ABSTRACT
Background:
Minimal intrusive TMJ operations have been recommended as a substitute for conservative therapy when conservative measures fail to relieve significant acute pain, chronic discomfort, inflammation, and/or degenerative illness, specifically in TMD cases.
Aim:
This study was conducted to investigate minimally invasive approaches (TMJ arthrocentesis and TMJ arthroscopy) in the treatment of temporomandibular joint (TMJ) disorders.
Methods and Materials:
It was a prospective study which included 30 clinically and radiographically diagnosed cases of TMDs. The study participants underwent two main therapy was carried out: TMJ arthrocentesis and TMJ arthroscopy. There was assessment of pain through VAS scale and maximum mouth opening (MMO) 1 month preoperatively as well as 3 months postoperatively.
Results:
There was statistically significant decrease in mean VAS score and increase in MMO in patients treated with TMJ arthrocentesis and TMJ arthroscopy. When there is comparison between TMJ arthrocentesis and TMJ arthroscopy, then there was more reduction in pain and increase in MMO in TMJ arthroscopy; however, the difference was non-significant statistically at both preoperative and postoperative situations.
Conclusion:
Minimally invasive approaches like TMJ arthrocentesis and TMJ arthroscopy can be useful in the treatment of TMJ disorders.
KEYWORDS: Minimum invasive therapy, TMDs, TMJ
INTRODUCTION
Disturbances of the muscles attached to jaws, temporomandibular joints (TMJs), and nerves linked to persistent facial pain are referred to as temporomandibular disorders (TMDs).[1,2] TMD can be caused by any issue that interferes with the intricate network of bones, muscles, and joints from functioning as a unit.[3,4]
Minimal intrusive TMJ operations have been recommended as a substitute for conservative therapy when conservative measures fail to relieve significant acute pain, chronic discomfort, inflammation, and/or degenerative illness, specifically in TMD cases.[5,6] These procedures’ primary benefits include: less discomfort and invasiveness for the patient; decreased risk of problems, quicker healing and quicker outcomes; less cosmetic disfigurement; minimal emotional impact; enhanced standard of life, as well as substantial satisfaction.[3,4,5]
While TMJ arthroscopy and TMJ arthrocentesis have a lower incidence of significant adverse effects, they are usually safe methods; however, they do carry a higher risk of difficulties due to anesthetic reactions and human errors.[5,6] The surgeon’s experience has a direct bearing on the degree of safety. In the rare event that difficulties arise, they are often transient, and numerous instances of spontaneous recovery happen without requiring for medical intervention. In order to mitigate the probability of vascular along with nerve accidents, injury to the brain, specifically preventing perforation of glenoid fossa, and ear wounds, the surgeon must proceed with prudence.[4,5,6,7]
When it comes to treating arthrogenous TMD to lessen discomfort and enhance mouth opening, these therapeutic options—particularly TMJ arthrocentesis and arthroscopy—showed quicker, more successful outcomes in clinical trials as well as long-term benefits when compared to conservative treatments.[1,2,3] This study was conducted to investigate minimally invasive approaches (TMJ arthrocentesis and TMJ arthroscopy) in the treatment of TMJ disorders.
METHODS AND MATERIALS
It was a prospective study which included 30 clinically and radiographically diagnosed cases of TMDs. The study participants underwent thorough clinical and radiological assessment before undergoing the minimally invasive therapy. Two main therapies were carried out: TMJ arthrocentesis and TMJ arthroscopy. The study participants were divided into two categories on the basis of treatment modality applied
Category 1: TMJ arthrocentesis (n = 15)
Category 2: TMJ arthroscopy (n = 15).
Outcomes
There was assessment of pain through VAS scale 1 month preoperatively as well as 3 months postoperatively in each study participants. The VAS scale was from 1 to 5. Then there was assessment of maximum mouth opening (MMO) 1 month preoperatively and 3 months postoperatively. The MMO was measured between the incisal edges of maxillary incisors and mandibular incisors. There was also assessment of the quality of life using WHO QoL questionnaire. There was also assessment of success of the results as good, acceptable, and failure.
All the clinical procedures of TMJ arthrocentesis and TMJ arthroscopy by the same oral and maxillofacial surgeon.
Statistical analysis
The findings of VAS scale assessment and MMO were put in MS Excel sheet. The values were obtained in the form of means and standard deviations. SPSS version 21 was used for statistical analysis. Chi-square test and one-way ANOVA were used for statistical analysis. P-value ≤ 0.05 was considered as statistically significant.
RESULTS
There was statistically significant decrease in mean VAS score in patients treated with TMJ arthrocentesis (5.15 ± 1.10 to 0.41 ± 0.04). There was statistically significant decrease in mean VAS score in patients treated with TMJ arthroscopy (4.89 ± 1.10 to 0.36 ± 0.03). When there is comparison between TMJ arthrocentesis and TMJ arthroscopy, then there was more reduction in pain in TMJ arthroscopy; however, the difference was non-significant statistically at both preoperative and postoperative situations.
There was statistically significant increase in MMO in patients treated with TMJ arthrocentesis (34.54 ± 6.63 to 45.37 ± 3.22 mm). There was statistically significant increase in MMO in patients treated with TMJ arthroscopy (36.45 ± 09.57 to 40.31 ± 03.02). When there is comparison between TMJ arthrocentesis and TMJ arthroscopy, then there was more increase in MMO in TMJ arthrocentesis; however, the difference was non-significant statistically at both preoperative and postoperative situations [Table 1].
Table 1.
Changes in pain and MMO in patients with TMDs treated with different minimally invasive approaches
| TMJ arthrocentesis | TMJ arthroscopy | P | |
|---|---|---|---|
| Preoperative VAS Pain, M±SD | 5.15±1.10 | 4.89±1.10 | 0.95 |
| Postoperative VAS Pain, M±SD | 0.41±0.04 | 0.36±0.03 | 0.91 |
| P | <0.001 | <0.001 | |
| Preoperative MMO, M±SD | 34.54±6.63 | 36.45±09.57 | 0.97 |
| Postoperative MMO, M±SD | 45.37±3.22 | 40.31±03.02 | 0.34 |
| P | <0.001 | <0.001 |
DISCUSSION
This study was conducted to investigate minimally invasive approaches (TMJ arthrocentesis and TMJ arthroscopy) in the treatment of TMJ disorders.
There was statistically significant decrease in mean VAS score in patients treated with TMJ arthrocentesis and TMJ arthroscopy. When there is comparison between TMJ arthrocentesis and TMJ arthroscopy, then there was more reduction in pain in TMJ arthroscopy; however, the difference was non-significant statistically at both preoperative and postoperative situations.
When conservative methods, particularly in cases of TMD, fail to relieve substantial acute pain, persistent discomfort, inflammation, and/or degenerative sickness, minimally invasive TMJ procedures have been suggested as a backup plan.[6,7,8] Primary benefits of these treatments include: reduced invasiveness and discomfort for the patient; lower risk of complications, faster healing and better results; less cosmetic deformity; little emotional impact; improved quality of life, and significant satisfaction.[1,2,3,4]
There was statistically significant increase in MMO in patients treated with TMJ arthrocentesis and TMJ arthroscopy. When there is comparison between TMJ arthrocentesis and TMJ arthroscopy, then there was more increase in MMO in TMJ arthrocentesis; however, the difference was non-significant statistically at both preoperative and post-operative situations.
These therapeutic options—especially TMJ arthrocentesis and arthroscopy—showed quicker, more successful outcomes in clinical trials as well as long-term benefits when compared to conservative treatments when it came to treating arthrogenous TMD to lessen discomfort and improve mouth opening.[2,3,4] TMJ double-puncture arthrocentesis is typically performed under local anesthesia and is an office-based procedure that is simple yet technically challenging. The principal aims of this methodology are the elimination of chemical substances that cause inflammation and the adjustment of intra-articular pressure through joint lavage, which may result in the buildup of medicinal materials.[3,4,5,6,7]
CONCLUSION
Minimally invasive approaches like TMJ arthrocentesis and TMJ arthroscopy can be useful in the treatment of TMJ disorders.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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