Temporomandibular Joint Internal Derangement
Conditions
Keywords
temporomandibular joint internal derangement, Reducing discomfort, restoring normal mandibular motions, enhancing patients' quality of life
Brief summary
Clinical Evaluation of Arthrocentesis, Combination of Platelet-Rich Plasma and Cyclooxygenase Enzyme-2 Inhibitor in Treatment of Temporo-Mandibular Joint Anterior Displacement
Detailed description
The internal derangement (ID) of the TMJ is an improper functional and positional connection between the articular components of the joint. It has been estimated that 80% of TMD patients have ID, which is typically classified into two classes: disc displacement with reduction and disc displacement without reduction. The ID of the TMJ was often accompanied by the increased expression of COX-2 in both synovium and synovial fluid. This allows the accumulation of prostaglandins in synovial fluid, accompanied by peripheral Vaso permeability, that may lead to swollen synovium. Patients may become suffering from limited jaw motion and associated pain around the TMJ in this stage. Arthrocentesis reduces the pain through removing the adherences, eliminates the negative pressure in the joint, washes the inflammatory mediators, distends the joint space, recovering the space of the joint disc and fossa, changes the viscosity of the synovial liquid. Reducing discomfort, restoring normal mandibular motions, and enhancing patients' quality of life are all necessary components of effective treatment for arthrogenous TMDs. Treatment of TMJ-ID with arthrocentesis, either alone or in conjunction with intraarticular injections, is quite successful. It enhances jaw motions, promotes mouth opening, and lessens discomfort. For intra-articular injections, hyaluronic acid, platelet-rich plasma, corticosteroids and non-steroidal anti-inflammatory medications (NSAIDS) are used.
Interventions
COMBINATION_PRODUCTInject Combination of Platelet-Rich Plasma and Cyclooxygenase Enzyme-2 Inhibitor after arthrocentesis
Inject Combination of Platelet-Rich Plasma and Cyclooxygenase Enzyme-2 Inhibitor meloxicam (Mobitil 15mg) after arthrocentesis
Sponsors
Suez Canal University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This study was conducted on adults between the age of 18-40 years old with temporomandibular joint internal derangement (20 cases) requiring arthrocentesis, the patients were divided to 10 cases with anterior disc displacement with reduction and 10 cases with anterior disc displacement without reduction, and the two groups will be injected after arthrocentesis by combination of PRP and Cyclooxygenase Enzyme-2 Inhibitor.
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* patients aged from 18 to 40 years old. * patients diagnosed with ID of TMJ, suffering from limited mandibular movements, joint pain and clicking. * Patients who are free from any systemic disease and controlled systemic disease (ASA I) (ASA II). * Patients willing to comply with the follow-up schedule and treatment protocol. * both genders are included
Exclusion criteria
* Patients with systemic diseases (ASA III, IV, V). * Patients who have myofascial pain dysfunction syndrome only. * Patients who have previous surgery in TMJ. * Patients who have previous arthrocentesis within 1 year. * Patients who received previous trauma to the joint. * Use of anticoagulants or immunosuppressive medications.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mandibular Movements: measured in millimeters using a ruler or digital caliper. | immediately, one, three and six months postoperatively | Mandibular Movements: Including maximum mouth opening (MMO), right and left lateral movements, and protrusive movement, measured in millimeters using a ruler or digital caliper. |
| pain assessed by visual analogue scale | preoperatively, one, three and six months postoperatively | Pain: Assessed using a Visual Analogue Scale ranging from 0 to 10 over the TMJ area \[ 0 is given when there is no pain, 1-3 mild pain, 4-6 moderate pain, 7-9 severe pain, 10 the worst pain\]. |
| Joint Clicking: Evaluated using a stethoscope and recorded as either present or absent. | immediately, one, three, six months postoperatively | Joint Clicking: Evaluated using a stethoscope and recorded as either present or absent. |
Countries
Egypt
Contacts
PRINCIPAL_INVESTIGATORhossni elshahat hossni, postgraduate student
Suez Canal University
PRINCIPAL_INVESTIGATORSuez Canal University
Suez Canal University
Outcome results
None listed