Long-term evaluation of arthrocentesis for the treatment of internal derangements of the temporomandibular joint

Purpose: Arthrocentesis is being used for treatment of patients with temporomandibular joint disorders, including anterior disc displacement with and without reduction. This study was designed to examine the long-term effects of temporomandibular joint arthrocentesis in such patients and to evaluate their overall satisfaction with this treatment. Patients and Methods: The study was based on the review of patients' records, a written questionnaire (self-evaluation), and clinical examination. Visual analog scales (VAS) were used for evaluation of pain and dysfunction. Twenty-six patients (39 joints) who had been treated at the Medical College of Virginia Hospital, Virginia Commonwealth University, were included in the study. There were 32 joints with anterior disc displacement without reduction (ADsR) and 7 joints with anterior displacement with reduction (ADcR). Patients all had undergone arthrocentesis as outpatients. Follow-up evaluations ranged from 10 to 96 months, with a mean of 48.7 months. Results: Maximum vertical opening (MVO) prearthrocentesis ranged from 20 to 40 mm, with a mean of 25.3 +/- 5.5 mm. Immediately after arthrocentesis, the MVO ranged from 30 to 55 mm, with a mean of 43.8 +/- 5.6 mm. Maximum vertical opening at long-term follow-up ranged from 15 to 50 mm, with a mean of 37.1 +/- 8.8 mm. There was a significant increase in MVO between prearthrocentesis and postarthrocentesis both short- and long-term (P < .001). The short- and long-term postoperative VAS values for pain and dysfunction showed a significant decrease (P < .001) when compared with the VAS values preoperatively. Fourteen of the 26 patients (54%) no longer experienced pain, and the remaining 9 had less pain than before arthrocentesis as assessed by self-evaluation and clinical examination. Three of 26 patients had improvement for a period, later relapsed, and required subsequent surgery. Twenty-three of the 26 patients (88%) were completely satisfied with their treatment. Overall, an 88% success rate was achieved. Conclusion: Arthrocentesis can reduce pain and dysfunction, both short- and long-term, in patients with anterior disc displacement. (C) 2000 American Association of Oral and Maxillofacial Surgeons.