Clinical evaluation of different arthrocenthesis techniques used in the treatment of temporomandibular joint disorders: A retrospective study

Introduction: Temporomandibular disorders (TMD) are common conditions in society, characterised by symptoms such as pain, limited movement and joint noises, which negatively affect an individual's quality of life. The primary goal of treatment is to restore the physiological functions of the joint by eliminating the aetiological factors. In cases where conservative methods prove ineffective, arthrocentesis, a minimally invasive approach, comes to the fore. Arthrocentesis aims to reduce pain by removing inflammatory mediators and to increase joint mobility. In this study, the intraoperative parameters and clinical outcomes of different arthrocentesis techniques were compared and evaluated in patients with Wilkes stage 2-3 TME disorders. Materials and Methods: This study was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Technical University. The medical records of 50 patients treated with two different arthrocentesis techniques (Group 1: n=25, Group 2: n=25) were retrospectively reviewed. In the first group, arthrocentesis was performed using a method developed by Mun et al., in which two 22-gauge needles bent to form a 'Y' shape with opposing angles were placed simultaneously and concentrically. In the second group, arthrocentesis was performed using a pre-prepared Y-shaped cannula, as described by Rahal et al. The procedure was performed under local anaesthesia in each patient, and the upper joint cavity was washed with an average of 100 ml of Ringer's Lactate solution. Following arthrocentesis, 1 ml of hyaluronic acid was injected into the patients. The jaw movements obtained from the patients (maximum mouth opening, assisted maximum mouth opening, and protrusion movements), chewing efficiency, pain level (VAS tests during and outside of function), joint sounds, deviation/displacement status, otological symptoms, and headache records were evaluated. Statistical comparisons were made between groups based on preoperative and postoperative values at 1 month and 6 months. Additionally, intraoperative parameters recorded during arthrocentesis (number of needle insertions, procedure duration, complication status, and treatment tolerance) were compared between groups. Findings: In terms of the number of needle insertions, procedures in Group 2 were completed with fewer insertions, and a statistically significant difference was observed . No significant differences were found between the groups in terms of procedure duration, complication rates, and treatment tolerance. Functional measurements showed postoperative improvement in both groups, but a significant difference was found only in protrusion movement in favour of Group 1 and in chewing efficiency scores in favour of Group 2. In symptomatic assessments (joint noise, deviation/deflexion, otological symptoms, and headache), significant improvement was observed in both groups during the postoperative period, but no statistically significant difference was found between the groups . Conclusion: This study compared different methods used in arthrocentesis procedures in terms of intraoperative parameters, functional measurements, pain levels, and symptomatic improvement. Both methods were found to be effective in improving joint function and symptoms, although differences were observed in favour of certain groups in some parameters. The findings support arthrocentesis as a reliable and effective method for treating temporomandibular joint disorders. Keywords: Temporomandibular Joint Disorders, Temporomandibular Joint Arthrocentesis, TME Arthrocentesis Modifications