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points; these points were termed “McCain’s points” and RESULTS
were marked on a line drawn from the middle of the
tragus to the lateral canthus. The entry points were Before treatment, the mean VAS score was 6.6 and the
marked along this canthotragal line. The first point, mean MMO was 23 mm. Posttreatment, the mean VAS
corresponding to the glenoid fossa, was marked 10 mm pain score decreased to a mean value of 2.7 at 1 week
from the mid-tragus and 2 mm below the line, and the and then to 1.2 at 6 months in the arthrocentesis-only
second point, corresponding to articular eminence, was group [Table 1], whereas the MMO increased to a mean
marked 10 mm from the first point and 10 mm below value of 34 mm at 1 week and 42.1 mm at 6 months in
the line. The simple flushing action in the joint may the steroid group [Table 1], which indicates significant
eliminate or reduce the effect of biochemical factors improvement in patient symptoms and complaints.
that contribute to inflammation and pain. Intra-articular However, the mean MMO after steroid injection increased
corticosteroid injections are occasionally administered from 23.9 to 42.2 mm [Table 1], and the mean pain
to alleviate inflammation. Intra-articular corticosteroid score decreased from 6.7 to 1.11 [Table 2], though the
injection has an unpredictable prognosis and can also difference between the two groups was not significant.
lead to local side-effects on the joint.
DISCUSSION
METHODS

A total of 20 patients (11 females and 9 males) aged Temporomandibular disorders comprise a wide variety
17–39 years were enrolled in this study. The review board of of disorders of the TMJ, masticatory muscles, or
University of Kashmir approved this study. The procedures both, [5,6] with the main symptoms presenting as pain
followed were in accordance with the ethical standards of and dysfunction. Pain associated with TMJ disorders may
the responsible committee on human experimentation and be due to vasoconstriction and release of nitric oxide,
with the Helsinki declaration. A detailed clinical examination reactive oxygen species (ROS), and thiobarbituric acid.
was performed, along with any necessary investigations. Elevated ROS levels in synovial fluid may result from
All the patients selected for the study had been diagnosed mechanical stress and high pressures directed to the upper
with TMJ internal derangement with closed lock through compartment during clenching and jaw movement.
[7]
clinical and radiographic examination (magnetic resonance Lavage of the upper compartment by TMJ arthrocentesis
imaging). Only such patients were taken for study in which forces apart the flexible disc from the fossa, washes away
all the conservative measures had failed. A written and degraded particles containing inflammatory components
verbal consent was obtained from the patients for treatment and decreases intra-articular pressure. Furthermore, the
and associated complications, after the treatment outcome elimination of nitric oxide and ROS relieves the pain.
were fully explained to them. A visual analog scale (VAS) The concept of TMJ arthrocentesis and lavage was first
was used to score pain (range 1–10), where 1 denoted no borne out of the successful use of TMJ arthroscopy
pain at all, and 10 denoted very severe pain. These values
were recorded at 1-week preoperatively, and at 6 months
postoperatively. The maximal mouth opening (MMO) was Table 1: Comparison of MMO between the two groups
evaluated and recorded (in mm) pre- and post-operatively. Group Mean Mean postoperative P value
The patients were divided into two groups, with 10 patients preoperative MMO (mm)
per group. One group underwent only arthrocentesis MMO (mm) At 1-week At 6 months
while the other group underwent arthrocentesis followed
by a single injection of triamcinolone acetonide (20 mg) Arthrocentesis 23 34 42.1 1.000
only (n=10)
into the joint. The results were compared both pre- and Arthrocentesis 23.9 33.3 42.2
post-operatively. The entire procedure was performed plus steroid (n=10)
by one surgeon and conducted under local anesthesia MMO: Maximum mouth opening; n: Number of patients
[Figure 1]. About 100 ml of Ringer’s lactate was used
for arthrocentesis. After the lavage was completed, the Table 2: Comparison of pain between the two groups
needles were removed, and the patient’s jaw was gently using a VAS
manipulated by the clinician in the vertical, protrusive Group Mean Mean postoperative P value
and lateral excursions to help further release the disc and preoperative pain
break the adhesions. The patients were then followed up pain
at 1 week and 6 months. The results were then analyzed At 1-week At 6 months
using an SPSS Statistics software package manufactured by Arthrocentesis 6.6 2.7 1.2 1.000
IBM Corporation (Armonk, New York, U.S.). Postoperative only (n=10)
changes in pain, lateral movements, and range of mouth Arthrocentesis 6.7 2.4 1.11
opening were compared with the preoperative values using plus steroid (n=10)
the Mann–Whitney U-test. VAS: Visual analog scale

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