Efficacy of arthrocentesis, splint therapy and MRI assessment in management of patients with temporomandibular joint disorders

ABSTRACT

To evaluate clinical biochemical and imaging assessment of the efficacy of lavage [arthrocentesis] of proinflammatory cytokines in the synovial fluid in symptomatic TMJ with or without the use of anterior repositioning splint. Radiodiagnosis Department. Faculty of Medicine, Alexandria University, Maxillofacial surgery, Prosthodentics and Oral surgery Departments, Faculty of Dentistry, Alexandria University. 20 patients [12 females and 8 males] with symptoms of TMJ pain, joint noise, limitation of joint opening, tenderness located in the articular region. all patients underwent full clinical examination and diagnostic imaging [panoramic radiographs] and MRI. patients were grouped into two; [group I] those treated by arthrocentesis of TMJ [the proinflammatory cytokines alone] and [group 2] those were treated by arthrocentesis and anterior repositioning splint therapy. arthrocentesis were done two times with interval of 6 weeks. MRI were done before treatment and after two months from treatment. the patients were divided into two groups both groups were treated with anhrocenzesis mandibular hard acrylic resin repositioning splint constructed for group 2 and was worn after arthrocentesis. clinical, biochemical and radiological imaging [MRI] evaluations were carried out to assess the efficacy of arthrocentesis [lavage] of the inflammatory cytokines in the synovial fluid of the symptomatic TMJ disc position and erosions can be fully assessed by MRI and both groups demonstrated marked clinical improvements after treatment mainly of group 2 and this match with the improvement of the disc position identified by MRI. patients with disc erosions were the least to improve. 1. the combination treatment of arthrocentesis of TMJ and mandibular repositioning splint give the advantages of pain relief and considered as the treatment modality of choice before surgical intervention to avoid the morbidity associated with surgery. 2. MRI is the only direct objective, very sensitive and accurate imaging modility to test the validity and effect as well as the prognosis of lavage [arthrocentesis] and prothesis treatment [splint therapy] of TMJ disorders. 3. erosion of the disc is a sign of bad omen in the way of anatomical repositioning of the disc after different modalities of treatment