Is there a role for arthrocentesis in recapturing the displaced disc in patients with closed lock of the temporomandibular joint?
OBJECTIVE
The aim of this study was to evaluate the effectiveness of arthrocentesis in releasing acute and chronic closed lock of the temporomandibular joint, improving function, reducing pain and recapturing the displaced disc.


METHODS
We performed arthrocentesis and mandibular manipulation (MM) as an initial treatment in 33 patients (unilateral involvement) with a variable duration of closed lock and magnetic resonance imaging (MRI) evidence of anterior disc displacement without reduction (ADDWR). Duration of locking ranged from 1 week to 2 years. After the procedure, soft diet, physiotherapy, and an interocclusal appliance (IA) were prescribed. Postoperative MRI images were obtained at 1 month. A clinical examination with analysis of maximal mouth opening (MMO), a visual analog scale (VAS), and a self-administered questionnaire were used for evaluation of pain, jaw dysfunction, and activities of daily living (ADL). The follow-up period was 1 year.


RESULTS
At 1-year follow-up, MMO had increased significantly from a mean of 24.7 +/- 5.9 mm to 39.6 +/- 6.2 mm (P < .05). Functional improvement was associated with a significant reduction in VAS (from 6.2 +/- 2.3 to 2.8 +/- 3.4), pain (from 11.7 +/- 7.1 to 4 +/- 3.8), dysfunction (from 8.6 +/- 4.9 to 3.2 +/- 2.8), and ADL scores (from 13.9 +/- 12 to 4.4 +/- 5), with P < .05. The overall success rate was 72.7%; it was higher in acute patients (87.5%) than in chronic patients (68.0%). The disc was recaptured (the disc was interposed between the condyle and the eminence on closed and open MRI images) in 3 cases in which the duration of locking was less than 1 month (acute patients).


CONCLUSIONS
The results indicate that arthrocentesis, in association with MM and IA, could be effective in improving function and reducing pain in patients with closed lock. Better results were obtained in terms of MMO, VAS, and questionnaire scores in acute closed lock cases than in chronic ones. Recapturing the anteriorly displaced disc is possible only in patients with acute closed lock.
Department of Maxillofacial Surgery, Faculty of Medicine, University of Udine, Udine, Italy. salvatore.sembronio@med.uniud.it
Salvatore
S
Sembronio
Alberto Maria
AM
Albiero
Corrado
C
Toro
Massimo
M
Robiony
Massimo
M
Politi
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D017090:Occlusal Splints; D010147:Pain Measurement; D019152:Paracentesis; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D019224:Temporomandibular Joint Disc / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome