Page 134 - Read Online

mouth. The problem was either reduced by patient themselves, Blood is injected into two regions, in the articular fossa and
or required some professional help or was self reducing. They pericapsular tissue. The blood injection causes fibrosis and
all had undergone conservative treatment for the condition but scarring in the areas of injection which stops the dislocation of
no significant improvement was noticed. The clinical diagnosis condyles from recurring. However, we feel that limited mouth in
was confirmed by lateral view of TMJ in open and closed mouth initial first week is important for the success of treatment. This
position. In all cases, the head of condyle was found to be anterior limitation can be achieved by TMJ bandage or intermaxillary
[1]
to the articular eminence in wide open mouth position. To all fixation, or asking the patient to take liquid or semi solid diet
the patients various treatment options were presented and only with efforts of not to open wide. We have used elastic bandaging
those patients who consented for intra-articulouar autologus for three weeks and kept the patients exclusively on liquid diets
blood injection (IABI) were included in the study. IABI was given in the first week and then soft and semisolid diet for the next
by two point puncture technique as described by Schulz. [7] two weeks to restrain the mandibular movements. After three
weeks patients were advised to start mandibular physiotherapy
Technique to maintain functional mouth opening. Some workers have
The procedure was planned to be performed under local shown their concern about development of ankylosis and
anesthesia using lignocaine 2% with adrenaline. The patient degeneration of articular cartilage after performing autologus
[1,2]
was asked to lie in supine position. After preparing the site blood injection. In our study, no such complications were
with antiseptic and draping, an auriculotemporal nerve block found at whole period of follow-up. We have opinion that there is
was given on either side using. A line from middle of tragus to no chance of ankylosis after IABI. Chances of ankylosis are always
lateral canthus of eye was drawn on either side and a point was there wherever the joint is traumatized to extent that structures
marked at articular fossa which was located 10 mm anterior and within the joint capsule are damaged and there is intrarticular
2 mm inferior to this line. Second point was marked 20 mm bleeding. Exogenous bleeding (intra-articular injection) doesn’t
anterior and 10 mm inferior to this canthotragal line and this line have same effect as endogenonus bleeding. The blood simply
corresponds to the peak of eminence [Figure 1a and b]. Then an pushes the condylar head in posterior position and helps in
18-gauge 1.5-inch long needle was inserted at the first point up maintaining the position. The periarticular fibrosis, which results
to a depth of 1 inch and stabilized. Another 18-gauge 1.5-inch due to autologous blood injection supplements the forward
long needle was inserted at the second mark corresponding to translation of condyle which is further aided by elastic bandage,
[8,9]
articular eminence. After insertion of needle at the two points, restricting the mouth opening.
joint lavage (arthrocentesis) was done using 10 mL of normal
saline solution [Figure 2]. After lavage of the joint second needle The disadvantage of the procedure is that it is a blind procedure,
was withdrawn and 4 mL of blood was taken from patients cubital even then it is safe and complication free. In our study, pain was
only reported complication which could be easily managed by
vein and 3 mL was injected in the articular fossa through first anti-inflammatory analgesics.
needle. Then the needle was withdrawn slightly outward for 1
cm and another 1 mL of blood was injected around pericapsular Results of our study support the findings of Daif who performed
[10]
tissue. The same procedure was done for the opposite side also a comparative study of autologus blood injection in the superior
[Figure 3]. After this an elastic bandage was applied for one week joint space alone vs. superior joint space and pericapsular tissues
and all the patients were advised to restrict their mouth opening and found higher success rate in the combined injection than
and to take liquid diets only. Anti-inflammatory analgesic the same in superior joint space alone. However, we performed
(aceclofenec 100 mg) was prescribed for 3 days. Subsequent clinical study using combined injection technique as it appeared
follow up was done at 1 week, 1 month and 6 months period much sound. Using combined technique we found success rate
and clinical outcomes and maximal mouth opening were noted of 89.1% at a follow-up period of 1 year.
during follow-up period.
Various means to restrict mandibular movement have been
The composition of patients and various observations pertaining applied. [11,12] We used elastic bandage for one month and soft
to study have been shown in Tables 1 and 2. diet in our cases. It was convenient, comfortable to patient and
easily adjustable.
RESULTS
There is no predictive indicator for success of treatment by non
The results of study indicate that success rate of treatment of surgical means including autologous blood injection. However,
recurrent dislocation of temporomandibular joint is 72.8% which the cases who don’t respond positively in the initial 3 weeks of
can be considered as impressive. After follow up period of one treatment should be considered as failure case. In such condition
year, only 3 patients suffered from recurrence (27.2%). surgical methods should be opted.

DISCUSSION We did not find any appreciable complications in the study.
Only 3/11 (27.3%) patients complained of mild pain which was
We have performed autologus blood injection in eleven controlled by tablet aceclofenac 100 mg in twice daily doses and
patients of recurrent dislocations. The results of study have did not affect the routines of the patients. These results are in slight
been summarized in Tables 1 and 2. At a follow up period of contrast to study of Candirli in which, 14 patients were treated
[13]
one year and only 3 of them suffered from recurrence. Their with autologous blood injection and found no complications.
average maximal mouth opening also reduced from 39.9 mm The only serious complication was recurrence which could be
preoperatively to 37.2 mm postoperatively. noticed in 2/11 cases (18.9%). In other words, the success rate is
124 Plast Aesthet Res || Volume 3 || April 25, 2016