Bhargava Darpan, Sivakumar Beena, Bhargava Preeti G
Maxillofacial Surgery & TMJ Consultancy Services, H-3/2, BDA Col, Lalghati, Airport Road, Bhopal, Madhya Pradesh India.
Oral & Maxillofacial Surgery, People's University, Bhopal, Madhya Pradesh India.
J Maxillofac Oral Surg. 2023 Mar;22(1):110-118. doi: 10.1007/s12663-022-01738-x. Epub 2022 Jun 3.
Temporomandibular joint (TMJ) sub-luxation can have a significant psycho-social impact on a patients' well-being. Several treatment modalities have been described in the literature for the same. The present study was undertaken to investigate the efficacy of heavy bupivacaine-dextrose prolotherapy (HDP) for the peri-articular tissues, superior joint space and the retro-discal area in the patients with symptomatic chronic sub-luxation.
A preliminary clinical study was conducted among 60 patients diagnosed with chronic painful sub-luxation of the TMJ. Patients were divided into control group (CG), = 30, where autologous blood was injected in the superior joint space, peri-capsular tissues and retro-discal area bilaterally as per the predetermined protocol; and the study group (SG), = 30 patients were administered heavy bupivacaine-dextrose injection bilaterally in the peri-articular tissues, superior joint space and retro-discal area. The efficacy of the treatment was evaluated by assessing pain, maximum inter-incisal opening (MIO), changes in computed tomography scan, magnetic resonance imaging study, number and need for subsequent injections in both the groups.
Among the 60 patients, majority of the patients exhibited successful outcome after both the interventions, ABI and HDP. There was statistically significant reduction in recorded pain score with reduced MIO post-treatment. No morphological changes were noted in the condyle in both the groups. No complications were recorded among the study population.
HDP is a safe and simple modality for treating symptomatic sub-luxation with predictable clinical outcome. Heavy bupivacaine-dextrose can be considered as a prolotherapeutic agent for symptomatic chronic temporomandibular joint sub-luxation with the pharmacological benefit of local anaesthesia and proliferent delivery through the same injection.
颞下颌关节（TMJ）半脱位会对患者的身心健康产生重大的心理社会影响。文献中已描述了多种针对此情况的治疗方法。本研究旨在探讨高浓度布比卡因 - 葡萄糖注射疗法（HDP）对有症状的慢性半脱位患者关节周围组织、上关节间隙和盘后区的疗效。
对60例诊断为TMJ慢性疼痛性半脱位的患者进行了一项初步临床研究。患者分为对照组（CG），共30例，按照预定方案在双侧上关节间隙、关节囊周围组织和盘后区注射自体血；研究组（SG），共30例患者在双侧关节周围组织、上关节间隙和盘后区注射高浓度布比卡因 - 葡萄糖注射液。通过评估疼痛、最大切牙间开口度（MIO）、计算机断层扫描变化、磁共振成像研究、两组后续注射的次数和需求来评估治疗效果。
在60例患者中，大多数患者在两种干预措施（ABI和HDP）后均取得了成功的结果。治疗后记录的疼痛评分有统计学意义的降低，MIO减小。两组髁突均未发现形态学变化。研究人群中未记录到并发症。
HDP是一种安全、简单的治疗有症状半脱位的方法，临床结果可预测。高浓度布比卡因 - 葡萄糖可被视为一种注射疗法药物，用于治疗有症状的慢性颞下颌关节半脱位，具有局部麻醉和通过同一注射进行增殖传递的药理学益处。
