Instituto Português da Face, Lisboa, Portugal; Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Portugal; Faculty of Medicine of Lisboa University, Portugal.
Instituto Português da Face, Lisboa, Portugal.
J Craniomaxillofac Surg. 2023 Nov;51(11):659-667. doi: 10.1016/j.jcms.2023.09.010. Epub 2023 Oct 7.
This 3-year prospective study evaluated the efficacy of temporomandibular joint (TMJ) arthrocentesis with viscosupplementation in different severity stages based on the Dimitroulis classification (categories 2-4 were included). TMJ arthrocentesis was performed under local anaesthesia, and the protocol consisted of a double-puncture technique with lavage of ≥150 cc Ringer Lactate plus viscosupplementation. Incobotulinum toxin A was administered 10-15 days preoperatively in patients with concomitant masticatory myalgia. The primary outcome was TMJ pain, assessed by visual analogue scale (VAS, 0-10), and the secondary outcomes were the maximum mouth opening (MMO, mm) and myalgia degree (0-3). All outcomes were assessed on the intervention day (T0) and after the procedure (T1) (minimum 1 month and then 3 months, 6 months, 1 year and every year since). A total of 108 patients were enrolled (mean age of 43.1 ± 18.9 years); 86 (80%) were women and 22 (20%) were men. Preoperative pain was 4.02 ± 3.12 (mean ± SD), MMO was 38.10 ± 9.56 (mean ± SD) and myalgia degree was 1.80 ± 1.18 (mean ± SD). After an average of 215.4 days (31-1253 days), a statistically significant improvement of pain (P < 0.0001), MMO (P = 0.005) and myalgia degree (P < 0.0001) was observed. The overall successful outcome of TMJ arthrocentesis with viscosupplementation was 76%. The authors observed increased arthrocentesis effectiveness and success rate with viscosupplementation in Dimitroulis category 2 (88.6%) compared to 3-4 (71.4%). An association was found between arthrocentesis with viscosupplementation failure and painful myalgia (ρ = 0.477; P < 0.0001). Thirteen patients (12%) underwent a second TMJ intervention after finalising the present trial. With a low complication rate, TMJ arthrocentesis with viscosupplementation led to an overall benefit for all the included patients. This study reinforces the important role of minimally invasive TMJ arthrocentesis as a first treatment option, with better results in the early stages compared to more severe stages.
这项为期 3 年的前瞻性研究根据 Dimitroulis 分类（包括类别 2-4）评估了颞下颌关节（TMJ）关节穿刺术联合粘弹性补充剂治疗不同严重程度阶段的疗效。TMJ 关节穿刺术在局部麻醉下进行，方案包括双穿刺技术，用 ≥150cc 林格乳酸盐冲洗，并联合粘弹性补充剂。对于伴有咀嚼肌痛的患者，在术前 10-15 天给予注射用肉毒毒素 A。主要结局是通过视觉模拟量表（VAS，0-10）评估 TMJ 疼痛，次要结局是最大张口度（MMO，mm）和肌痛程度（0-3）。所有结果均在干预日（T0）和术后（T1）评估（至少 1 个月，然后 3 个月、6 个月、1 年和此后每年）。共纳入 108 例患者（平均年龄 43.1±18.9 岁）；86 例（80%）为女性，22 例（20%）为男性。术前疼痛为 4.02±3.12（均值±标准差），MMO 为 38.10±9.56（均值±标准差），肌痛程度为 1.80±1.18（均值±标准差）。在平均 215.4 天（31-1253 天）后，疼痛（P<0.0001）、MMO（P=0.005）和肌痛程度（P<0.0001）均有统计学显著改善。TMJ 关节穿刺术联合粘弹性补充剂的总体成功结局为 76%。作者观察到在 Dimitroulis 分类 2（88.6%）中，与 3-4 类（71.4%）相比，关节穿刺术联合粘弹性补充剂可提高关节穿刺术的有效性和成功率。作者发现关节穿刺术联合粘弹性补充剂失败与疼痛性肌痛之间存在关联（ρ=0.477；P<0.0001）。13 例患者（12%）在完成本研究后接受了第二次 TMJ 干预。TMJ 关节穿刺术联合粘弹性补充剂的并发症发生率低，对所有纳入患者均整体有益。本研究进一步证实了微创 TMJ 关节穿刺术作为首选治疗方案的重要作用，在早期阶段的疗效优于晚期阶段。
