Arthrocentesis for the Treatment of Internal Derangement (Evaluatet Clinico-Arthrography)

The normal mouth opening which is about 40-50mm arise from the unique-construction of the temporomandibular joint (TMJ). Any Obstacle within the domain of the TMJ will interfere with it& #039, s maneuverability and limit mouth opening. We have three types of painful intra articular disorders of the TMJ, 1- internal derangement (anterior disc displacement with and without reduction).2- deterioration of the TMJ stractures (osteoarthritis-and rheumatoid arthritis).3- Anchord disc phenomenon in which the disc is stick to the glenoid fossa preventing sliding movment of the condyle. The structural associated with the functional limitation caused by disc displacement have been demonstrated by arthrography and MRI (Westesson PL, 1993). Arthrocentesis is used to manage TMJ problems in patients who don& #039, t respond well to non surgical therepy. Themajor indications for use are 1-acute or chronic limitation of motion dueto anterior displaced disc and 2-hypomobility due to restriction of condylar translation in the upper joint space, 3- patients with normal range of motion despite an anterior disc displacement with reduction who nonstheless have chronic pain. Arthrocentesis may also be used to manage pain and dysfunction in patients who have undergone previous invasive procedures that failed to releve pain with limitation of function. The altertion of the biochemical environment within the intra capsular space by arthrocentesis to relieve variorus vasoactive pain mediators is also another strong indication for treatment. Arthrocentesis my bridge the gap between non surgical therapy and invasive TMJ surgery. Frost DE, 1999. There are few published reports of out conies for arthrocentesis of the TMJ. Nitzan et al& #039, s study in 1991 was the first published. They reported a technique with a success rate 91.8 % in treatment of internal derangcmat most recently, Dimitroulis et al in 1995 evaluated the efficiency of TMJ arthrocentesis and lavage for treatment of acute persistant closed lock of TivlJ. Norman Trieger in 1999, show the efficiency of TMJ arthrocentesis in the management of the symptoms of rheumatoid arthritis. Arthrocentesis is an easy, minimally invasive, and highly efficient procedure to decrease joint pain and incease the range of mouth opening in patients with closed lock of the temporomandibalar joint. This can be performed under local anesthesia in the out patient clinic. Clinical trials suggested Arthrocentesis, arthroscopiclysis and lavage, and arthrotomy, has been effective for TMJ signs and symptoms. Tumor necrosis factor (TNF) is a potent proinflamatory cytokine that has been recoverd from symptomatic human Tmj& #039, s by Arthrocentesis. This cytokin has been implicated with the progression of degenerative joint disease. Shafer Dm in 1994 estimate that atotal arthrocentesis volume of approximately loonil is sufficient for therapeutic lavage of the superior joint space of the humen TMJ. Also brady kin in concentration during arthrocentesis was effectively reduced. Mu& #039, rakamik in 1998 suggested that BK might be key regulator of arthralgia and synovitis of the TMJ. Zrdeneta G in 1997 reported that the protein& #039, concentration in the lavage fluids used for arthrocentesis of patients with TMD fell in a volume dependent manner and that approximately 1.00ml of total perfusate is sufficient for therapeutic lavage.