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Effectiveness of double-puncture temporomandibular joint arthrocentesis with viscosupplementation in different categories of severity – a prospective study

2023-11Artigo científico Acesso aberto
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datacite.subject.fosCiências Médicas::Outras Ciências Médicas
datacite.subject.fosCiências Médicas::Medicina Clínica
datacite.subject.sdg03:Saúde de Qualidade
datacite.subject.sdg09:Indústria, Inovação e Infraestruturas
datacite.subject.sdg12:Produção e Consumo Sustentáveis
dc.contributor.authorÂngelo, David Faustino
dc.contributor.authorSanz, David
dc.contributor.authorCardoso, Henrique José
dc.date.accessioned2026-10-15T13:56:44Z
dc.date.available2026-10-15T13:56:44Z
dc.date.issued2023-11
dc.descriptionLink para o documento - https://davidangelo.org/wp-content/uploads/2024/05/3.-Effectiveness-of-double-puncture-temporomandibular-joint-arthrocentesis.pdf
dc.description.abstractThis 3-year prospective study evaluated the efficacy of temporomandibular joint (TMJ) arthrocentesis with viscosupplementation in different severity stages based on the Dimitroulis classification (categories 2–4 were included). TMJ arthrocentesis was performed under local anaesthesia, and the protocol consisted of a double-puncture technique with lavage of ≥150 cc Ringer Lactate plus viscosupplementation. Incobotulinum toxin A was administered 10–15 days preoperatively in patients with concomitant masticatory myalgia. The primary outcome was TMJ pain, assessed by visual analogue scale (VAS, 0–10), and the secondary outcomes were the maximum mouth opening (MMO, mm) and myalgia degree (0–3). All outcomes were assessed on the intervention day (T0) and after the procedure (T1) (minimum 1 month and then 3 months, 6 months, 1 year and every year since). A total of 108 patients were enrolled (mean age of 43.1 ± 18.9 years); 86 (80%) were women and 22 (20%) were men. Preoperative pain was 4.02 ± 3.12 (mean ± SD), MMO was 38.10 ± 9.56 (mean ± SD) and myalgia degree was 1.80 ± 1.18 (mean ± SD). After an average of 215.4 days (31–1253 days), a statistically significant improvement of pain (P < 0.0001), MMO (P = 0.005) and myalgia degree (P < 0.0001) was observed. The overall successful outcome of TMJ arthrocentesis with viscosupplementation was 76%. The authors observed increased arthrocentesis effectiveness and success rate with viscosupplementation in Dimitroulis category 2 (88.6%) compared to 3–4 (71.4%). An association was found between arthrocentesis with viscosupplementation failure and painful myalgia (ρ = 0.477; P < 0.0001). Thirteen patients (12%) underwent a second TMJ intervention after finalising the present trial. With a low complication rate, TMJ arthrocentesis with viscosupplementation led to an overall benefit for all the included patients. This study reinforces the important role of minimally invasive TMJ arthrocentesis as a first treatment option, with better results in the early stages compared to more severe stages.eng
dc.description.sponsorshipThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors would like to thank biostatistician Ricardo São João, PhD, (CEAULCentro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal) for the statistical review of the paper.
dc.identifier.citationDavid Faustino Ângelo, David Sanz, Henrique José Cardoso, Effectiveness of double-puncture temporomandibular joint arthrocentesis with viscosupplementation in different categories of severity – a prospective study, Journal of Cranio-Maxillofacial Surgery, Volume 51, Issue 11, 2023, Pages 659-667, ISSN 1010-5182, https://doi.org/10.1016/j.jcms.2023.09.010.
dc.identifier.doi10.1016/j.jcms.2023.09.010
dc.identifier.eissn1878-4119
dc.identifier.issn1010-5182
dc.identifier.urihttp://hdl.handle.net/10400.8/17074
dc.language.isoeng
dc.peerreviewedyes
dc.publisherElsevier
dc.relation.hasversionhttps://www.sciencedirect.com/science/article/pii/S1010518223001816?via%3Dihub
dc.relation.ispartofJournal of Cranio-Maxillofacial Surgery
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectTemporomandibular joint disorders
dc.subjectTMJ arthrocentesis
dc.subjectViscosupplementation
dc.subjectMinimally invasive surgical procedures
dc.titleEffectiveness of double-puncture temporomandibular joint arthrocentesis with viscosupplementation in different categories of severity – a prospective studyeng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage667
oaire.citation.issue11
oaire.citation.startPage659
oaire.citation.titleJournal of Cranio-Maxillofacial Surgery
oaire.citation.volume51
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameÂngelo
person.givenNameDavid
person.identifier.ciencia-id2C1B-F1D5-5A08
person.identifier.orcid0000-0001-8411-9946
relation.isAuthorOfPublication6d9ebcd1-9dd6-48a8-916d-3ca7b9c912eb
relation.isAuthorOfPublication.latestForDiscovery6d9ebcd1-9dd6-48a8-916d-3ca7b9c912eb

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This 3-year prospective study evaluated the efficacy of temporomandibular joint (TMJ) arthrocentesis with viscosupplementation in different severity stages based on the Dimitroulis classification (categories 2–4 were included). TMJ arthrocentesis was performed under local anaesthesia, and the protocol consisted of a double-puncture technique with lavage of ≥150 cc Ringer Lactate plus viscosupplementation. Incobotulinum toxin A was administered 10–15 days preoperatively in patients with concomitant masticatory myalgia. The primary outcome was TMJ pain, assessed by visual analogue scale (VAS, 0–10), and the secondary outcomes were the maximum mouth opening (MMO, mm) and myalgia degree (0–3). All outcomes were assessed on the intervention day (T0) and after the procedure (T1) (minimum 1 month and then 3 months, 6 months, 1 year and every year since). A total of 108 patients were enrolled (mean age of 43.1 ± 18.9 years); 86 (80%) were women and 22 (20%) were men. Preoperative pain was 4.02 ± 3.12 (mean ± SD), MMO was 38.10 ± 9.56 (mean ± SD) and myalgia degree was 1.80 ± 1.18 (mean ± SD). After an average of 215.4 days (31–1253 days), a statistically significant improvement of pain (P < 0.0001), MMO (P = 0.005) and myalgia degree (P < 0.0001) was observed. The overall successful outcome of TMJ arthrocentesis with viscosupplementation was 76%. The authors observed increased arthrocentesis effectiveness and success rate with viscosupplementation in Dimitroulis category 2 (88.6%) compared to 3–4 (71.4%). An association was found between arthrocentesis with viscosupplementation failure and painful myalgia (ρ = 0.477; P < 0.0001). Thirteen patients (12%) underwent a second TMJ intervention after finalising the present trial. With a low complication rate, TMJ arthrocentesis with viscosupplementation led to an overall benefit for all the included patients. This study reinforces the important role of minimally invasive TMJ arthrocentesis as a first treatment option, with better results in the early stages compared to more severe stages.
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