Prospective Randomized Study Between Arthrocentesis and Operative Arthroscopy in the Management of Temporomandibular Joint Internal Derangement
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 40
- 试验地点
- 2
- 主要终点
- mouth opening
研究概览
简要总结
Introduction: Temporomandibular disorders (TMDs) are relatively common conditions and internal derangement is the most common among them. Different methods have been suggested for treatment , beginning with conservative approaches ending with surgery. Nowadays, arthroscopy and arthrocentesis have eliminated the use of many of the more complex surgical procedures. Despite such advancements, there is lack of prospective, randomized, clinical studies to support the use of either both. In doing the necessary studies, and comparing the results, it will be important to develop standardized patient selection criteria and treatment options to be used by all investigators.
Objectives: To compare between arthrocentesis and operative arthroscopy in the management of patients with internal derangement of temporomandibular joint stage II and III Wilkes.
Materials and Methods: a prospective study was done on 40 patients with temporomandibular joint internal derangement and were divided into 2 groups, 20 patients were treated with arthrocentesis and 20 patients were treated with operative arthroscopy.
详细描述
The temporomandibular joint (TMJ) is known as ginglymo-arthrodial joint and is formed by the bony articulations of the mandibular condyle with the glenoid fossa of the temporal bone. Interposed between the condyle and the fossa is a piece of dense avascular fibrous connective tissue namely the TMJ disc which divides the joint into superior and inferior compartments.
TMJ disorders are relatively common conditions with incidence rate of 28% - 88%. They affect up to one-third of all adults at some stage in their life.
Two fundamental components form the temporomandibular system, the temporomandibular joint (TMJ) and the associated neuromuscular system. Any defect of one or both components lead to temporomandibular disorder (TMD). Symptoms can be unilateral or bilateral involving the face, head or jaw. TMDs are broadly divided by the American Academy of Orofacial Pain (AAOP) into muscle related TMD (myogenous), and joint-related TMD (arthrogenous). The two types can be present concurently, making diagnosis and treatment more testing.
Internal derangement of the temporomandibular joint (TMJ) is one of the most common temporomandibular disorders. It was defined by Dolwick in 1983 as an abnormal relation between the temporomandibular disc with respect to the temporal fossa, the mandibular condyle, and the temporal eminence of the TMJ. It may be present with anterior disc displacement, with or without reduction, perforation of the the articular disc or even the retrodiscal tissue, and degenerative changes of the joint surfaces. Clinically, it is usually accompanied by clicking, pain, limitation of mouth opening, and locking.
In 1989, Wilkes first established a classification which consists of 5 stages based on clinical, radiologic, and intraoperative findings.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •The patients with TMJ internal derangement will be divided into 5 stages according to Wilkes Classification. Only patients with stages II and III will be included in this study.
排除标准
- •Medically unfit patients.
- •Stages I, IV & V Wilkes (Stage I patients will get benefit from conservative treatment and stage IV and V represent an advanced stages).
- •Patients with TMDs secondary to malocclusion.
- •Psychological instability.
- •Patients operated before for other TMJ problems.
结局指标
主要结局
mouth opening
时间窗: 6 months
mouth opening was measured using the maximum interincisal opening in millimeter
次要结局
- post operative pain score(6 months)
- lateral excursion movement(6 months)
- protrusive movement(6 months)
研究者
Hams Hamed Abdelrahman
Assistant lecturer
Alexandria University