Clinical outcomes in TMD patients after arthrocentesis with lysis, lavage and viscossuplementation

Abstract

Introduction: Temporomandibular disorders (TMD) affect a considerable part of the population [1]. Its most prominent symptoms are restricted joint function with limited maximum mouth opening (MMO), pain and headache, with an important impact on Quality of Life [2,3]. The aim of this study is to evaluate the effect of Arthrocentesis with Lysis, Lavage and Viscosupplementation (ALLV) with hyaluronic acid in the treatment of pain related to TMJ internal derangements. Materials and methods: Thirty patients diagnosed with internal derangement of the temporomandibular joint through magnetic resonance imaging were submitted to ALLV, after 6months of ineffective conservative treatment. A classic, single session, two-needle technique arthrocentesis was performed in all cases, encompassing the injection of 200-300mL of Ringer lactate solution to the superior joint compartment for lysis and lavage, followed by intra-articular injection of 1mL of hyaluronic acid for viscossuplementation [4,5]. Patients were prescribed a simple program of physical exercises to be repeated daily at home for one month. Evaluation was carried pre-operatively on the day of surgery and post-operatively at 1 week, 1month, 3months, 6months and 12months after the procedure. Evaluated clinical parameters included: pain (at rest and in function) - Visual Analogic Scale (VAS); maximum mouth opening (MMO) - millimetres (mm); mastication efficiency - VAS. Overall tolerability of the procedure (Likert scale: 0-4) was evaluated at 1-week post-operative time. Data was collected between September 2016 and May 2019. Statistical significance was set at p