Rossini Rafael, Grossmann Eduardo, Poluha Rodrigo L, Setogutti Ênio T, Dos Santos Marcos Fabio
Pos-Graduacao em Ciencias Cirurgicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Departamento de Ciencias Morfologicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
Clinics (Sao Paulo). 2021 Apr 26;76:e2840. doi: 10.6061/clinics/2021/e2840. eCollection 2021.
Arthrocentesis is the simplest surgical intervention for the temporomandibular joint (TMJ). It can be performed on an outpatient basis at a low cost and with low morbidity. The objective is to release the articular disc by disrupting the adhesion formed between its surfaces and the mandibular fossa through hydraulic pressure generated by irrigation of the upper compartment of the TMJ. Viscosupplementation with hyaluronic acid during or after arthrocentesis improves clinical outcomes, increases mouth opening, and reduces pain levels. The aim of this study was to evaluate the efficiency of arthrocentesis plus hyaluronic acid viscosupplementation through clinical examination and preoperative magnetic resonance imaging in patients with unilateral disc displacement without reduction (DDwoR).
This analytical retrospective cross-sectional study clinically and radiologically evaluated 72 patients of both sexes with unilateral DDwoR. The following data were collected: sex, pain, age, duration of pain, maximum mouth opening, and patient pain perception on a visual analog scale. TMJ arthrocentesis was performed only once for each of the indicated joints. Data were collected before arthrocentesis (baseline) and at 7, 14, 30, 60, 90, and 180 days after the procedure (final evaluation).
Between the baseline and final evaluation, there was a significant reduction in pain (p=0.001) and restoration of articular function. In addition, there was a significant increase in maximum mouth opening (p=0.001).
Patients with DDwoR undergoing arthrocentesis combined with hyaluronic acid injection showed significant improvement in the perceived pain and maximum mouth opening in the mid-term follow-up periods.
关节穿刺术是颞下颌关节（TMJ）最简单的外科干预措施。它可以在门诊进行，成本低且发病率低。其目的是通过颞下颌关节上腔冲洗产生的液压破坏关节盘表面与下颌窝之间形成的粘连，从而使关节盘复位。在关节穿刺术期间或之后使用透明质酸进行粘弹性补充可改善临床效果，增加开口度并减轻疼痛程度。本研究的目的是通过临床检查和术前磁共振成像评估关节穿刺术联合透明质酸粘弹性补充对单侧不可复性盘移位（DDwoR）患者的疗效。
这项分析性回顾性横断面研究对72例单侧DDwoR的男女患者进行了临床和放射学评估。收集了以下数据：性别、疼痛情况、年龄、疼痛持续时间、最大开口度以及患者在视觉模拟量表上的疼痛感知。每个指定关节仅进行一次TMJ关节穿刺术。在关节穿刺术前（基线）以及术后7、14、30、60、90和180天（最终评估）收集数据。
在基线和最终评估之间，疼痛显著减轻（p = 0.001），关节功能得以恢复。此外，最大开口度显著增加（p = 0.00）。
接受关节穿刺术联合透明质酸注射的DDwoR患者在中期随访期间，其疼痛感知和最大开口度有显著改善。
