Clinical And MRI Study On Wilkes Stage Patients Treated â…¢ With Arthrocentesis

Objective:To evaluate the effectiveness of arthrocentesis on Wilkes Ⅲstage patients,clinical examination and MRI findings before and after six months treatment were compared and analyzed in this study.Methods:1 Case materials:137 outpatients at TMJ clinic of our hospital from January 2013 to December 2014 were randomly included in this study,All the patients who were successfully treated with arthrocentesis were dignosed as TMD in wilkes Ⅲstage by clinical examination and MRI findings.The patients consist of 21 males and 116 females,aged from 14 to 62 years with the mean age of 38.31 years,and with the history 4 to 24 months,(mean history 10.39 months).The patients that suffering from TMJ specific inflammation、 cancer、 the history of trauma recently、 rheumatism, rheumatoid arthritis、collagen vascular disease and other sy-stemic diseases were excepted from this study. All the patients have not received any conservative treatment within lateral five months, as for: the treatment of non-steroidal anti-inflammatory drugs, muscle relaxant treatment, splint treatment, local physiotherapy etc,the patients that fufill the above criterion and successfullytreated were incoporrated in this study.2 Arthrocentesis methods:All of the subjects was treated with arthrocentesis by a same surgeon, The patient was seated at 45° angle on the dental chair with the head turned towards the unaffected side. The target site was prepared, scrubbed and isolated with the sterile drapes. The points of needle insertion were marked on the skin. 1st point(posterior entrance point) which corresponds to the glenoid fossa was marked on the skin and 2nd point(anterior entrance point) which corresponds to the articular eminence was marked 5 mm from the first point. Patient were asked to open the mouth wide and mandible held in protruded position. Then a 7 gauge needle was introduced at 1st point and 5 ml of lidocaine lactate injected through this needle to distend the joint space. Another 7 gauge needle was then inserted at the 2nd point to establish a free flow of the solution through the joint space. A total of 150 ml carboxymethyl chitosan(CMCS) adhesion-preventing solution was used to lavage the superior joint space,Then needles were removed.3 Research Methods:All the patients accepted clinical and MRI examination before and after six months treatment, clinical examination including:Visual Analogue Scale(VAS,0-100), opening degree between incisors(mm), MRI examination including: poseterior band position、articular disc morphology、effusion in upper compartment.4Statistical Methods:Statistical analysis was done by paired t test and Chi-square methods using SPSS20.0 software,and significance level was set at P <0.05.Results:1 All of patients,the opening degree between incisors before and after treatment was according:21.73 ± 4.35 mm, 34.89 ± 2.39 mm.statistical analysis showed significance,(t1=27.42, P=0.000). the VAS before and after treatment was according:50.98±10.44,10.67±2.45.statistical analysis showed significance,(t2=32.12, P=0.000).2 The distance from A to D’(AD’) before and after treatment was according:AD’=5.37±1.48 mm,AD’=3.43± 0.75 mm, statistical analysis showed significance,(t3=17.15,P=0.003).The distance from C to D’(C’D’) before and after treatment was according:C’D’=5.94±0.97 mm,C’D’=7.52±0.72 mm, statistical analysis showed significance,( t4=18.17, P=0.014).3 The rate of disc deformity turn from 93.4% to 98.5% after arthrocentesis.The changes of disc morphology before and after treatment were as follows: the biconcave discs were from 9 cases to 2 cases,enlargement of poseterior band were from 31 cases to 17 cases,uniform thickness were from 10 cases to 29 after treatment, Linear change were from 15 cases to 19 cases, round change were from 15 cases to 26 cases, analyzed the data with Chi-square test,X2=4.85,0.025<P<0.05,statistical analysis showed significance.Bilaminar zone adaptive changes(disk-like) were found 7(5.1%) cases of the patients after treatment.The study found that 13(9.4%) cases of ADDWR turned into ADDR.4 The positive rate of effusion decreased from 38.6% to 8.0% aftersix months treatment,analyzed the data with Chi-square test, X2=53.18, P<0.005,statistical analysis showed significance.Conclusions:1 Temporomandibular joint arthrocentesis could invert disc displacement from ADDWR to ADDR. but anatomical reduction was not found in any patients.With the disappearance of clinical symptoms, adaptive changes in bilaminar zone occured in 5.1% of the patients.2 Arthrocentesis could effectively eliminate the articular effusion, with the success rate 92.4%;There is a trend that the disc deformity become serious,with the time passed,as for: folding type turned to circular type,posterior band enlargement type turned to thickness or atrophy,the disc smaller volume.3 Arthrocentesis was effective for the treatment of Wilkes Ⅲstage in shorterm evaluation,it can successfully improve mouth opening and relief pain with the success rate 81.3% and 78.4% respectively.