Arthrocentesis with or without additional drugs in temporomandibular joint internal derangement: comparison of three treatment protocols

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Internal derangement of temporomandibular joint (TMJ) is a common condition faced by maxillofacial surgeons. Although different lines of treatment have been proposed for such condition, there is no agreement about specific algorithm for its management. Arthrocentesis has gained popularity among those treatment modalities; hence, it offers greater success rate than conservative therapy and at the same time is less invasive than open joint surgery. Intrajoint medication has been used either alone or in combination with arthrocentesis.


This study aimed to compare the use of arthrocentesis alone versus arthrocentesis in combination with intrajoint medication (corticosteroid or sodium hyaluronate) in management of TMJ internal derangement.

Materials and methods

Eighteen patients who failed conservative treatment of TMJ internal derangement were randomly selected and divided into three equal groups. Arthrocentesis of upper joint space was then performed using 150–200 ml of lactated Ringer’s solution under general anesthesia for group 1, whereas in group 2 arthrocentesis was followed by injection of 1 ml betamethasone and in group 3 arthrocentesis was followed by injection of 1 ml of sodium hyaluronate. Clinical data were collected in form of Visual Analog Scale for pain, maximum painless opening, and mandibular excursions (lateral and protrusion) before treatment as baseline record, then at 1 and 6 months postoperatively.


All patients in the three groups benefited from treatment regarding pain and mouth opening. However, there was no statistically significant difference between the three groups.

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