Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study

doi:10.1016/j.ijom.2010.02.010

International Journal of Oral and Maxillofacial Surgery

Volume 39, Issue 5, May 2010, Pages 440-445

https://doi.org/10.1016/j.ijom.2010.02.010 Get rights and content

Abstract

This study examined the clinical and radiological effects of intra-articular tenoxicam injection following arthrocentesis and compared them with arthrocentesis alone in patients with disc displacement without reduction (DDwoR). 24 temporomandibular joints (TMJs) in 21 patients with DDwoR were studied. Patients were divided randomly into Group A in which only arthrocentesis was performed (14 TMJs in 14 patients) and Group AT which received arthrocentesis plus intra-articular injection of tenoxicam (10 TMJs in 7 patients). Patients were evaluated before the procedure, on postoperative day 7, then 2, 3, 4 weeks, and 2, 3, 4, 5, 6 months postoperatively. Intensity of joint pain was assessed using a visual analog scale. Maximum mouth opening was recorded at each follow-up. TMJ sounds and palpation scores were noted as positive or negative. Magnetic resonance imaging (MRI) was performed before and 6 months after treatment in both groups. Disc form, disc location during neutral position, reduction with movement, joint effusion, structures of the articular surfaces, and bone marrow anomalies were evaluated all in MRIs. Both treatments succesfully increased maximum mouth opening and reduced TMJ pain; there were no complications. Difference between the groups was not statistically significant and a larger controlled study is necessary to clarify this use of tenoxicam.

Section snippets

Materials and Methods

This study was carried out with the approval of the Istanbul University Ethics Committee of School of Medicine (2006/1204) and informed consent was obtained from all patients.

Patients included in this study had TMJ pain and limited mouth opening between August 2006 and December 2007. 24 TMJs from 21 patients (4 males, 17 females) aged 15–52 years (mean 26.43 years) with clinical and radiological diagnosis of TMJ DDwoR were included in this study (Table 1). A clinical diagnosis of TMD was made

Results

No complications or complaints were noted during or after arthrocentesis or intra-articular tenoxicam injections. 12 cases (86%) were judged successful in Group A and 8 (80%) in Group AT (Table 2). There was no statistically significant difference between the two groups according to their treatment success.

Within group analysis showed an increase in assisted and unassisted maximum mouth opening in both groups following arthrocentesis at all time intervals, but the increase was significant only

Discussion

Classically, TMDs, such as osteoarthrosis and internal derangements, have been considered to be non-inflammatory diseases²⁸, but recent studies have shown biochemical evidence of inflammation particularly following biochemical analysis of synovial fluid²³.

Little is known about the mechanism(s) involved in the initiation and maintenance of inflammation and inflammation-related pain within the TMJ²⁹. Two eicosanoids, immunoreactive PGE₂ and leukotrien B₄, have been isolated from human TMJ lavage

Funding

None.

Competing interests

None declared.

Ethical approval

This study was carried out with the approval of the Istanbul University Ethics Committee of School of Medicine (2006/1204).

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Although arthrocentesis has been used for the management of patients with temporomandibular joint pain, the benefit of hyaluronic acid (HA) or corticosteroid (CS) remains uncertain. The purpose of this study was to assess the efficacy of HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis for changes in quality of life (QoL), jaw function (Jaw Function Limitation Scale [JFLS] score), and maximum incisal opening (MIO).
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One hundred two patients were enrolled in the study. Four were lost to follow-up, leaving 98 patients for analysis of data at 1 month. An additional 51 were lost to follow-up at 3 months, leaving 51 patients for data analysis at this time point. There was no difference among groups for QoL Mental Health Composite score at 1 month (P = .70) or 3 months (P = .69). There was no difference among groups for JFLS score at 1 month (P = .71) or 3 months (P = .98). There was no difference among groups for MIO at 1 month (P = .47) or 3 months (P = .31). All groups showed within-group improvements in JFLS score and MIO at 1 and 3 months.
Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in improving jaw function and MIO at 1 and 3 months. QoL is not improved with arthrocentesis alone or in combination with CS or HA.
The next step in the treatment of persistent temporomandibular joint pain following arthrocentesis: A retrospective study of 18 cases
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Citation Excerpt :
In their study they compared intra-articular tenoxicam injection following arthrocentesis and arthrocentesis alone in patients with disc displacement without reduction. In their study no significant differences were found between the groups and they eventually required a larger controlled study to clarify this type of tenoxicam usage (Aktas et al., 2010). The findings of the present study show that VAS scores decreased in the arthrocentesis plus viscosupplementation group, at all time intervals, however these decreases were not statistically significant.
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Clinical PaperTMJ DisordersIntra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study

Abstract

Section snippets

Materials and Methods

Results

Discussion

Funding

Competing interests

Ethical approval

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Int J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

JADA

Semin Arthritis Rheum

Clinical Paper
TMJ Disorders
Intra-articular injection of tenoxicam following temporomandibular joint arthrocentesis: a pilot study