Single Injection Technique Prolotherapy for Hypermobility Disorders of TMJ Using 25 % Dextrose: A Clinical Study

Introduction

Hypermobility disorders of the Temporomandibular joint (TMJ) can be treated by both conservative and surgical approaches. Conservative approaches should be considered as first line treatment for such disorders. Prolotherapy with 25 % dextrose being injected into the posterior pericapsular tissues is one such treatment modality with favorable outcomes.

Aim

To study the efficacy of single injection of 25 % dextrose in pericapsular tissues in the management of hypermobility joint disorders of TMJ as first line treatment.

Patients and Methods

We have studied a total of 23 patients suffering from either chronic recurrent dislocation or subluxation of the TMJ who were treated with the single injection technique prolotherapy with 25 % dextrose into the pericapsular tissues along with auriculotemporal nerve block and found encouraging results.

Results

Overall success rate in our study was 91.3 % (21/23) with a minimum follow up period of 13.9 months. Number of successfully treated patients requiring one injection was 7 (30.4 %), two injections was 8 (34.7 %) and requiring three injections was 6 (26.1 %). There were no permanent complications.

Conclusion

Hence the use of 25 % dextrose as a proliferant to treat hypermobilty disorders of the TMJ is recommended by us as a first line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.

     

Dextrose prolotherapy for pain and dysfunction of the TMJ reducible disc displacement: A randomized,double-blind clinical study

To assess the efficacy of dextrose prolotherapy on the clinical signs and symptoms of patients having disc displacement with reduction (DDWR).This prospective, randomized, double-blind clinical study included thirty patients suffering from bilateral DDWR. The patients were randomly divided into two equal groups. After induction of local anesthesia, each joint was injected in two sites; one in the superior joint space and the other in the retrodiscal tissue, using 25% dextrose solution in group I and normal saline in group II. Pain intensity, maximal interincisal opening (MIO), and joint sounds (JS) were evaluated preoperatively, 1 week after each injection, and 3 months and 6 months after the last injection.Patients in group I showed significant improvement in pain and MIO, and higher satisfaction with treatment than patients in group II. Compared to saline injection, dextrose injection resulted in an improvement in JS but without significant difference within and between groups.Intra-articular injection of 25% dextrose is effective in the treatment of pain and dysfunction of TMJ DDWR as shown by significant improvement in pain and MIO and patient satisfaction. The technique is simple, easy to do, safe and should be adopted whenever appropriate.     

Arthrocentesis followed by intra-articular autologous blood injection for the treatment of recurrent temporomandibular joint dislocation

Temporomandibular joint (TMJ) dislocation is an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. This study was conducted to assess autologous blood injection to the TMJ for the treatment of chronic recurrent TMJ dislocation. Fifteen patients with bilateral chronic recurrent condylar dislocation were included in the study. Bilateral TMJ arthrocentesis was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxation, recurrence rate, and presence of facial nerve paralysis. Eighty percent of the subjects (12 patients) had a successful outcome with no further episodes of dislocation and required no further treatment at their 1-year follow-up, whereas three patients had recurrent dislocation as early as 2 weeks after treatment. Autologous blood injection is a safe, simple, and cost-effective treatment for chronic recurrent TMJ dislocation.     

Efficacy of Prolotherapy in Temporomandibular Joint Disorders: An Exploratory Study

IntroductionTemporomandibular joint (TMJ) disorders can be treated by both conservative and surgical approaches. Conservative interventions with predictable benefits can be considered as first-line treatment for such disorders. Dextrose prolotherapy is one of the most promising approaches in the management of TMDs, especially in refractory cases where other conservative management has failed.AimTo study the efficacy of prolotherapy and to establish it as an effective procedure in patients with TMJ disorders, to provide long-term solution to chronic TMJ pain and dysfunctions.Patients and MethodsWe conducted a study on 25 patients suffering from various TMJ disorders who were treated with prolotherapy, the solution consisting of 1 part of 50% dextrose (0.75 ml); 2 parts of lidocaine (1.5 ml); and 1 part of warm saline (0.75 ml). The standard programme is to repeat the injections three times, at 2-week interval, which totals four injection appointments over 6 weeks with 3-month follow-up.ResultsThere was appreciable reduction in tenderness in TMJ and masticatory muscles with significant improvement in mouth opening. The effect of the treatment in improving clicking and deviation of TMJ was found to be statistically significant (P < 0.05). There were no permanent complications.ConclusionOur study concluded that prolotherapy is an effective therapeutic modality that reduces TMJ pain, improves joint stability and range of motion in a majority of patients. It can be a first-line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.     

高渗葡萄糖关节上腔注射治疗颞下颌关节囊松弛（半脱位）和复发性脱位的临床应用

目的：探讨高渗葡萄糖硬化治疗颞下颌关节囊松弛（半脱位）和复发性脱位的效果。方法：采用50%葡萄糖注射剂行关节上腔注射治疗6例颞下颌关节半脱位的患者和7例复发性颞下颌关节脱位的患者,观察疗效;并对其治疗前后Fricton颞下颌关节紊乱指数进行评分,评价患者颞下颌关节功能的变化。结果：13例患者临床疗效满意,随访2月至半年无复发,治疗后患者的颞下颌关节紊乱指数明显改善。结论：采用50%葡萄糖注射剂行关节上腔注射治疗颞下颌关节半脱位和复发性脱位具有良好的效果。     

Impact of prolotherapy in temporomandibular joint disorder: a quality of life assessment

Chronic pain and functional impairment associated with temporomandibular joint (TMJ) disorders (TMD) considerably reduce oral health-related quality of life (OHRQoL). In the present study we have assessed the influence of prolotherapy in patients with TMD by the subjective measurement of QoL using the Oral Health Impact Profile-14 (OHIP-14). Twenty-five patients diagnosed with TMD (mean (range) age 38 (18 – 70) years) were included. They had all undergone dextrose prolotherapy to the TMJ at regular time intervals (four times at intervals of two weeks) using the method suggested by Hemwall-Hackett. They were asked to answer the OHIP-14 questionnaire before and two years after prolotherapy. Seven domains of OHRQoL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domain scores and total OHIP-14 scores were compared using inferential statistics (chi squared and Wilcoxon signed rank tests). Prolotherapy was effective over time, as all the domains’ mean scores decreased considerably after treatment. The total mean score before prolotherapy was 21.20, which was extensively reduced to 13.08 after prolotherapy (p=0.001). There was statistically significant improvement in all domains, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap (p≤0.005 in all cases). We concluded that prolotherapy has a promising role in the improvement of OHRQoL of patients with TMD, and its beneficial effects persist at least two years after treatment.     

Treatment of chronic recurrent dislocation of the temporomandibular joint with injection of autologous blood alone,intermaxillary fixation alone,or both together: a prospective,randomised, controlled clinical trial

Our aim was to evaluate the efficacy of autologous blood injection in the treatment of chronic recurrent dislocation of the temporomandibular joint (TMJ) in a prospective randomised controlled clinical study. Forty-eight patients (11 men and 37 women) with chronic recurrent dislocation of the TMJ were randomly assigned to 1 of 3 equally sized groups. Patients in the first group were treated with injection of autologous blood (ABI) alone into the superior joint space and the pericapsular tissues. Those in the second group were treated with intramaxillary fixation (IMF) alone for 4 weeks, and those in the third group were treated with ABI and IMF for 4 weeks. Interincisal distance, digital panoramic radiograph, incidence of recurrent dislocation, and pain in the TMJ were assessed postoperatively at 2 weeks and at 1, 3, 6, and 12 months. The mean (SD) reduction in interincisal distance in the group treated with both techniques was 11.0 (1.9), which was significantly higher than in either the group treated with ABI, which was 8.5 (2.4) or IMF, which was 9.1 (2.1). The results in the ABI group and the IMF group did not differ significantly. The combined group showed the biggest decrease. The ABI alone group had the most recurrences (n = 8, which were treated by repeated injections with no recurrence after the third). The IMF alone group had only 3 and there were none in the combined group. We conclude that ABI is a simple and safe technique for the treatment of dislocation of the TMJ in the outpatient clinic. Recurrence can be overcome by multiple injections. However, the best clinical results are given by a combination of ABI and IMF.     

A new surgical approach for the treatment of chronic recurrent temporomandibular joint dislocation

Chronic recurrent temporomandibular joint (TMJ) dislocation is defined as the complete loss of articular relationships, during mouth-wide opening, between the articular fossa of the temporal bone and the condyle-disk complex. The most frequent pathogenetic factors involved in chronic recurrent dislocation of the TMJ are supposed to be trauma, abnormal chewing movements, TMJ ligaments, capsule laxity, and masticatory muscles disorders. In fact, TMJ dislocation occurs more frequently in people with general joint laxity and in patients with internal derangement of the TMJ or with occlusal disturbance.Management of TMJ dislocation remains a challenge. Eminectomy, whose validity has been demonstrated by several authors, acts on the bony obstacle, preventing condylar locking, but does not have a therapeutic effect on TMJ ligament and capsular laxity or masticatory muscle incoordination, which seem to be the real cause of TMJ dislocation in most cases.The authors present a mini-invasive modified technique of eminectomy, which aims to act on both the obstacle and the cause with respect and restoration of TMJ biomechanical constraints.     

Dautrey's procedure: an alternative for the treatment of recurrent mandibular dislocation in patients with pneumatization of the articular eminence

Temporomandibular joint (TMJ) dislocation is an involuntary forward movement of the mandible beyond the articular eminence with the condyle remaining stuck in the anterior-most position, leaving the patient unable to close their mouth. Conservative treatment for this condition includes the injection of sclerosing agents or the intramuscular administration of botulinum toxin type A, while surgical therapy requires either removal or augmentation of the articular eminence. Once the surgical treatment plan has been determined, pneumatization of the articular eminence may turn a relatively simple procedure into a great surgical challenge. We present herein the cases of two patients suffering from recurrent mandibular dislocation who happened to have pneumatization of the articular eminences. Both patients were treated with a down-fracture of the zygomatic arch, known as Dautrey's procedure, modified by the application of a miniplate connecting the displaced arch and the lateral portion of the articular eminence. Neither patient had suffered a new episode of dislocation at their most recent postsurgical visit.     

自体血注射治疗复发性颞下颌关节脱位的临床观察

对19例复发性颞下颌关节脱位患者行关节腔和囊周组织自体血注射治疗。1年后随诊,16例无关节脱位复发,有效率为84.2%。也没有观察到TMJ骨质破坏和关节强直的现象。自体血注射治疗复发性颞下颌关节脱位是一种简单、安全、经济、有效的微创治疗方法。     

Prolotherapy (proliferation therapy) in the treatment of TMD

Proliferation therapy, or "prolotherapy," is also known as regenerative injection therapy (RIT). Since the 1930s, the technique has been used to stabilize injured joints and to relieve joint pain. This article reviews the history and scientific literature regarding prolotherapy and describes the application of the technique to treat injured or unstable temporomandibular joints (TMJ). Alternative medicaments and the likely mechanisms of action are discussed. A brief preliminary summary of a retrospective clinical study of the efficacy of prolotherapy is included. The study shows that prolotherapy can be an effective therapeutic modality that reduces TMJ pain and joint noise in a majority of patients who have reached a plateau with use of an intraoral appliance, physical therapy, and home care.     

45例复发性颞下颌关节前脱位的分类及治疗探讨

目的 介绍一种基于MRI上关节盘与髁突相对位置的颞下颌关节复发性前脱位分类方法,以及针对不同类型采用不同手术方法治疗的经验。方法 选择2003年5月—2016年5月治疗的45例颞下颌关节复发性前脱位患者。依据MRI分为Ⅰ型（关节盘无移位）、Ⅱ型（关节盘移位）、Ⅲ型（骨关节病）及Ⅳ型（存在精神或神经功能障碍）,依据分类选择不同的手术治疗方法。结果 Ⅰ型28例（62.2%）,Ⅱ型12例（26.7%）,Ⅲ型2例（4.4%）,Ⅳ型3例（6.7%）。Ⅰ型患者采用关节结节增高术或关节镜下硬化剂注射术;Ⅱ型患者采用颞下颌关节盘复位固定术（锚固）及关节镜下关节盘复位固定术,辅助关节结节增高术;Ⅲ型患者根据临床症状进行手术;Ⅳ型患者均采用关节结节凿平术。随访期间未发现开口受限、开口疼痛、脱位复发。结论 基于MRI影像学特点对颞下颌关节脱位进行分类,对术者选择合适的治疗方案具有指导意义。     

Surgical managements of subluxation and dislocation of the temporomandibular joint: clinical and experimental studies

Subluxation and dislocation of the temporomandibular joint (TMJ) are very unpleasant and distressing conditions to patients; they are not common diseases, but large groups of people in countries such as Yemen and Somalia are affected owing to daily chewing of Qat for several hours every day, but in Iraq, the conditions are not common. These clinical studies were conducted on 133 patients: 87 men and 36 women; their age ranged between 18 and 72 years (mean, 45 y), and their complains were difficulties of chewing food, speech, laughing, or yawning. Patients were divided into 3 groups: the first group included 65 patients (45.53%) who were treated by surgical reconstruction of the TMJ by using a fingerlike fascial flap from the temporal fascia for reconstruction of a lax capsule and reenforcement and a block of corticocancellous bone graft from the iliac crest squeezed and impacted in a gap in front of the eminence of TMJ; the second group included 15 patients with delayed dislocation of TMJ (12.20%) who were treated by surgical release fusion of the capsule and condyle from the infratemporal fascia with reenforcement of the capsule by reverse L-shaped plication technique and eminectomy; and the last group included 45 patients with acute dislocation of the TMJ (34.96%) who were treated by modified manual reduction, and follow-up of the patients was between 1 and 20 years. An experimental study was done on rabbits to support our clinical study by using a temporal fascial flap for the reconstruction of a rabbit TMJ capsule, and the aim was to show that any pathologic changes might occur in the capsule or the condyle. The result was very optimistic, and there were no cellular changes observed in the condyle or surrounding structures.     

The Effect of Chronic Temporomandibular Joint Dislocation: Frequency on the Success of Autologous Blood Injection

Autologous blood injection (ABI) is a conservative, non-surgical method of treating chronic temporomandibular joint (TMJ) dislocation. Although many clinicians have reported positive results, procedural success has not been evaluated according to dislocation type. This study investigated the success of ABI on chronic TMJ dislocation with respect to dislocation frequency. ABI was used to treat 27 joints in 17 patients. The patients were divided into two groups based on dislocation frequency: (A) at least twice a week on different days and (B) at least twice a day. The procedure was successful in 13 of the 15 injected joints (86.6 %) in group A and six of the 12 injected joints (50 %) in group B. This difference was statistically significant (p = 0.03814). Autologous blood injection had limited success in patients with very frequent dislocation, while it was useful for treating less frequently dislocated TMJs.     

Radiographic signs in the temporomandibular and hand joints in patients with psoriatic arthritis

The temporomandibular (TMJ) and hand joints of 64 patients with psoriatic arthritis (PA) were examined radiographically with panoramic tomography and dorsovolar projection. The associations between radiographic signs in the condyle of the TMJ and finger joints were analyzed with Pearson's product-moment correlation coefficient. Twenty-six patients (41%) had radiographic signs in their TMJs. Arthritic signs were seen in 14 (22%) and degenerative signs in 12 (19%) patients. Fifty-five patients (86%) had radiographic signs in their hands; 33 patients (52%) had arthritic and 22 (34%) degenerative signs. In the TMJ statistically significant correlations were found among erosion, flattening, and cortical sclerosis and also between osteophyte and cortical sclerosis. In the finger joints erosion correlated significantly with dislocation and loss of space. Erosion in the condyle of the TMJ was the only sign that correlated with changes in the finger joints such as erosion, dislocation, and ankylosis. Erosion in the TMJ also correlated with erosion in the metacarpophalangeal joint and wrist.     

Ultrasound-guided lateral pterygoid muscle botulinum toxin: an injection for recurrent temporomandibular joint dislocation in a brain injury patient

Oral and Maxillofacial Surgery - Botulinum toxin type A (BTX-A) injection using nerve stimulation or electromyography for recurrent temporomandibular joint (TMJ) dislocation has been reported for...     

Histological evaluation of the changes in temporomandibular joint capsule and retrodiscal ligaments following autologous blood injection

IntroductionIn recent years injection of autologous blood into the temporomandibular joint (TMJ) has been reintroduced as a treatment of chronic recurrent TMJ dislocation. The effects of this treatment on components of the TMJ is not fully understood. The purpose of this article is to evaluate the effects of autologous blood on TMJ capsule and the retrodiscal ligament.Material and methodsA total of 16 healthy adult country bred pig were used in this study. Autologous blood were injected into the upper joint space (4 ml) and around the capsule of TMJ unilaterally (1 ml). This procedure was then repeated on the opposite side only by using 5 ml of 0.9% saline. TMJ capsules and retrodiscal ligaments were examined four weeks following the injections.ResultsHistological examination of TMJs injected with autologous blood revealed fibrotic changes in 81.25% of the retrodiscal ligaments and 56.25% of the capsular areas. Whilst no changes were seen in the retrodiscal ligaments nor in the capsules of TMJs injected with saline alone.ConclusionThere is little published clinical data on the use of autologous blood injection and as such the mechanism of action is still unclear. The rate of induction of fibrosis within the retrodiscal ligaments in this study were similar to previously reported studies and case series. However, further studies to evaluate the mechanism of this safe and simple technique are needed.     

Clinical application of sclerosing agent injection in treating habitual dislocation of temporomandibular joint]

Based on the experimental study, small amount of sclerosing agent was injected to the site outside the joint and below the ridge of TMJ on 105 cases for the treatment of habitual dislocation of TMJ. All of the cases were followed-up for more than 2 years and it was found that the cure rate reached 89 percent, including one case who was followed-up for 19 years free from recurrence. This method is suggested as it is simple to perform and acceptable to the patients. It has to be mentioned, however, that this injection was not so effective for those with cerebrovascular disease associated with habitual dislocation of TMJ.     

Condylectomy: treatment of recurrent unilateral dislocation of the temporomandibular joint in a patient with Ehlers-Danlos syndrome

We report the use of unilateral condylectomy to treat the recurrent dislocation of the temporomandibular joint (TMJ) in a 21-year-old woman with Ehlers-Danlos syndrome. Eighteen months after operation the patient had no further dislocation on full mouth opening, and no surgical complications.     

Clinical evaluation of arthroscopic eminoplasty for habitual dislocation of the temporomandibular joint: comparative study with conventional open eminectomy

OBJECTIVE: We sought to compare the clinical courses of patients who underwent arthroscopic eminoplasty and conventional open eminectomy for habitual dislocation of the temporomandibular joint (TMJ). STUDY DESIGN: Arthroscopic eminoplasty was performed by using Segami's method in 24 joints in 13 patients (arthroscopic group) with habitual dislocation of the TMJ, while conventional open eminectomy was performed by using Myrhaug's method in 18 joints in 11 patients (open group). Clinical factors were retrospectively compared between the 2 groups. RESULTS: The operation time per joint was, on average, 14 minutes shorter in the arthroscopic group (77 minutes versus 63 minutes), and the average blood loss was less in the arthroscopic group (2 g versus 15 g). During the follow-up period (mean, 41 months), dislocation recurred in 5 TMJs (28%) in the open group and in 6 TMJs (25%) in the arthroscopic group. No major postoperative complications were observed in either group. CONCLUSION: In treating patients with habitual dislocation of the TMJ, the use of arthroscopic eminoplasty produces clinical outcomes that are as effective as those obtained with the use of conventional open eminectomy.