determination of effects of arthrocentesis and intra-articular hylan G-F 20 injection on pain and maximum mouth opening for internal derangement of temporomandibular joint

The arthrocentesis is a simple irrigation of the superior joint space under local anesthesia which provides by releasing the stuck disc from the fossa, improving disc mobility and gaining normal maximal mouth opening. However reducing the pain by removing inflammation mediators form the joint might be a temporary effect of arthrocentesis. Therefore, it is considered that injection of hyaluronic acid exogenously may lead permanent role in the restoration of microstructure. The aim of this study was to evaluate the effects of arthrocentesis and high molecular weight hyaluronic acid on the mouth opening and joint pain in patient with anterior disc deplacement without reduction and/or osteoarthritis of temporomandibular joint disorder. This study involved 23 joints with ID in 21 female patients (mean age 36.85 ± 15.23 years, ranging 17 years to 65 years) complaint of pain and limited mouth opening and did not respond to conservative treatment. Pain and function disturbance intensity was measured by the visual analog scale (VAS). Before treatment, patient?s MR images were obtained. All objective and subjetive evaluations were performed before and after treatment, 1., 3., 6., and 12. mouths. The mean pre-treatment maximum mouth opening was 30.38 ± 4.70, after the first injection was 32.66 ± 4.66 and 1 year follow-up was 40.0 ± 3.65. VAS scores were 6.42 ± 2.46, 4.80 ± 2.71, 0.70 ± 1.05 respectively. The main pain intensity statistically significant decreased with time. (p<0.01). There was no significant difference between the pre-treatment and post-treatment VAS (p>0.05). MR images were obtained from 14 patient. While 3 joints showed erosion, 6 joints showed osteophyte and 2 joints had sclerosis, the remaining 3 joints showed no degenerative changes in the condyle. In our study any major complications did not observe after the treatment. At the injection side of all patients open-bite was observed in centric occlusion. Fullness and fluid movement sense on ear region were observed during 1?2 days. Significant increase of mouth opening, lateral and protrusive movement range and significant decrease of pain dysfunction were found at 3 months follow up. In conclusion, all patients showed slow recovery tendency and satisfaction results, which may be attributed to mechanical effects of HA.