Investigation of the efficacy of ultrason-guided arthrocentesis+PRP in the treatment of temporomandibular joint internal derangements based on mri and clinical findings

This study aims to investigate the effectiveness of ultrasound guidance in the combined application of arthrocentesis and platelet-rich plasma (PRP) for the treatment of temporomandibular joint internal derangements, based on magnetic resonance imaging (MRI) and clinical findings. This study was designed as a prospective, randomized, and controlled trial. A total of 42 patients who applied to our clinic between October 2023 and March 2024 were included in the study. The patients were divided into two equal groups: the ultrasound group, where ultrasound-guided arthrocentesis and PRP applications were performed, and the control group, where conventional methods were used for arthrocentesis and PRP applications. Type II single-puncture arthrocentesis (TPA) was preferred for the arthrocentesis procedure. Clinical assessments included visual analog scale (VAS), maximum mouth opening (MMO), and measurements of ipsilateral, contralateral, and protrusive movements. Additionally, the procedure times for arthrocentesis and PRP applications were recorded separately. Radiological evaluations involved assessing the disc shape, disc position, condyle-disc alignment, joint effusion, capsular width, degeneration on joint surfaces, type of condylar head, and bone marrow edema in the condyle. Clinical evaluations were performed preoperatively, at the 1st week, 1st month, and 3rd month; treatment outcomes were additionally assessed by MRI at the 3rd month. Statistical analyses of the measurements were performed using SPSS 22 software. In the combined application of Type II TPA and PRP performed under ultrasound guidance, no significant difference was observed between the preoperative status and the results at the third month regarding VAS, MAA, ipsilateral, contralateral, and protrusive movement measurements (p>0.05). However, it was observed that ultrasound-guided procedures yielded results more quickly in MMO, ipsilateral, contralateral, and protrusive movements. When comparing the durations of Type II TPA and PRP applications, the procedures guided by ultrasound were found to have longer durations (p<0.05). Radiological evaluations revealed that the disc shape, condyle-disc alignment, type of condylar head, and degeneration on the condyle head remained unchanged in both groups, while joint effusion and capsular width decreased similarly, and bone marrow edema in the condyle showed similar changes (p>0.05). In conclusion, ultrasound-guided Type II TPA+PRP applications resulted in earlier clinical improvement in patients; however, after a 3-month follow-up, both methods yielded similar outcomes. Keywords: arthrocentesis, magnetic resonance imaging, temporomandibular joint disorders, ultrasonography