Application of auriculotemporal nerve block and dextrose prolotherapy in exercise therapy of TMJ closed lock in adolescents and young adults

Dextrose prolotherapyeffectin improving thetemporomandibular joint disc displacement symptoms without reduction refractory to conservative treatment: a pilot study

This study aimed to evaluate the efficacy of intra-articular injection of 5% Dextrose (D5W) prolotherapy in treatment symptoms of Temporomandibular Joint (TMJ) Disc Displacement without Reduction (DDwoR) with limited mouth opening (Closed-Lock) of patients'refractory to pharmacological and physical therapy. This pilot study included twenty female patients suffering from symptoms of DDwoR with limited mouth opening mentioned in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Participants were randomly assigned into two groups; the study group patients were injected with D5W, while the control group patients were injected with 0.9% normal saline (NS). The measured variables included pain intensity on opening and closing according to the Numerical Rating Scale (NRS). Moreover, Unassisted Maximum Interincisal Opening (MIO) was measured with a millimeter-scaled ruler. These were measured before and four times after injection (2 weeks, 2 months, 6 months, and 12 months). The level of significance was set at α = 0.05. Gradual increase in MIO values in both groups with significant difference in the last time (p < 0.001), while values of NRS in both groups decreased with a significant difference in favor of the study group (p < 0.001), except for the last time (p = 0.065). In conclusion, D5W significantly affects relieving pain in female closed-lock patients.

Impact of age on degenerative joint disease of the temporomandibular joint: A systematic review and meta-analysis

BACKGROUND

It is unclear that the influence of age on degenerative joint disease (DJD) of the temporomandibular joint (TMJ).

METHODS

Relevant literature was retrieved from PubMed, Elsevier, Web of Science, and Google Scholar. EndNote 21 was used to consolidate the literature retrieved from these databases. Key information were extracted from the included studies, statistical analysis was performed using Stata 15.0. The quality of the studies was evaluated using the cross-sectional study evaluation criteria recommended by the Agency for Healthcare Research and Quality.

RESULTS

A total of 11 studies involving 2832 participants (1099 males, 1744 females) were included. The incidence of DJD of the TMJ was approximately 35% among individuals aged 20 to 39, 43% among those aged 40 to 59, and 54% among those aged 60-69.

CONCLUSION

Age progression is a key risk factor for the development of DJD of the TMJ. The incidence of DJD of the TMJ increases progressively across different age groups, with a significant rise observed in middle to older age groups.

Evaluation of the effectiveness of dextrose injection in improving chewing function in patients with the temporomandibular joint closed lock: a pilot study

OBJECTIVE

To evaluate the intra-articular injection of 5% Dextrose efficacy in treating difficulty chewing patients with Temporomandibular Joint (TMJ) Closed Lock (CL).

MATERIALS AND METHODS

This pilot study included twenty female patients suffering from symptoms of Disc Displacement without Reduction (DDwoR) with limited mouth opening (Closed Lock) mentioned in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Participants were randomly assigned into two groups; the study group patients were injected with D5W, while the control group patients were injected with 0.9% normal saline. The chewing Pain Index (CPI) was measured based on the criteria recommended by the International Association of Oral and Maxillofacial Surgeons (IAOMS) that assessed mandibular function by relating pain with the type of food eaten and using it as an index of improvement in function. The CPI was measured before and thrice after injection (2 weeks, 2 months, and 6 months). The significance level was set at α = 0.05.

RESULTS

A decrease in the CPI grades was observed in both groups, with a significant difference in favor of the study group at all follow-up times(< 0.001).

CONCLUSION

D5W improved the chewing function in female closed-lock patients.

Efficacy of dextrose prolotherapy on temporomandibular disorder: a retrospective study

Objectives

Dextrose prolotherapy is one of the most promising minimally invasive interventions for temporomandibular disorder (TMD), particularly in refractory cases where other conservative treatments have failed. The purpose of this study was to demonstrate the efficacy of a new treatment, temporomandibular joint (TMJ) prolotherapy, in patients with TMD to alleviate symptoms.

Materials and Methods

A retrospective analysis was conducted on TMD patients with chronic pain who did not respond to conventional treatments. TMJ prolotherapy was performed using hypertonic dextrose in the TMJ area, targeting the retrodiscal attachment tissue, anterior disc attachment tissue, lateral capsule, origin of the masseter muscle, and the stylomandibular ligament. Pain or discomfort intensity in the TMJ was evaluated using a numerical rating scale (NRS). Maximum mouth opening and subjective satisfaction were also analyzed.

Results

Nineteen patients (6 males, 13 females, average age 43 years) participated in this study. All patients experienced pain improvement with a maximum of three prolotherapy sessions. The initial mean NRS was 5.7, which ultimately decreased to a final mean TMJ discomfort score of 1.7 postintervention. The patients' maximum mouth opening increased from an initial 34.5 mm to 38.8 mm, and they reported positive satisfaction with the prolotherapy treatment. The clinical outcomes were positive regardless of main origin of TMD symptoms.

Conclusion

Hypertonic TMJ prolotherapy is an effective minimally invasive intervention for TMJ disorders with chronic pain.

Ultrasound Imaging of Facial Vascular Neural Structures and Relevance to Aesthetic Injections: A Pictorial Essay

The facial and submental regions are supplied by complicated neurovascular networks; therefore, facial aesthetic injections may be associated with serious adverse events such as skin necrosis and blindness. Pre-injection localization of neurovascular structures using high-resolution ultrasound can theoretically prevent unexpected complications. Therefore, a systematic protocol that focuses on these facial neurovascular structures is warranted. In this pictorial essay, we discuss the sonoanatomy of facial and submental neurovascular structures and its relevance to aesthetic injections. Moreover, we have highlighted the mechanisms underlying potential neurovascular injuries during aesthetic injections.

Effects of Radial Extracorporeal Shock Wave Therapy in Reducing Pain in Patients with Temporomandibular Disorders: A Pilot Randomized Controlled Trial

Temporomandibular disorders (TMD) are primarily characterized by pain as well as issues concerning the proper functioning of individual elements of the stomatognathic system. The aim of the study was to assess the safety and efficacy of physical exercise, with or without radial Extracorporeal Shock Wave Therapy (rESWT), in patients with TMD. Eligible patients were adults (≥18 years) with diagnosed myofascial pain with or without mouth opening limitation (Group Ia, Ib) based on the Diagnostic Criteria for TMD (DC/TMD). Enrolled patients (n = 15) were randomly assigned 1:1 to receive physical exercise combined with rESWT (n = 8) or sham rESWT (n = 7) for four weeks. The primary endpoint was the pain intensity measured by a visual analogue scale (VAS). The secondary endpoints were muscle activity and function assessed through the surface electromyography evaluation of the anterior temporalis and the masseter muscles. The rESWT group (mean age: 28.50 ± 8.85 years) showed a statistically significant pain reduction (VAS Right side: ΔT0-T1 MD = −3.00; p = 0.023, Left side: ΔT0-T1, MD = 3.57, p = 0.021), whereas patients in the sham WBV group (mean age: 30.71 ± 8.98 years), did not reach statistical significance (VAS: Right side: ΔT0-T1 MD = 1.00, p = 0.155; Left side: ΔT0-T1 MD = 1.25 SE = 0.25, p = 0.094). Concurrently, muscle activity and performance significantly improved in the active rESWT group, with an improvement in the percentage of the overlapping coefficient (POC) compared to the control group. No dropouts and no side effects were recorded. Taken together, the findings of this pilot RCT suggested that rESWT combined with physical therapy could be effective in relieving pain and improving function in muscle-related TMD patients.