Arthrocentesis for Internal Derangement of Temporomandibular Joint: with and without Sodium Hyaluronate

Arthrocentesis is an effective, diagnostic and therapeutic modality for internal derangement of temporomandibular joint. Sodium Hyaluronate has been proposed as an alternative therapeutic agent with similar therapeutic effects. The aim of the study was to evaluate the role of Sodium Hyaluronate as an adjunct in treatment of patients with internal derangement of temporomandibular j oint. Methodology: A comparative study on 40 patients between the age group 20-64 years with internal derangement of temporomandibular joint was undertaken to evaluate the role of sodium hyaluronate as an adjunct in treatment.These patients were diagnosed clinically and radiographically with temporomandibular joint internal derangement who failed to respond to conservative treatments. They were divided in two groups randomly, each comprising of 20 patients. Group A comprised of patients who underwent arthrocentesis with Ringer Lactate and followed by injection with Sodium Hyaluronate. Group B were patients who underwent arthrocentesis with Ringer Lactate only. Results were evaluated on the parameters of pain, mouth opening, clicking, deviation, determination of range of lateral and protrusive movements and other complications. They were evaluated on pre -operative day, immediate post operative day and first, third and sixth month post operatively. Results: There was marked difference in all symptoms viz. of pain, mouth opening, clicking, deviation, determination of range of lateral and protrusive movements in group A as compared to group B with group A showing better response. Conclusion: Sodium Hyaluronate injection is the preferred treatment for patients suffering with temporomandibular joint internal derangement who were refractory to corroborative methods. INTRODUCTION Temporomandibular joint (TMJ) is a giglymoarthroidal joint. It is the only mobile joint in the entire maxillofacial region and is a part of craniomandibular articulation. It is unique because of the fact that both the joints need to move simultaneously for proper functioning as the force per unit area is much larger than most weight bearing joints of the body.' To facilitate the ease in motion the joint consists of fibro articular disc, synovial fluid, ligaments and capsule. It is a dual compartment structure. The condyle articulates with the temporal bone in the mandibular fossa. These two bones are separated by articular disk, which divides the TMJ into superior and inferior compartment, but as the force of mastication overcome the resistance of these structures. TMJ is subjected to disorders commonly known as temporomandibular joint disorders (TMDs) such as TMJ hypermobility, ankylosis, internal derangement, degenerative joint disease. The symptoms include pain, limitation and deviation in mandibular range of motions, TMJ sounds, headache and facial paint, internal derangement and osteoarthritis.