TMD.

Use of occlusal digital splint for treating the patients with temporomandibular joint dysfunction and planning orthopedic treatment

Objective of the study: to develop and assess the occlusal digital splint for treating patients with temporomandibular joint dysfunction (TMJD). Material and Methods — 17 patients between the ages of 30 and 49 diagnosed with TMJD were admitted for treatment. To normalize mandibular position, an occlusal digital splint for all patients was manufactured in accordance with our original method. An intensity of pain sensations in all patients prior to, and after, the treatment was assessed by a visual analogue scale, along with the changes in the mandibular movements’ amplitude, and the signs of splint wear and stability of occlusal contacts. Results — Patients have adapted themselves well to the splint and found it convenient in use. The study results showed that it was sufficiently effective in treatment of TMJD. Reduction in pain intensity and restoration of mandibular movements’ amplitude were detected with certainty. Only in 2 (11.7%) cases, the signs of wear on the splint were found, as evidenced by the changes in pre-treatment occlusal contacts. In all other cases throughout the study, a stable occlusal contact has been encountered. Conclusion — Our results indicated that proposed occlusal digital splint may be considered as a treatment option for the patients with TMJ disorders.

Combining extracorporeal shock waves with movement in treating temporomandibular joint disorders

Objective To observe the clinical effect of shock waves combined with movement therapy in the treatment of temporomandibular joint dysfunction. Methods Forty patients with class-Ⅲ temporomandibular joint function disorders were randomly divided into an observation group and a control group, each of 20. In addition to the exercise therapy, the observation group was provided with extracorporeal shock wave therapy, while the control group was given ultrashortwave therapy. The intervention lasted for 4 weeks for both groups. Before and after the intervention, discomfort was quantified using a visual analogue scale, and maximum mouth opening and Fricton′s temporomandibular joint function index were measured for both groups. Results There was no significant difference between the two groups before the intervention. After the treatment the average discomfort rating and maximum mouth opening were significantly better in the observation group. The observation group′s average Fricton index was also significantly better. Conclusion Extracorporeal shock waves can be combined with movement therapy to significantly relieve the pain of patients with temporomandibular joint dysfunction. It can improve their maximum mouth opening and the functioning of the temporomandibular joint. Key words: Temporomandibular joint; Extracorporeal shock waves; Exercise therapy

[Treatment of 60 patients with temporomandibular joint dysfunction by manipulative reduction of cervical vertebrae combined with Pi needle release].

To evaluate the clinical effects of manipulative reduction of cervical vertebrae combined with Pi needle release for the treatment of temporomandibular joint dysfunction. From March 2012 to May 2017, 60 patients with temporomandibular joint dysfunction were treated by manipulative reduction of cervical vertebrae with Pi needle release, including 26 males and 34 females, ranging in age from 18 to 60 years old, with an average of 32.5 years old. The courses of the disease ranged from 1 week to 5 years, with a mean duration of 3 months. The patients were followed up before and after treatment by maximum active opening of temporomandibular joint, joint clicking and comparison of visual analogue scale (VAS) pain scores. All 60 patients were followed up, and the duration ranged from 6 to 24 months, with an average of 12 months. The maximum active opening of temporomandibular joint increased from(1.99±0.47) cm before treatment to(3.17±0.19) cm. The joint clicking decreased from 100% before treatment to(27.33±13.51)% after treatment. The VAS score decreased from 4.73±0.67 before treatment to 1.80±0.53 after treatment. Treatment of temporomandibular joint dysfunction by manipulative reduction of cervical vertebrae combined with Pi needle release has such advantages as easy operation, obvious curative effect, short course of treatment, which is an effective method for the treatment of temporomandibular joint dysfunction.

Diagnostic Imaging and Different Modalities of Treatment of Temporomandibular Joint Dysfunction

Temporomandibular joint dysfunction (TMD) is a common condition that affects up to 39% of the population and associated with a wide range of clinical signs and symptoms such as, pain, clicking, crepitation, restriction of movement, deviation of the jaw, headache, vertigo, and tinnitus. The etiology of TMD is of multifactorial origin like trauma, parafunction, malocclusion and degenerative joint diseases. Materials and Methods This study included 18 patients who had symptoms of temporomandibular joint dysfunction. The patients were evaluated in the plastic surgery department at Sohag University Hospital. Results The study conducted on 18 patients; 8male and 10 female, the mean age is 26 years ranging from 17 to 40 years. From the 18 patients; 2 cases received no treatment and 16 patients (7 males and 9 females) had received several modalities of treatment. In this study we used a variety of modalities of treatment such as, medical treatment to 8 cases, relaxation to 1 case, splint to 2 cases, arthrocentesis to 1 case, arthroscopy to 2 cases, discectomy for 1 case and arthroplasty for 1 case.

THE CLINICAL EFFICIENCY OF PLATELET RICH PLASMA IN THE TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

INTRODUCTION: Temporomandibular joint dysfunction (TMD) is a clinically significant condition which can be a source of acute or chronic orofacial pain and dysfunction including limitation of mandibular movement. Platelet-rich plasma (PRP) is a blood product that allows in a simple, low cost, and minimally invasive way to obtain a concentration of many growth factors when activated. Many researchers proved PRP safety and efficacy in the management of musculo articular disorders. OBJECTIVES: to evaluate the efficiency of intra-articular PRP injection in comparison with conventional arthrocentesis in the treatment of TMD. MATERIALS AND METHODS: Twenty patients suffering from TMD were included in the study diagnosed according to The Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD) and divided into two groups as follow; ten patients underwent intra-articular injections of 2 ml PRP into the temporomandibular joint (TMJ) (study group) and the other ten patients were treated by the conventional arthrocentesis using Ringer’s solution (control group). The patients were clinically evaluated preoperatively and postoperatively at the intervals of 1week, 3, and 6 months. RESULTS: The differences between the two groups in all the measured parameters were statistically insignificant throughout the postoperative period. But PRP group showed superior result than arthrocentesis group regarding pain and tenderness, and inferior result in clicking. CONCLUSIONS: PRP injection is a safe and effective method in the treatment of TMDs.

Arthroscopie de l’articulation temporo-mandibulaire. Mise au point

Temporomandibular joint (TMJ) dysfunction associates pain, limited mouth opening and joint noise. Failures of conservative treatments may lead to arthroscopy. The aim of our study was to evaluate the current interest of arthroscopy in the treatment of TMJ dysfunction. Using the keywords "TMJ" and "Arthroscopy", 1668articles were found in the Sciencedirect database. We selected 17papers published between September 2012and May 2016. Six questions were asked: (1) what treatment should be given to patients suffering from TMJ dysfunction? (2) What treatment should be performed for TMJ disorders when conservative treatments failed? (3) Does Wilkes staging change the surgical indication? (4) What has to be done in case of arthroscopy failure? (5) Can disc position be improved after surgery? (6) Should the disc position be improved? (1) Conservative treatment should always be considered in first intention (2) In case of conservative treatment failures, surgery can be proposed, beginning with the less invasive one (3) Whatever the Wilkes stage, treatment should begin by the less invasive one (4) In case of arthroscopy failure, TMJ arthrotomy can be indicated (5) Disc position may be improved in the long term but it is complex to obtain (only one paper) (6) there is no evidence that disk has to be repositioned.

Arthrocentesis - A minimally invasive treatment of temporomandibular joint dysfunction: Our experience

Background: Temporomandibular joint dysfunction (TMJD) is a clinically significant condition which can be a source of acute or chronic orofacial pain and dysfunction including limitation of mandibular movement, pain with mandibular function and joint sounds. Arthrocentesis is joint lavage which washes out these inflammatory mediators, thereby, relieving pain. Aim: The aim of this study is to evaluate the efficacy of arthrocentesis of temporomandibular joint (TMJ) followed by intra-articular injection of piroxicam in patients with TMJD. Materials and Methods: Forty TMJ's from thirty patients, aged 18-48 years (mean age 27.33 years) with clinical and radiological diagnosis of TMJD, based on clinical diagnostic criteria (CDC/TMD) were included in the study and underwent arthrocentesis followed by injection of piroxicam. Patient evaluation was done preoperatively and post operatively immediately following the procedure and on 7 th day, 2 nd , 3 rd and 4 th week, 2, 3, 4, 5 and 6 months. Pain on mouth opening on a Visual Analogue Scale (VAS) scale (score 0-10), clicking or popping sounds and maximum mouth opening were recorded at each interval. Magnetic resonance imaging (MRI) was performed before treatment and 6 months after treatment in both groups. Results: Evaluation of assisted and unassisted mouth opening showed increase at all time intervals. There was significant improvement in pain, range of motion, joint effusion and joint sounds. Conclusion: Arthrocentesis followed by intra-articular injection of piroxicam is a safe, simple, minimally invasive and effective treatment of temporomandibular joint dysfunction.

Avaliação vestibular em mulheres com disfunção temporomandibular

OBJETIVO: avaliar o comportamento vestibular em pacientes com disfunção temporomandibular. MÉTODOS: avaliaram-se 27 pacientes do sexo feminino, na faixa etária de 30 a 53 anos, encaminhadas do Centro de Diagnóstico e Tratamento da Articulação Temporomandibular para o Laboratório de Otoneurologia da Universidade Tuiuti do Paraná. Realizaram-se os seguintes procedimentos: anamnese, inspeção otológica e avaliação vestibular por meio da vectoeletronistagmografia. RESULTADOS: as queixas mais freqüentes foram: dificuldade ou dor ao movimento do pescoço (77,7%), dor irradiada para ombro/braço (77,7%), zumbido e formigamento de extremidade superior (77,7%), tontura e dor de cabeça (66,6%), ansiedade (55,5%), sensação de cabeça oca (51,8%), agitação durante o sono (51,8%) e depressão (51,8%). O exame vestibular esteve alterado em 20 pacientes (74,0%) na prova calórica. Houve freqüência de alteração no sistema vestibular periférico. Houve predomínio das síndromes vestibulares periféricas deficitárias. CONCLUSÃO: ressalta-se a importância de se estudar a relação do sistema vestibular com a disfunção temporomandibular uma vez que observamos, na presente pesquisa, um número elevado de alteração no exame labiríntico.

O.201 Endoscopic treatment of temporomandibular joint dysfunction: Long-term results

The treatment of complex orbital floor fractures with extensive orbital prolapse remains a surgical challenge in craniomaxillofacial traumatology and is still controversially discussed. Reduction of orbital tissue via a transcutaneous or transconjunctival approach alone can be very difficult and lead to unsatisfying results.Over a 3-year-period, we enrolled 13 patients who underwent endoscopy-assisted reconstruction of isolated orbital floor fractures via a combined subciliary and transantral approach. Patient data, imaging and ophthalmologic examination were reviewed prospectively.Ten patients underwent primary surgical treatment, 3 patients had secondary surgical treatment because of unsatisfactory results of primary surgical intervention. All patients had an uneventful postoperative course without ophthalmologic deterioration, no further surgical procedures were necessary.The additional use of an endoscopy-assisted transantral approach provides a reliable treatment modality in selected cases. To our knowledge, this is the only study of patients treated with a combined subciliary and transantral approach. Special emphasis was given to postoperative functional results, a short algorithm for use of an additional transantral endoscopy-assisted approach is presented.

Short-term therapeutic outcome of intra-articular high molecular weight hyaluronic acid injection for nonreducing disc displacement of the temporomandibular joint

In a patient with temporomandibular disorder who does not respond to conservative treatment, treatment with intra-articular injection of high molecular weight sodium hyaluronate can be suggested. In our study, 27 patients with nonreduced disc displacement were diagnosed clinically and confirmed by magnetic resonance imaging. The age range was from 21 to 63 years old, with a mean of 39.3 years. Two cycles of injection of high molecular weight sodium hyaluronate was performed on alternative weeks. Pain intensity was measured by the visual analog scale. Maximal mouth opening, clicking joint noise, and lateral movement were measured before and after injection for more than 6 months. Reduction of pain intensity and improvement in the maximum mouth opening parameter was statistically significant. In conclusion, this intra-articular injection using high molecular weight sodium hyaluronate looks very positive for patients affected by nonreduced disc displacement and is encouraged to be used as a primary treatment of temporomandibular joint dysfunction.

Complete pterygoidectomy--a novel method for the topographical investigation of the deep masticator space and its contents.

The complexity of the topographical anatomy of the infratemporal fossa (=masticator space) remains underappreciated because of limitations of the methods used to expose it; these methods are described and critiqued. The disposition of the lateral pterygoid (LPt) muscle in the masticator space obscures the anatomical relations of clinically significant neurovascular structures. Controversies regarding the nerve supply and actions of the two LPt heads are summarized. Since the LPt has been implicated in temporomandibular (joint) dysfunction (TMD), its precise relationships to the mandibular neurovascular structures is essential in understanding its role in TMD. We recently developed a method involving the en bloc removal of the LPt-tensor veli palatini complex along with all vital neurovascular structures. Further investigations using our method--in conjunction with contemporary imaging techniques (CT, MRI)--should help describe the detailed topography of masticatory structures. This information should help in understanding, differential diagnosis, and treatment of TMD.

Acupuncture as a Treatment for Temporomandibular Joint Dysfunction: A Systematic Review of Randomized Trials

Objective To summarize the data from randomized controlled trials of acupuncture for temporomandibular joint dysfunction. Methods Four independent computerized literature searches were performed. Only randomized trials were admitted in which acupuncture was tested vs sham acupuncture, standard therapy, or no treatment at all. Data were extracted in a predefined, standardized fashion. Results Six reports met the inclusion and exclusion criteria, representing 3 distinct trials. Overall, their results suggest that acupuncture might be an effective therapy for temporomandibular joint dysfunction. However, none of the studies was designed to control for a placebo effect. Conclusion Even though all studies are in accordance with the notion that acupuncture is effective for temporomandibular joint dysfunction, this hypothesis requires confirmation through more rigorous investigations.