The Clinical, Radiological Study Of Temporomandibular Joint Disc Perforation With Injection Of Hyaluronic Acid Or Disc Repair&Case Reports

Temporomandibular joint disc perforation (DP) is one of the most important pathologic signs of temporomandibular joint disorders (TMDs). DP is mostly caused by trauma, anterior disc displacement without reduction, osteoarthrosis, injury and infection. It is related to signs of cartilage destruction. In clinical, the typically symptoms of DP are pain, crepitus sounds, limited mouth opening and jaw dysfunction. Some clinical studies have focused on the clinical efficacy and outcomes of arthroscopy in patients with DPs or HA injections with TMJOA. But the use of CBCT for analyzing osseous condylar changes after HA injection in DPs, has not been reported. The aim of this study was to assess the effectiveness of intra-articular injection of sodium hyaluronate in the treatment of patients with disc perforation by using Cone-beam computed tomography (CBCT).Part One:The Clinical, Radiological Study of Temporomandibular Joint Disc PerforationObjective:To analyze the clinical, radiological characteristics of Temporomandibular Joint Disc Perforation. Methods:186patients with TMJ Disc perforation were retrospectively analyzed. The analyses covered major aspects of DPs’identities, including patient gender, age distribution, clinical features, and radiology. Results:33(17.7%) of186DPs were males, other153DPs were females with an average patient age of38.0years (age range14-80years). The average maximum mouth opening(MMO) was34.20±8.78mm,the average pain measured with VAS was50.67±18.35mm,and the average Helkimo’s index was5.88±1.68. CBCT showed that about98.01%of DPs appeared destruction of the condyle. Conclusion:The occurrence of TMJ disc perforation may relate to gender and age difference.The clinical features of DP are pain, limited mouth opening. CBCT showed DP is associated with condyle destruction. Part Two:Treatment effectiveness of intra-articular injection of Hyaluronic Acid in patients with temporomandibular joint disc perforation.Objective:To assess the effectiveness of intra-articular injection of sodium hyaluronate in the treatment of patients with temporomandibular joint disc perforation by using Cone-beam computed tomography (CBCT). Patients and Methods:106patients (141joints) with disc perforation observed through arthrography who received intra-articular injection of sodium hyaluronate were included in this study. TMJ pain (visual analog scale, scores0to100), maximal mouth opening, Helkimo’s clinical dysfunction index and TMJ examinations with CBCT were obtained before and3,9,21months after treatment. Results:In3-mouth follow-up, osseous remodeling in62.4%of patients after treatment, and the mean progression index of condylar change was1.29; in9-mouth follow-up,74.2%of the patients appeared bone remodeling, and the mean progression index of condylar chang was1.89; in21-mouth follow-up, the effective rate of treatment was55.1%, the mean progression index of condylar change was1.53. A statistically significant increase (p<0.05) in TMJ function was also observed at each follow-up. Conclusions:Intra-articular injection of sodium hyaluronate is an effective procedure for treatment of temporomandibular joint disc perforation and promotes bone remodeling.Part Three:Treatment effectiveness of TMJ disc repair in patients with temporomandibular joint disc perforation.Objective:To assess the effectiveness of disc repair in the treatment of patients with temporomandibular joint disc perforation by using Cone-beam computed tomography (CBCT). Patients and Methods:47patients (68joints) with disc perforation observed through arthrography who received disc repair were included in this study. They were assigned to one of three groups according to their treatment history. TMJ pain (visual analog scale, scores0to100), maximal mouth opening, Helkimo’s clinical dysfunction index and TMJ examinations with CBCT were obtained before and3,9months after treatment. Results:In first group who didn’t respond to HA injection, osseous remodeling in63.2%of patients after treatment, and the mean progression index of condylar change was1.00±1.29; in the second group who had Jaw deformity,47.8%of the patients appeared bone remodeling, and the mean progression index of condylar chang was1.13±1.60; A statistically significant increase (p<0.05) in TMJ function was also observed at each follow-up. Conclusions:Disc repair is an effective procedure for treatment of temporomandibular joint disc perforation and promotes bone remodeling especially in the first and second groupsPart Four:Treatment of temporomandibular joint disc perforation with injection of hyaluronic acid or disc repairObjective To compare the clinical results and osseous changes of TMJ injection of sodium hyaluronate (SH) and disc repair operation in the treatment of patients with TMJ disc perforation by using cone-beam computed tomography (CBCT) and temporomandibular joint (TMJ) function. Methods Fifty-one patients (62joints) with disc perforation observed through arthrography who received injection of sodium hyaluronate and other47patients (68joints) who received disc repair were included in this study. Pain (visual analog scale, scores0to100), maximal mouth opening, modified Helkimo’s clinical dysfunction index and TMJ examinations with CBCT were obtained before and3,9months after treatment. Results A statistically significant increase (P<0.05) in TMJ clinical outcome was observed at each follow-up. The MMO (Maximal mouth opening) increased4.92,6.36mm mm and、6.29mm at3and9months follow-up in the hyaluronic acid (HA) group, and the MMO increased2.98mm and6.29mm at3and9months follow-up in the operation group. Osseous remodeling occurred in74.2%(46of62joints) of patients after HA injection and51.4%(35of68joints) of patients appeared bone remodeling after disc repair. Conclusions Both injection of hyaluronic acid and disc repair are effective for treatment of temporomandibular joint disc perforation.