Internal Derangement of Temporomandibular Joint: An Evaluation of Effect of Corticosteroid Injection Compared with Injection of Sodium Hyaluronate after Arthrocentesis

Abstract

Aims and Objectives Internal derangements are the commonest disorders of temporomandibular joint (TMJ). Different treatment modalities including conservative and surgical methods have been proposed to treat the same. Arthrocentesis is gaining popularity in the treatment of internal derangement of TMJ. Being minimally invasive it does not have the demerits of surgical approaches and at the same time is producing better results than conservative approaches. This study evaluates and compares corticosteroid and sodium hyaluronate after arthrocentesis in the treatment of internal derangement of TMJ. Materials and Methods Sixteen patients with internal derangement were randomly selected and divided into 2 groups (8 in each group). Arthrocentesis of the upper joint space was then performed using Ringer lactate under local anaesthesia followed by injection of either betamethasone or sodium hyaluronate into the joint. Clinical data was collected in the form of pain (visual analog scale), maximum mouth opening, joint sound and deviation before and after treatment up to 6 months. Results Both groups of patients were benefited from the treatment at the 6 month follow up and there was slightly less intensity of pain in sodium hyaluronate group compared with corticosteroid group. Maximum mouth opening was also increased in both groups. A decrease in clicking and deviation were seen in both groups. There was no statistically significant difference between betamethasone and sodium hyaluronate. Conclusion Intra articular injection of corticosteroid or sodium hyaluronate after arthrocentesis had considerable effect on the TMJ. Both betamethasone and sodium hyaluronate can be used after arthrocentesis with similar results.

Different Treatments in Patients with Temporomandibular Joint Disorders: A Comparative Randomized Study

“…In the current literature, there are several studies that have compared the outcome of the use of hyaluronic acid and corticosteroids [16,[28][29][30][31][32], but very few have focused on the benefits of the use of platelet-rich plasma [33][34][35]. To the authors' knowledge, there is no research currently available that compares the use of these three products in TMJ arthralgia.…”

“…It should be noted that, as demonstrated in several previous studies, the use of bite splint shows a high efficacy [36], as well as the use of intra-articular infiltrations of betamethasone, hyaluronic acid and platelet-rich plasma [28,29,[31][32][33][34][35]37,38]. However, most of the studies associate them with more invasive procedures, such as arthrocentesis that is very effective in the TMJDs and can be performed on an outpatient basis under local anesthesia.…”

Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1

“…Multiple studies with different follow-up periods have shown that a single arthrocentesis procedure results in a decrease in pain ranging from 37 to 86%. 3,31,36,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] These studies generally involve heterogeneous populations and most inject HA or CS as part of the procedure. These studies are not double blinded and most are not randomized, which introduces potential bias and confounders.…”

“…They are used in multiple joints for inflammatory arthropathy, including the TMJ. 32,[42][43][44][45] When comparing HA with CS, some investigators have found them equally effective, 42,45 whereas others have found HA to be superior. 32 The relative lack of evidence supporting or refuting the use of HA or CS makes recommending either problematic.…”

A Clinical Study of Efficacy of Hydrocortisone Compared With Hyaluronic Acid After Arthrocentesis In TMJ Disorders

“…13 Intra-articular corticosteroid injection alone or after arthrocentesis provides, long-term palliative effects on subjective symptoms and clinical signs of TMJ pain. 14,15 The anti-inflammatory effects of intra-articular corticosteroids on synovial tissues have been well documented.…”