Intra-articular corticosteroids for treatment of temporomandibular joint internal disorders: protocol for systematic review and network meta-analysis

Injectable Platelet-Rich Fibrin (I-PRF) Administered to Temporomandibular Joint Cavities: A Scoping Review

The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular joints (TMJs). Medical databases covered by the ACM, BASE, Google, NLM, and ResearchGate were searched on 23 February 2023. The assessment of the level of evidence was based on the Oxford Center for Evidence-Based Medicine 2011 scale. The risk of bias was assessed for randomized controlled trials with the RoB2 tool. Extracted data were tabulated, and the changes in effect values were calculated. A total of eight studies qualified, of which five trials on 213 patients were randomized and controlled (RCTs). In each of the RTC study groups, arthrocentesis was performed, and 1-2 mL per joint of I-PRF (700 rpm/3 min/60 g centrifugation) was administered. Articular pain in three months decreased to 0-25% of the initial pre-interventional values in the study and 38-50% in the control groups. Mandible mobility increased to 121-153% and 115-120% in the I-PRF groups and controls, respectively. The main limitations of the evidence were the small number of RCTs and the lack of any RCT study groups receiving I-PRF without prior arthrocentesis. In conclusion, supplementing the temporomandibular joint rinsing with I-PRF administration further relieves pain and improves mandible mobility. The lack of RCTs on the intra-articular administration of I-PRF as a stand-alone procedure encourages further research. This research received no external funding. The review protocol has not been previously published.

The effects of botulinum toxin A injection on the lateral pterygoid muscle in patients with a painful temporomandibular joint click: a randomized clinical trial study

Background

Temporomandibular disorder (TMD) is the main cause of non-dental pain in orofacial area. The most common symptoms of TMD are joint pain, joint sound and limitation of jaw function. Botulinum toxin (BTX) injection is considered a potential treatment for TMD due to its pain-relieving properties and its ability to reduce muscle activity. Most of the studies are case series and further investigations are required to prove the efficacy of this treatment modality. Thus, in this study, we aimed to investigate the effect of BTX-A injection on the lateral pterygoid (LP) muscle and to evaluate its efficacy regarding TMD.

Materials and methods

Thirty-eight patients (19 women and 19 men; mean age of 26.53 years) with painful unilateral temporomandibular joint click and LP muscle tenderness were enrolled in this study. They were divided into two groups; one received an extraoral BTX-A injection in the LP muscle, and the other received a placebo injection. Pain severity, jaw movements, click severity, and Helkimo index were recorded at the first visit, as well as one week, one month, and three months after the intervention. Data were analyzed using repeated-measures analysis of variance and t-tests.

Results

The results showed that click severity was not significantly different between the BTX-A and placebo groups (P = 0.07). Pain and Helkimo index decreased significantly in the BTX group (P = 0.00 and P = 0.006, respectively); however, there was no significant difference between the two groups (P = 0.22 and P = 1, respectively). There was a significant difference in lateral movements between the groups (P = 0.00) but not in protrusive movement (P = 0.095).

Conclusions

It can be concluded that although some studies have stated that BTX injection can make the click sound disappear, in this study, we did not find a significant difference between the two groups. Furthermore, our results showed that click and pain severity decreased, but the difference was not statistically significant. Therefore, further studies with a higher dosage of BTX and more participants are recommended.

Trial registration The local Ethics Committee of Shiraz University of Medical Sciences approved this research (IR.SUMS.REC. 01/10/2018 and IRCT20130521013406N3).

A Narrative Review of Therapeutic Peripheral Nerve Blocks for Chronic Orofacial Pain Conditions

AIMS

To provide an analysis of the different therapeutic peripheral nerve blocks (PNBs), as well as their limitations and the related evidence base for their use in chronic orofacial pain (OFP) conditions, excluding migraine and other headache conditions.

METHODS/RESULTS

The evidence base for therapeutic PNBs for chronic OFP is poor and highlights the need for improved research in this area. The diagnostic criteria and interventional PNB definitions and techniques varied between studies. In addition, the placebo effect of a peripheral injection and its resultant bias was rarely considered. Most of the PNB interventions for temporomandibular disorders were for arthrogenous disorders (arthritis and disc entrapment with pain). However, there is emerging evidence for the use of onabotulinum toxin (BTX-A) in trigeminal neuralgia, with four prospective randomized controlled trials (pRCTs), and for postherpetic neuralgia. However, despite high-level evidence for BTX-A in posttraumatic neuropathic pain outside the trigeminal system, there is no evidence for its use for PTNP within the trigeminal system.

CONCLUSION

There may be emerging evidence for treating trigeminal neuralgia with BTX-A injections; however, there is a need for future clinical studies of therapeutic PNBs in orofacial pain conditions.

Follow-up evaluation of temporomandibular joints using magnetic resonance imaging after mandibular trauma: Case series analysis of young adult males

BACKGROUND/AIMS

A relationship between mandibular fractures and traumatic temporomandibular joint (TMJ) conditions has been suggested in many studies. Although magnetic resonance imaging (MRI) is the best option for a TMJ evaluation, few studies have evaluated the TMJ condition after a mandibular fracture using MRI follow-up. The aim of this study was to evaluate the TMJ for post-traumatic conditions following a mandibular fracture using follow-up MRI.

MATERIALS AND METHODS

Fourteen TMJs of seven young adult males (aged 19-21 years) with mandibular fractures were analyzed by MRI, and 12 TMJs of six patients were evaluated by follow-up MRI after the trauma. Regarding the intensity of MRI, the pathologic condition of TMJ was classified into acute joint inflammation, marrow edema, and joint space widening.

RESULTS

Thirteen joints (92.9%) showed pathologic conditions, including 11 with acute joint inflammation (84.6%), 10 with joint space widening (76.9%), and six with marrow edema (46.2%). Five out of 12 evaluated joints were injected with dexamethasone. Among these, four joints healed within one week, and one healed within one month. Among the seven untreated TMJs, four and one joint healed within one week and one month, respectively, but two joints of one patient did not improve until one month. Although that patient received arthrocentesis, the right joint showed osteoarthritis six months after the trauma.

CONCLUSIONS

Most TMJs were acutely damaged due to mandibular trauma and healed within one week to one month. A follow-up examination could be considered at one month after the injury to confirm the possibility of traumatic TMJ disorder, such as osteoarthritis.