Severity of arthroscopically observed pathology and levels of inflammatory cytokines in the synovial fluid before and after visually guided temporomandibular joint irrigation correlated with the clinical outcome in patients with chronic closed lock.
OBJECTIVE
This study aimed to investigate the severity of arthroscopically observed pathologies and the levels of a set of inflammatory cytokines in aspirated synovial fluid (A-SF) in patients with chronic closed lock (CCL) of the temporomandibular joint (TMJ) before and after visually guided TMJ irrigation (VGIR). Furthermore, the findings were correlated with the clinical outcome after VGIR.


METHODS
VGIR was performed in 56 consecutive patients with unilateral CCL. Forty-nine of them, who underwent a second VGIR either as a follow-up arthroscopy or as a repeated therapeutic irrigation, were analyzed. They were assigned to either the successful (s-) group (n = 31) or unsuccessful (u-) group (n = 18), according to the clinical success criteria. The severity of arthroscopic findings of osteoarthritis (OA), synovitis, and fibrous adhesion (FA) were evaluated as arthroscopic scores. The levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, IL-8, IL-12, and IL-10 in the A-SF were measured. At the first and second VGIR, the arthroscopic scores and the levels of each investigated cytokine were compared between the s- and u-groups. In each group, same parameters were compared between the first and second VGIR.


RESULTS
At the first and second VGIR, there are no differences in the arthroscopic scores between the s- and u-groups. After the first VGIR, the severity of synovitis significantly improved, that of OA was unchanged, and that of FA became worse in the s- and u-groups. At the first VGIR, the levels of IL-6 and IL-8 were significantly higher in the u-group, and the IL-10 level was significantly higher in the s-group. At the second VGIR, however, there were no differences in the levels of each investigated cytokine between the s- and u-groups. The levels of each cytokine did not significantly change between the first and second VGIR, regardless of the clinical outcome.


CONCLUSIONS
VGIR may contribute to the remission of synovitis in patients with TMJ CCL. However, the severity of arthroscopically observed pathologies and the levels of each investigated cytokine do not seem to be reflected by the clinical state. Moreover even if the intra-articular inflammation is asymptomatic, an exacerbation may not be ruled out even after a successful VGIR.
First Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, Yokohama, Japan. hamada-y@tsurumi-u.ac.jp
Yoshiki
Y
Hamada
Anders B
AB
Holmlund
Toshirou
T
Kondoh
Kazutoshi
K
Nakaoka
Hideki
H
Sekiya
Noriyuki
N
Shiobara
Akito
A
Gotoh
Kenichi
K
Kumagai
Ryuji
R
Suzuki
Kanichi
K
Seto
D000328:Adult; D001182:Arthroscopy; D002908:Chronic Disease; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis; D007378:Interleukins / Q000032:analysis; D004204:Joint Dislocations / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D010003:Osteoarthritis / Q000473:pathology / Q000601:surgery*; D019152:Paracentesis; D013582:Synovial Fluid / Q000737:chemistry; D013585:Synovitis / Q000473:pathology; D013704:Temporomandibular Joint / Q000473:pathology* / Q000601:surgery*; D013705:Temporomandibular Joint Disorders / Q000473:pathology / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000379:methods; D000267:Tissue Adhesions / Q000473:pathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D018836:Inflammation Mediators; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha