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State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review

Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the temporomandibular joint has become a widely approved method for non-invasive treatment, bridging the gap between conservative and...

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Autores principales: Siewert-Gutowska, Marta, Pokrowiecki, Rafał, Kamiński, Artur, Zawadzki, Paweł, Stopa, Zygmunt
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342956/
https://www.ncbi.nlm.nih.gov/pubmed/37445474
http://dx.doi.org/10.3390/jcm12134439
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author Siewert-Gutowska, Marta
Pokrowiecki, Rafał
Kamiński, Artur
Zawadzki, Paweł
Stopa, Zygmunt
author_facet Siewert-Gutowska, Marta
Pokrowiecki, Rafał
Kamiński, Artur
Zawadzki, Paweł
Stopa, Zygmunt
author_sort Siewert-Gutowska, Marta
collection PubMed
description Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the temporomandibular joint has become a widely approved method for non-invasive treatment, bridging the gap between conservative and surgical approaches. Regardless of technique, treatment is based upon joint lavage and lysis of the inflammatory fibrous tissue adhesions, which, in turn, improves joint mobility and reduces pain and closed lock. Recently, approaches for intra-articular injections have been proposed as adjuvant or replacement therapy. The aim of this study was to assess the most efficient technique of arthrocentesis. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, a reference list search and a manual search, was performed. Relevant articles were selected after three search rounds for final review. The studies pulled for the analysis presented information about the relevant predictors, including the technique of arthrocentesis (single- or two-needle method), fluid used for lavage (Ringer lactate or saline), volume of the fluid, application of the injectable, number of interventions, pain (VAS) and mouth opening scores (MMO) and follow-up. All cohorts showed improvement in mouth opening, but significant pain reduction was observed only in cohorts treated either by arthrocentesis alone or arthrocentesis followed by intra-articular injectables. Intra-articular injectables used alone failed to reduce pain post-operatively when compared to other cohorts. We concluded that both double-needle and single-puncture arthrocentesis techniques are equally efficient. Application of the adjuvant injectable did not improve the outcomes of arthrocentesis performed alone. The volume of the fluid used for joint lavage and its chemical composition were not significant in clinical outcomes. However, due to the lack of homogeneity in the study settings, a meta-analysis could not be applied and a systematic review was conducted. We still, however, state that there is a knowledge gap in the current literature regarding the use of injectables alone, as well as a longitudinal follow-up, which provides information about treatment efficiency. More high-quality and randomized controlled trials are required to shed light on this subject.
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spelling pubmed-103429562023-07-14 State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review Siewert-Gutowska, Marta Pokrowiecki, Rafał Kamiński, Artur Zawadzki, Paweł Stopa, Zygmunt J Clin Med Systematic Review Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the temporomandibular joint has become a widely approved method for non-invasive treatment, bridging the gap between conservative and surgical approaches. Regardless of technique, treatment is based upon joint lavage and lysis of the inflammatory fibrous tissue adhesions, which, in turn, improves joint mobility and reduces pain and closed lock. Recently, approaches for intra-articular injections have been proposed as adjuvant or replacement therapy. The aim of this study was to assess the most efficient technique of arthrocentesis. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, a reference list search and a manual search, was performed. Relevant articles were selected after three search rounds for final review. The studies pulled for the analysis presented information about the relevant predictors, including the technique of arthrocentesis (single- or two-needle method), fluid used for lavage (Ringer lactate or saline), volume of the fluid, application of the injectable, number of interventions, pain (VAS) and mouth opening scores (MMO) and follow-up. All cohorts showed improvement in mouth opening, but significant pain reduction was observed only in cohorts treated either by arthrocentesis alone or arthrocentesis followed by intra-articular injectables. Intra-articular injectables used alone failed to reduce pain post-operatively when compared to other cohorts. We concluded that both double-needle and single-puncture arthrocentesis techniques are equally efficient. Application of the adjuvant injectable did not improve the outcomes of arthrocentesis performed alone. The volume of the fluid used for joint lavage and its chemical composition were not significant in clinical outcomes. However, due to the lack of homogeneity in the study settings, a meta-analysis could not be applied and a systematic review was conducted. We still, however, state that there is a knowledge gap in the current literature regarding the use of injectables alone, as well as a longitudinal follow-up, which provides information about treatment efficiency. More high-quality and randomized controlled trials are required to shed light on this subject. MDPI 2023-06-30 /pmc/articles/PMC10342956/ /pubmed/37445474 http://dx.doi.org/10.3390/jcm12134439 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Siewert-Gutowska, Marta
Pokrowiecki, Rafał
Kamiński, Artur
Zawadzki, Paweł
Stopa, Zygmunt
State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review
title State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review
title_full State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review
title_fullStr State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review
title_full_unstemmed State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review
title_short State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review
title_sort state of the art in temporomandibular joint arthrocentesis—a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342956/
https://www.ncbi.nlm.nih.gov/pubmed/37445474
http://dx.doi.org/10.3390/jcm12134439
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