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Original Article Plastic and Aesthetic Research

Internal derangement of temporomandibular

joint: role of arthocentesis with steriod

Altaf Hussain Malik
Department of Oral and Maxillofacial Surgery, Govt Dental College, University of Kashmir, Hazratbal, Srinagar 190006, J&K, India.
Address for correspondence: Dr. Altaf Hussain Malik, Department of Oral & Maxillofacial Surgery, Govt Dental College, University of
Kashmir, Hazratbal, Srinagar 190006, J & K, India. E-mail:drmalikaltaf@gmail.com

ABSTRACT
Aim: The aim of this study was to compare the efficacy of arthrocentesis with arthrocentesis plus steroid
in the treatment of temporomandibular joint (TMJ) internal derangements. Methods: Nine males
and 11 females aged 17–39 years were enrolled in the study. The patients were complaining of limited
mouth opening and TMJ pain. Arthrocentesis was performed under aseptic conditions. All patients
were clinically evaluated before the procedure, and 1 week and 6 months after the procedure. Intensity
of TMJ pain and maximal mouth opening was recorded at each follow-up visit. Results: Both groups
showed significant improvement in mouth opening and a reduction in pain scores in the postoperative
period; however, the addition of steroid did not improve the overall outcome of the procedure.
Conclusion: Arthrocentesis is a simple and safe procedure for patients with internal derangement of
the TMJ with closed lock. However, the outcome was not improved by the addition of steroid.

Key words:
Arthrocentesis, internal derangement, steroid, temporomandibular joint

INTRODUCTION displacement of the TMJ disc. Arthrocentesis for the
[1]
TMJ was introduced by Nitzan et al. in 1991 and bridged
[2]
The temporomandibular joint (TMJ) is subject to many the gap between surgical and nonsurgical treatment. It
[3]
disorders commonly known as temporomandibular joint involved irrigation of the upper joint compartment with
disorders (TMD). These disorders are accompanied by a therapeutic substance, releasing adhesions, and flushing
pain, limitation, and deviation in mandibular range of out inflammatory substrates, thereby relieving pain and
motion, TMJ sounds, headache, and facial pain. Among improving function. TMJ arthrocentesis signifies the
these, internal derangement and TMJ osteoarthritis are lavage of the upper joint compartment with physiological
the most common disorders, ranging from normal mouth saline or Hartmann’s solution (Ringer’s lactate) using
[4]
opening and clicking to varying degrees of pain, restricted a needle for in- and out-flow. Arthrocentesis can be
mouth opening, and loss of functional activity. The term performed either under low pressure using an elevated
[1]
“internal derangement” was introduced by Hey in 1814 as infusion bag or under normal pressure using a syringe.
a general orthopedic term for a localized mechanical fault This technique was first introduced at the beginning of
in a joint, but was later used more specifically to describe the 1990s and was derived directly from TMJ arthroscopy,
based on the hypothesis that the most effective
Access this article online successful component of TMJ arthroscopy was merely
that the patient was submitted to an intervention, and
Quick Response Code:
Website: not based on all the complicated maneuvers intended
www.parjournal.net
to recapture the disc, fix the disc, and remove the
adherences within the joint using tiny and sophisticated
[2]
DOI: instruments. Arthrocentesis, as originally proposed,
10.4103/2347-9264.135547 employed a technique involving the use of two needles
that were inserted into the superior joint space at certain

Plast Aesthet Res || Vol 1 || Issue 1 || Jun 2014 29