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MRI Findings of Patients With Disc Displacement Without Reduction of the TMJ: Before and After Arthrocentesis and Stabilization Splint
Oral Abstract Session 6: TMJ MRI Findings of Patients With Disc Displacement Without Reduction of the TMJ: Before and After Arthrocentesis and Stabilization Splint
Tsurumi University, 2-1-3 Tsurumi Tsurumi-ku, Yokohama, 230-8501, Japan (Kondoh T; Saito T; Nakaoka K; Horie A; Nakajima T; Mishima A; Sekiya H; Seto K)
Hyun-Joong Yoon, DDS, PhD, Department of Oral and Maxillofacial Surgery, St Mary’s Hospital, #62 Yeouidodong, Yeongdeungpo-gu, Seoul, 150-713, Korea (Lee SH; Park YH)
Statement: This study aimed to explore the changes in arthroscopic findings and levels of a set of inflammatory cytokines in the aspirated synovial fluid (A-SF) after visually guided TMJ irrigation (VGIR) in patients with chronic closed lock (CCL). Moreover, the correlation of the obtained findings with the clinical outcome of VGIR was studied. Materials and Methods: The VGIR technique involved a simple TMJ irrigation concomitant with arthroscopic examination in the superior joint compartment. VGIR was performed in 56 consecutive patients with unilateral CCL. Forty-nine of the 56 patients underwent a second VGIR as a follow-up arthroscopy or a repeated treatment. They were assigned into either the successful (s-) group (n⫽31) or unsuccessful (u-) group (n⫽18), based on the clinical course after the first VGIR. The severities of arthroscopically observed osteoarthritis (OA), synovial lesion, or fibrous adhesion were scored respectively, as the arthroscopic scores. The levels of TNF-␣, IL-1, IL-6, IL-8, IL-12, and IL-10 per milligram of total protein in the A-SF were measured. This study has been approved by Tsurumi University Ethical Committee (No. 220), and informed consent of the study was obtained from all patients. Method of Data Analysis: The distributions of arthroscopic scores were compared between the s- and ugroups at the first and second VGIRs. In each group, the arthroscopic scores at the first VGIR were compared with those at the second VGIR. Same comparisons in the levels of each investigated cytokine were also performed. Mann-Whitney U test or Wilcoxon signed-ranks test were used for statistical analyses. A probability value (p-value) of less than 0.05 was considered to indicate significance. Results: At the first and second VGIRs, there are no differences in the distributions of arthroscopic scores between the both groups. In both groups, the severity of synovial lesion at the second VGIR significantly improved (g-group, p⫽0.006; u-group, p⫽0.034) when compared to that at the first VGIR. The IL-10 level was significantly greater in the s-group at the first VGIR (p⫽0.003). Reversely, the levels of IL-6 and IL-8 were significantly greater in the u-group (IL-6, p⫽0.007; IL-8, p⫽0.019). At the second VGIR, there were no differences in the each cytokine level between the both groups. Each cytokine level at the second VGIR did not differ from those at the first VGIR in the both groups.
Statement: The purpose of this study was to evaluate magnetic resonance imaging (MRI) changes and the clinical outcome of patients with disc displacement without reduction before and after performance of arthrocentesis and splint therapy of the temporomandibular joint. Materials and Methods: Twenty-four patients with unilateral internal derangement (disc displacement without reduction) that were successfully treated were included in this study. MRI changes in the disc position, disc mobility, disc morphology, joint effusion, bone marrow edema patterns in the mandibular condyle, osteoarthrosis and clinical outcome before and after treatment were compared. Method of Data Analysis: a. Sample size: 24 patients b. Duration of study: 30 months c. Statistical methods: The pain, functional capability and MRI changes were analyzed by the t-test (P⬍0.05) to compare before and after treatment results. Results: The results showed that the performance of arthrocentesis and splint therapy provided significant improvement in all clinical outcomes. However, there were no significant changes on the MRI. Conclusion: Although the clinical signs and symptoms were alleviated by treatment, most of the discs remained with the anterior disc displacement without reduction on MRI after treatment. These findings suggest that this treatment modality does not necessarily improve the position and deformity of the disc. References Iwase H, Sasaki T, Asakura S et al: Characterization of Patients With Disc Displacement Without Reduction Unresponsive to Nonsurgical Treatment: A Preliminary Study. J Oral Maxillofac Surg 63:1115, 2005 Rao VM, Liem MD, Farole A, et al: Elusive “stuck” disk in the temporomandibular joint: Diagnosis with MR imaging. Radiology 189:823, 1993
The Changes in Arthroscopic Findings and Inflammatory Cytokine Levels in the Synovial Fluid After Visually Guided Temporomandibular Joint Irrigation Yoshiki Hamada, DDS, PhD, First Department of Oral & Maxillofacial Surgery, School of Dental Medicine, 38.e1
AAOMS • 2007
Tsurumi University, 2-1-3 Tsurumi Tsurumi-ku, Yokohama, 230-8501, Japan (Kondoh T; Saito T; Nakaoka K; Horie A; Nakajima T; Mishima A; Sekiya H; Seto K)
Hyun-Joong Yoon, DDS, PhD, Department of Oral and Maxillofacial Surgery, St Mary’s Hospital, #62 Yeouidodong, Yeongdeungpo-gu, Seoul, 150-713, Korea (Lee SH; Park YH)
Statement: This study aimed to explore the changes in arthroscopic findings and levels of a set of inflammatory cytokines in the aspirated synovial fluid (A-SF) after visually guided TMJ irrigation (VGIR) in patients with chronic closed lock (CCL). Moreover, the correlation of the obtained findings with the clinical outcome of VGIR was studied. Materials and Methods: The VGIR technique involved a simple TMJ irrigation concomitant with arthroscopic examination in the superior joint compartment. VGIR was performed in 56 consecutive patients with unilateral CCL. Forty-nine of the 56 patients underwent a second VGIR as a follow-up arthroscopy or a repeated treatment. They were assigned into either the successful (s-) group (n⫽31) or unsuccessful (u-) group (n⫽18), based on the clinical course after the first VGIR. The severities of arthroscopically observed osteoarthritis (OA), synovial lesion, or fibrous adhesion were scored respectively, as the arthroscopic scores. The levels of TNF-␣, IL-1, IL-6, IL-8, IL-12, and IL-10 per milligram of total protein in the A-SF were measured. This study has been approved by Tsurumi University Ethical Committee (No. 220), and informed consent of the study was obtained from all patients. Method of Data Analysis: The distributions of arthroscopic scores were compared between the s- and ugroups at the first and second VGIRs. In each group, the arthroscopic scores at the first VGIR were compared with those at the second VGIR. Same comparisons in the levels of each investigated cytokine were also performed. Mann-Whitney U test or Wilcoxon signed-ranks test were used for statistical analyses. A probability value (p-value) of less than 0.05 was considered to indicate significance. Results: At the first and second VGIRs, there are no differences in the distributions of arthroscopic scores between the both groups. In both groups, the severity of synovial lesion at the second VGIR significantly improved (g-group, p⫽0.006; u-group, p⫽0.034) when compared to that at the first VGIR. The IL-10 level was significantly greater in the s-group at the first VGIR (p⫽0.003). Reversely, the levels of IL-6 and IL-8 were significantly greater in the u-group (IL-6, p⫽0.007; IL-8, p⫽0.019). At the second VGIR, there were no differences in the each cytokine level between the both groups. Each cytokine level at the second VGIR did not differ from those at the first VGIR in the both groups.
Statement: The purpose of this study was to evaluate magnetic resonance imaging (MRI) changes and the clinical outcome of patients with disc displacement without reduction before and after performance of arthrocentesis and splint therapy of the temporomandibular joint. Materials and Methods: Twenty-four patients with unilateral internal derangement (disc displacement without reduction) that were successfully treated were included in this study. MRI changes in the disc position, disc mobility, disc morphology, joint effusion, bone marrow edema patterns in the mandibular condyle, osteoarthrosis and clinical outcome before and after treatment were compared. Method of Data Analysis: a. Sample size: 24 patients b. Duration of study: 30 months c. Statistical methods: The pain, functional capability and MRI changes were analyzed by the t-test (P⬍0.05) to compare before and after treatment results. Results: The results showed that the performance of arthrocentesis and splint therapy provided significant improvement in all clinical outcomes. However, there were no significant changes on the MRI. Conclusion: Although the clinical signs and symptoms were alleviated by treatment, most of the discs remained with the anterior disc displacement without reduction on MRI after treatment. These findings suggest that this treatment modality does not necessarily improve the position and deformity of the disc. References Iwase H, Sasaki T, Asakura S et al: Characterization of Patients With Disc Displacement Without Reduction Unresponsive to Nonsurgical Treatment: A Preliminary Study. J Oral Maxillofac Surg 63:1115, 2005 Rao VM, Liem MD, Farole A, et al: Elusive “stuck” disk in the temporomandibular joint: Diagnosis with MR imaging. Radiology 189:823, 1993
The Changes in Arthroscopic Findings and Inflammatory Cytokine Levels in the Synovial Fluid After Visually Guided Temporomandibular Joint Irrigation Yoshiki Hamada, DDS, PhD, First Department of Oral & Maxillofacial Surgery, School of Dental Medicine, 38.e1
AAOMS • 2007