The Clinical Study Of Non Direct Vision Injection Under Synovial Membrane In Blaminar Zone For The Treatment Of Habitual Dislocation

Objective:To investigate the clinical effect of non direct vision injection under synovial membrane in blaminar zone and to explore a new method with precise positioning,minimal invision and reliable outcome for the treatment of TMJ habitual dislocation.Methods:1 Case materials: 32 cases outpatients who suffered from TMJ habitual dislocation at TMJ clinic of our hospital from October 2014 to June 2016,a total of 42 joints including unilateral 22 cases and bilateral 10 cases,the average medical history was 3.61 years(Table 1).2 Research methods: all patients received MRI examination before injection to observe the articular disc shape,position and bone structure of condyle.We recorded the maximal interincisor opening(MIO)of patients before injection and six months after injection by used the non direct vision injection under synovial membrane in blaminar zone,and note down VAS values at 24 hours,three days a week,two weeks,one month and three months after injection(Table 2)and keep each patients' s jaw function questionnaire and note the change of jaw function score with time(Table 3 and Table 4).All the patients were followed up for 6 months to two years.3 Injection method: first we prepared the mixture that mixed normal saline with 2% lidocaine by 1:1,take out the mixed liquor for 5ml with a 5gauge needle and 5ml syringe,then keep the patients 45 degrees supine position,head to the contralateral side and keep big mouth,vertically puncture into the injection spot where about 5mm before intertragic notch(Fig.1),injected a little mixture in subcutaneous tissue,and then forward about 15 degrees,inward about 30 degrees,upward into the joint cavity,injectedmixture about 2.5ml,and then withdrawn the needle slowly,at the same time suctioned the liquid,labeled and fixed the needle before injection when the liquid cannot be drawn out(Fig.2),injected sodium morrhuate 0.5ml(Fig.3),continue withdrawn the needle under subcutaneous,we can complete multiple injections by adjusting the angle of the needle 5 degrees ~10 degrees in internal and external direction,pull out the needle after injection.4 Post injection treatment:the mandible was fixed by gauze with using cross method for 10 days and had a soft diet food in two weeks.5 Statistical methods: in this study,we calculated the success rate based on the standard that no joint dislocation occurred after injection.Statistical analysis was done by SPSS21.0 software and to test the data which include patients' MIO before injection and six months after injection,the value of VAS about 24 hours,3 days,1 week,2 week and 1 months after treatment,jaw function index about 24 hours,3 days,1 week,1 months,3months and 6months after injection treatment.P<0.05 was statistically significant.Results:1 Success rate: a unilateral and abilateral patients were treated with two in the half of a year,according to the standard of success,the success rate of a single injection is 92.9%(39/42),followed up two years,the success rate of second injections is 100%(42/42).2 Wilcoxon paired signed rank sum test was used to compared the 32 cases patients' MIO before injection(39.84±3.952)? and six months after injection(47.69±4.115)?,The results(z=-4.955,P=0.000<0.05)have statistically significant.3 Rank sum test was used to analyze VAS value after injection: 24 hours(4,4),3 days(4.47±2.170),1 weeks(1,1).The results(? 2=110.938,P=0.000<0.05)showed that there was no difference in VAS between at 24 hours and 2 days,2 weeks and 1 months,other comparisons have statistic significance.Similarly,there was no significant difference in the mandibular function index(?2=141.824,P=0.000<0.05),between 24 hours and the 3 days,1 months and 3months after treament.Conclusions:1 The method of non direct vision injection under synovial membrane in blaminar zone is precise positioning,the success rate of the first injection was92.9%(39/42),and the success rate of the second injection was 100%(42/42)within two years of following up.2 Non direct vision sclerosing agent injection under synovial membrane in blaminar zone have the advantage of minimal invision.Only mild pain in joint and disappeared in a week.Mandibular functional recovered in two weeks to a month.