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dysfunction. They concluded that arthrocentesis, rather
[11]
than being an alternative to arthroscopic surgery, would
be indicated for patients with acute TMJ closed lock
refractory to medication and mandibular manipulation.
In their review, Al-Belasy and Dolwick have reported that
no medication was used for intra-articular injection in
4 studies, steroid was used in 14 studies, and hyaluronic
acid was used in 2 studies. [9]
Complications are rare in arthrocentesis and occur
more often with arthroscopy. Nevertheless, potential
[12]
complications may develop with arthrocentesis, such as
damage to capsular tissues and discal tissue, increased
risk of the facial nerve injury, preauricular hematoma,
middle ear injury, and intra-articular instrument breakage.
Redundant injury of the capsule by needles can also
Figure 1: Arthrocentesis in progress
aggravate inflammation in the joint and increase the
incidence of solution extravasation to neighboring tissues
not only as a diagnostic tool, but also as a therapeutic when the arthrocentesis is finally performed. [13-16] A rare
technique, resulting in remarkable improvement in pain, case of extradural hematoma has also been reported
jaw opening and function in selected patients simply with the conventional technique of arthrocentesis, which
by lavage of the superior joint space. The hydraulic could have occurred because of blind triangulation of the
[4]
distension provoked by the lavage pressure under the needle. Arthrocentesis and arthroscopy are the primary
upper joint compartment with a large volume of saline treatments for patients who fail conservative methods
has been considered the reason for the positive clinical of management of TMJ pain, restriction, and locking. An
[8]
outcomes in patients with sudden-onset closed lock. A improvement in mouth opening is observed irrespective
single-session arthrocentesis procedure was then proven of the Wilkes score. There is a clear improvement in
effective also in improving pain and dysfunction in pain score based on this intervention, and as such, this
subjects affected by TMJ osteoarthritis, likely due to a management should be offered routinely. Our results
[17]
thorough removal of catabolytes from the joint space. In concur with the study conducted by Xu et al., who showed
[6]
the case of the closed lock, the central portion of healthy that lavage and arthrocentesis helped to improve range
disc indeed separates from the fossa, leaving rims of mouth opening and lateral movements, and reduce
fastened to the surface of the eminence, which leads to patient complaints. In the absence of a clear history of
[18]
increased negative pressure in the closed space between trauma, arthrocentesis should be the first-line treatment
the fossa and disc. This pressure difference constitutes a in patients aged under 25 years. [15]
force sufficient to keep the disc compressed against the
fossa (the “suction cup effect”). [9] The results of this study concur with those of other
studies, which show that arthrocentesis improves range
In our study, the maximum mouth opening increased of mouth opening and relieves pain, but the addition of
from 23 to 42.1 mm in the arthrocentesis-only group, steroids does not help to alleviate the symptoms of TMJ
whereas it increased from 23.9 to 42.2 mm in the steroid derangements.
group [Table 1]. The VAS score decreased from 6.6 to 1.2
in the arthrocentesis group, whereas it decreased from CONCLUSION
6.7 to 1.11 in the steroid group [Table 2]. The results
did not support the clear superiority of one treatment Temporomandibular joint arthrocentesis and lavage with
protocol over the others to achieve pain management manipulation is a simple, less invasive and less expensive
in TMJ inflammatory-degenerative joint disease over a technique than TMJ arthroscopy with low morbidity rates.
short-term, namely a 6-month follow-up period. Findings It should be considered as an effective and efficient
suggested that neither statistically nor clinically significant alternative to more invasive surgical procedures for a
differences existed between the treatment groups. This selected group of patients and as a minimally invasive,
concurs with the study conducted by Manfredini who highly effective procedure in the treatment of patients
compared six different treatment protocols. All protocols with internal derangement of the TMJ with closed lock.
were associated with positive outcomes, in line with the
TMD literature highlighting improvements, at least to REFERENCES
some extent. Murakami et al. compared arthrocentesis,
[10]
arthroscopic surgery, and nonsurgical treatments in TMJ 1. Adams JC, Hamblen DL. Outline of Orthopedics. 13th ed. London, UK:
closed lock and found similar values for pain level and jaw Churchill Livingstone; 2001.

Plast Aesthet Res || Vol 1 || Issue 1 || Jun 2014 31