Clinical Evaluation of Arthrocentesis, Combination of Platelet-Rich Plasma and Cyclooxygenase Enzyme-2 Inhibitor in Treatment of Temporo-Mandibular Joint Anterior Displacement

The internal derangement (ID) of the TMJ is an improper functional and positional connection between the articular components of the joint. It has been estimated that 80% of TMD patients have ID, which is typically classified into two classes: disc displacement with reduction and disc displacement without reduction.

The ID of the TMJ was often accompanied by the increased expression of COX-2 in both synovium and synovial fluid. This allows the accumulation of prostaglandins in synovial fluid, accompanied by peripheral Vaso permeability, that may lead to swollen synovium. Patients may become suffering from limited jaw motion and associated pain around the TMJ in this stage.

Arthrocentesis reduces the pain through removing the adherences, eliminates the negative pressure in the joint, washes the inflammatory mediators, distends the joint space, recovering the space of the joint disc and fossa, changes the viscosity of the synovial liquid.

Reducing discomfort, restoring normal mandibular motions, and enhancing patients' quality of life are all necessary components of effective treatment for arthrogenous TMDs.

Treatment of TMJ-ID with arthrocentesis, either alone or in conjunction with intraarticular injections, is quite successful. It enhances jaw motions, promotes mouth opening, and lessens discomfort. For intra-articular injections, hyaluronic acid, platelet-rich plasma, corticosteroids and non-steroidal anti-inflammatory medications (NSAIDS) are used.

Inclusion criteria

• patients aged from 18 to 40 years old.
• patients diagnosed with ID of TMJ, suffering from limited mandibular movements, joint pain and clicking.
• Patients who are free from any systemic disease and controlled systemic disease (ASA I) (ASA II).
• Patients willing to comply with the follow-up schedule and treatment protocol.
• both genders are included

Exclusion criteria

• Patients with systemic diseases (ASA III, IV, V).
• Patients who have myofascial pain dysfunction syndrome only.
• Patients who have previous surgery in TMJ.
• Patients who have previous arthrocentesis within 1 year.
• Patients who received previous trauma to the joint.
• Use of anticoagulants or immunosuppressive medications.