Results of Using Arthrocentesis in the Treatment of Temporomandibular Disorders Associated with Fractures of the Mandibular Condylar Process

Abstract

The purpose of the work was to study the effectiveness of arthrocentesis in the complex treatment of post-traumatic temporomandibular disorders. Materials and methods. The clinical part of the study included 24 patients, who had a history of fractures of the mandibular articular process. Patients underwent radiological examination – orthopantomography, computer tomography, ultrasound and magnetic resonance. Patients with titanium mini-plates after osteosynthesis were subjected to ultrasound, and since the reposition and fixation of fragments was performed using intermaxillary fixation they were subjected to magnetic resonance imaging. Pain assessment was performed according to visual analogue scale. Temporomandibular joint arthrocentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia. Results and discussion. All patients complained of the temporomandibular joint pain, which was rated from 1 to 6 points. All patients noted pain on palpation of the temporomandibular joint. Limited mouth opening ranging from 30 to 38 mm was found in 11 patients. Lower jaw deviation was observed in 18 patients. All patients had articulatory noises – clicking, and 11 had blocked movement of the joint head. Orthopantomograms or computer tomography revealed satisfactory restoration of the anatomical shape of the mandible after fractures and complete consolidation of the fracture. Ultrasound and magnetic resonance revealed signs of unabsorbed hematoma as consequences of hemarthrosis; in 18 patients – deformity of the capsule, in 17 – a slight thickening of the posterior edge of the articular disc, in 18 patients – disc adhesion, in 13 people – forward disc displacement with reduction, in 11 patients – disc protrusion without reduction. According to clinical and radiological signs after traumatic temporomandibular disorders, patients were divided into two groups according to Wilkes classification: 13 patients with stage II (early-middle) and 11 – with stage III (middle). We also found that after surgical treatment – osteosynthesis, the number of patients with stage III according to Wilkes makes up 58.33% (7 people), while those after splinting – 33.33% (4 people). The control ultrasound and MRI carried out 3-6 months after arthrocentesis showed no signs of hemarthrosis in 11 (84.61%) patients with intra-articular disorders of the second degree, and in 8 (72.72%) patients with internal disorders of the third degree, the position and function of the articular disc were restored. Conclusion. Arthrocentesis with temporomandibular joint lavage is a minimally invasive surgical manipulation that has proven itself in temporomandibular disorders of traumatic origin, in particular after fractures of the articular process of the mandible. Arthrocentesis is recommended to be used after ineffective conservative treatment, as well as to prevent post-traumatic intra-articular disorders in the early post-treatment fractures (intermaxillary fixation or osteosynthesis) with the attenuation of acute post-traumatic events, which is our goal of further work