Injection of sodium hyaluronate compared to a corticosteroid in the treatment of patients with temporomandibular joint osteoarthritis: a CT evaluation. [Influence of intra-articular injections of sodium hyaluronate on clinical features and synovial fluid nitric oxide levels of temporomandibular osteoarthritis]. Conservative treatment of temporomandibular joint osteoarthrosis: intra-articular injection of sodium hyaluronate. Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements. Intraarticular Hyaluronic Acid Injection for the Treatment of Reducing and Nonreducing Disc Displacement of the Temporomandibular Joint Effects of occlusal treatment and intraarticular injections on temporomandibular joint pain and dysfunction. Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Short-term effects of intra-articular sodium hyaluronate, glucocorticoid, and saline injections on rheumatoid arthritis of the temporomandibular joint. Preliminary studies on the use of a viscoelastic solution in arthroscopic surgery of the temporomandibular joint. Use of sodium hyaluronate in treating temporomandibular joint disorders: a randomized, double-blind, placebo-controlled clinical trial. Treatment of temporomandibular joint osteoarthritis with viscosupplementation and arthrocentesis on rabbit model. The efficacy of intra-articular sodium hyaluronate in patients with reducing displaced disc of the temporomandibular joint. The short-term effect of intra-articular injections of sodium hyaluronate and corticosteroid on temporomandibular joint pain and dysfunction.
OBJECTIVE Osseous changes in the temporom and ibular joint ( TMJ ) were evaluated using computed tomography ( CT ) examinations before and after TMJ injections of sodium hyaluronate or a corticosteroid in patients with osteoarthritis ( OA ) . STUDY DESIGN Forty patients were r and omly allocated into 2 groups for 2 intra-articular injections with either sodium hyaluronate or a corticosteroid . Bilateral TMJ examinations with high resolution CT were obtained in 36 patients before and 6 months after treatment . Treated and contralateral TMJs were evaluated for the presence of osteoarthritic osseous abnormalities by 2 review ers independently . RESULTS Progression , regression , and no changes of osseous abnormalities were demonstrated in 13 , 9 , and 14 TMJs , respectively , 6 months after treatment . There was no significant difference between the groups . CONCLUSIONS Progression/regression and no changes of osteoarthritic abnormalities were observed on CT examinations in both the treated and the contralateral TMJs after treatment with intra-articular injection with sodium hyaluronate or corticosteroid OBJECTIVE This study was design ed to assess the effect of intra-articular injection of sodium hyaluronate ( SH ) on clinical findings of temporom and ibular osteoarthritis ( OA ) and on synovial fluid ( SF ) levels of nitric oxide ( NO ) . METHODS Twenty seven patients ( 7 men , 20 women , mean ( SD ) age 53.9 ( 11.8 ) years ) with OA of the temporom and ibular joint were r and omly allocated to receive an injection of either SH ( 2 ml , Hyalgan , Fidia SpA , Abano T. , P.M. 500 - 700.000 , 20 mg/2 ml ; once a week for 5 weeks ) or a Ringer 's lactate solution ( once a week for 3 weeks ) . Clinical evaluation was done before each procedure , and at 1 week , 1 , 3 and 6 months post-injection . Intensity of temporom and ibular joint pain , jaw function , maximal mouth opening and lateral jaw movements were recorded at each visit . NO was measured on SF collected by rinsing the joint with saline 1 ml before the treatment . RESULTS Injection of SH caused significant improvement in the main clinical symptoms until the last follow-up which was carried out 6 months after last injection . Among patients who received SH injection , those who reached a good outcome showed the lowest basal levels of NO . CONCLUSIONS The results of this study showed that intra-articular injections of SH lead to a lasting improvement in the clinical symptoms of temporom and ibular OA . Furthermore , our findings suggest that low NO levels in SF are related to a better outcome of temporom and ibular OA among patients treated with SH intra-articular injection Promising short-term results in the treatment of temporom and ibular joint osteoarthrosis with intra-articular injections of sodium hyaluronate ( SH ) have been reported in preliminary studies . The present prospect i ve study compared long-term outcomes of temporom and ibular joint SH injections with those of a conventional non-surgical treatment ( bite-plane ) .  Data from three groups of 20 patients with degenerative temporom and ibular joint disease were considered . Group A underwent one cycle of five injections of 1 mL SH . Group B underwent a bite-plane treatment for at least 6 months . We considered a control group of 20 patients who refused any treatments . The description of the outcomes was based on objective and subjective parameters after a 6-month follow-up . Sodium hyaluronate and bite-plane treatments significantly improved patients conditions in all considered parameters . No significant differences in outcomes were confirmed by the statistical analysis . The tolerability of SH treatment result ed to be significantly higher . The analysis of results of serial controls in the SH treated group disclosed a significant worsening in pain at rest by comparing 1 and 6 months follow-up . Sodium hyaluronate infiltration result ed a valid non-surgical treatment for temporom and ibular joint degenerative disease . Five well-tolerated intra-articular SH injections achieved equivalent results to those of a 6 months bite-plane treatment . We did not diagnose any complications of SH intra-articular injections . Longer time follow-up is necessary to determine the stability of SH properties The purpose of this study was to compare the efficacy and the complications of intra-articular temporom and ibular joint ( TMJ ) injections in 40 patients with osteoarthritis of the TMJ . The subjects were r and omly divided into two groups , and the patients received either two intra-articular injections with sodium hyaluronate or two intra-articular injections with corticosteroids , 14 days apart . The effect of the treatment was evaluated 14 days , 1 and 6 months after the initial injection and was based on the following measurements : pain intensity , pain localization , joint sounds , m and ibular function and complications . Both groups of patients had less pain intensity at the 6-month follow-up , and there was significantly less pain intensity in the group of patients receiving sodium hyaluronate compared with corticosteroids ( P = 0.001 ) . A decrease in crepitation was seen in both groups . In the 20 subjects receiving sodium hyaluronate both the m and ibular vertical opening and protrusion increased significantly ( P < 0.000 ) . Lateral movement from the affected side increased both in subjects injected with sodium hyaluronate ( P = 0.024 ) , and those injected with corticosteroids ( P = 0.042 ) . In conclusion , this study confirms that injections in the TMJ with sodium hyaluronate or corticosteroids may reduce pain and improve function in patients with osteoarthritis . The injections were more effective in patients with only TMJ pain compared with patients suffering from both TMJ and myofascial pain . Injection with sodium hyaluronate was significantly more effective in decreasing pain intensity than corticosteroids .  Temporary pain after injections may be observed PURPOSE This study was design ed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate ( SH ) into the upper joint space in the treatment of temporom and ibular joint ( TMJ ) internal derangements . PATIENTS AND METHODS Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material . The patients ' complaints were limited mouth opening , TMJ pain and tenderness , and joint noises during function . Patients were r and omly divided into 2 groups in which only arthrocentesis was performed in 1 group and arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in the other group . Both groups contained patients with disc displacement with reduction and with closed lock . Clinical evaluation of the patients was done before the procedure , immediately after the procedure , on postoperative day 1 , and at 1 , 2 , 3 , 4 , 5 , 6 , 9 , 12 , 18 , and 24 months postoperatively . Intensity of TMJ pain , jaw function , and clicking sounds in the TMJ were assessed using visual analog scales . Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit . RESULTS Both techniques increased maximal mouth opening , lateral movements , and function , while reducing TMJ pain and noise . CONCLUSIONS Although patients benefitted from both techniques , arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone Temporom and ibular dysfunction ( TMD ) has been established as a therapeutic challenge in the plastic and maxillofacial clinics . The current treatment recommendations for TMD include resting the jaw , soft diet , and pain medication with nonsteroidal analgesic agents . If conservative and noninvasive techniques do not work , more invasive techniques may be considered . The main goal of this study was to assess the safety and clinical utility of intraarticular injection of sodium hyaluronate for the treatment of symptoms associated with internal derangement of the temporom and ibular joint ( TMJ ) . In this prospect i ve study , 40 TMJs of 33 patients who have TMD were treated with intraarticular sodium hyaluronate injections at weekly intervals for 3 weeks . Pre- and postinjection pain intensity , the presence of joint sounds , and interincisial distance were documented . The follow-up period was 12 months . There was a statistically significant reduction of pain intensity ( P < 0.01 ) and joint sound ( P < 0.05 ) in all patients . This study shows that intraarticular hyaluronic acid injection for the treatment of reducing and nonreducing disc displacement of TMJ is an effective and safe management The long-term effect ( 2 years ) of occlusal treatment and intra-articular injections of a mixture of corticosteroid and local anaesthetic was investigated in two groups of patients with pain and dysfunction in the temporom and ibular joint ( TMJ ) . Fifteen patients were treated with injections and eighteen patients with occlusal adjustment . The TMJ was tender to palpation in all patients . The intra-articular injections were given once a week for three weeks . The occlusal treatment included splints , grinding on natural teeth and occlusal correction of complete dentures . The severity of the subjective symptoms and clinical signs was estimated before and after treatment . Both sorts of treatment reduced the subjective symptoms and the clinical signs significantly , but the reduction was significantly greater after the intra-articular injections . The effect of the injections was less efficient in patients with radiographic signs of remodelling of the TMJ and general joint symptoms .  It was concluded that both intra-articular injections of corticosteroid combined with local anaesthetic and occlusal treatment have a long palliative effect on  TMJ pain and dysfunction . The intraarticular treatment , however , had a greater effect on the clinical signs OBJECTIVE Several reported studies suggest that repeated intra-articular injections of hyaluronan result in sustained relief from pain and functional disability in patients with knee osteoarthritis . Several in vivo data suggest that hyaluronan might have a beneficial structural effect in osteoarthritis . The objective of the study was to evaluate the potential structure-modifying effects of Hyalgan ( 500 - 730 kDa molecular weight ) , a highly-purified sodium hyaluronate . DESIGN Patients with painful knee osteoarthritis ( ACR criteria ) were enrolled in a prospect i ve , controlled study of 1-year duration . After r and omization , either conventional therapy or three cycles ( every 3 months ) of three intra-articular injections of Hyalgan ( once a week during 2 weeks ) were given . Clinical outcome was added using pain visual analog score ( VAS ) , functional impairment : Lequesne 's index , quality of life : arthritis impact measurement scale ( AIMS 2 ) and structural outcome using X-rays : joint space narrowing and arthroscopy : global assessment using VAS , SFA scoring and grading systems . RESULTS Of the 39 recruited patients , 36 completed the 1-year trial ( 19 in the Hyalgan group and 17 in the control group ) . There was no difference between groups at entry . Between-group comparison for changes in clinical parameters reached statistical significance for the quality of life index ( AIMS 2 : -0.4 + /- 0.7 vs 0.2 + /- 0.9 in the Hyalgan and control groups respectively , P < 0.05 ) . Deterioration in the structural parameters was less in the Hyalgan group , with a statistically significant difference for two of the three evaluated parameters ( overall assessment of chondropathy : + 5.1 + /- 12.7 vs 16.7 + /- 18.3 , P = 0.016 ; SFA scoring system : + 3.7 + /- 7.3 vs + 9.0 + /- 11.5 , P = 0.05 ) in the Hyalgan and control groups , respectively . CONCLUSIONS This study supports existing data concerning the favorable symptomatic effect of intra-articular injections of Hyalgan in osteoarthritis of the knee and suggests that repeated intra-articular injections of Hyalgan might delay the structural progression of the disease . Other studies are required to confirm these results and to determine the long-term monitoring of osteoarthritic patients using such local therapy The short-term effect ( 4 weeks ) of intra-articular injections of sodium hyaluronate , glucocorticoid , and saline was studied in three groups comprising 41 patients with rheumatoid arthritis of the temporom and ibular joint .  Sodium hyaluronate and glucocorticoid treatments had a significant positive effect according to the patients ' subjective evaluation . A comprehensive clinical dysfunction score was reduced significantly in all groups , while the number of tender muscle regions was significantly reduced and the maximum voluntary mouth opening significantly increased in the glucocorticoid and sodium hyaluronate groups only Arthroscopic surgery of the temporom and ibular joint includes the potential for iatrogenic damage of intracapsular structures during introduction of instruments and manipulation of the tissues . A modification of an elastoviscous solution of crosslinked sodium hyaluronate , called hylan fluid , was used for irrigation during surgery in 55 temporom and ibular joints . Forty-nine of the joints were monitored postoperatively in a study to measure safety and efficacy of the material during the arthroscopic procedure . The hylan fluid was found to be as safe as the st and ard irrigating fluid . The hylan fluid also significantly protected the joint surfaces and facilitated the surgical procedure This study assessed the efficacy of high-molecular-weight sodium hyaluronate as a treatment for certain intracapsular temporom and ibular joint ( TMJ ) disorders . One hundred twenty-one patients were studied at three test sites using a r and omized , double-blind , placebo-controlled experimental design . Patients were selected on the basis of 1 ) confirmed diagnosis of either degenerative joint disease ( DJD ) , reducing displaced disc ( DDR ) , or nonreducing displaced disc ( DDN ) ; 2 ) nonresponsiveness to nonsurgical therapies ; and 3 ) severe dysfunction as established by the Helkimo indices ( HI ) , visual analog scales ( VASs ) , and physical measurements of joint movement and joint noise ( arthrophonometry [ APM ] ) . Subjects received a unilateral upper joint space injection of either 1 ) 1 % sodium hyaluronate in physiologic saline ( MedChem Products , Woburn , MA ) or 2 ) USP physiologic saline . Clinical evaluations were performed using HI , VAS , and APM at weekly intervals for the first month and then at monthly intervals up to 6 months postinjection . Statistical analyses for both categorical and continuous variables were performed for each diagnostic category at each examination interval . For DJD , no difference in outcome was seen between treatment groups . For DDN , significant between-group differences were seen through 1 month ; however , beyond this time point , the number of DDN patients was insufficient to draw meaningful conclusions concerning efficacy . For DDR , statistically significant within-group and between-group improvement in all three measures ( HI , VAS , APM ) was seen for the hyaluronate group compared to the saline group throughout the 6-month test period . At the month-2 and month-3 examination intervals , twice as many patients treated with hyaluronate ( 90 % ) showed improvement compared to patients given placebo . Further , only 3 % of patients with DDR who were treated with hyaluronate  relapsed compared with 31 % of patients with DDR given placebo OBJECTIVE To evaluate the treatment effect of temporom and ibular joint ( TMJ ) osteoarthritis using viscosupplementation and arthrocentesis on rabbit model . STUDY DESIGN Bilateral TMJ osteoarthritis of 24 rabbits was established by intraarticular injection with matrix metaloproteinase-1 . The subjects were r and omly divided into 3 groups : arthrocentesis group ( group A ) , viscosupplementation group ( group B ) , and combination group ( group C ) . The rabbits were treated in the second , third , and fourth week on the left joint cavities . The right joint was used as a control . In group A ,  arthrocentesis  was applied . In group B , viscosupplementation was applied . In group C , arthrocentesis and viscosupplementation were applied together . All rabbits were killed after the 8th week for sample collection . Sections were stained with hematoxylin and eosin and sample s observed under light microscope . RESULTS There were no significant difference in pathologic change between left and right joints of group A. In group B , the average histologic assessment result of the pathologic changes in the left joint was 3.75 , and it was 7.75 in the right joint . In group C , the average histologic assessment result of the pathologic changes in the left joint was 2.50 , and it was 6.50 in the right joint . CONCLUSION Viscosupplementation inhibits the development of osteoarthritis . There was synergism when viscosupplementation was applied together with arthrocentesis In this clinical trial , we examined the efficacy of intra-articular hyaluronic acid ( HA ) treatment in 38 patients with reducing displaced disc of the temporom and ibular joint ( TMJ ) . Subjects received two unilateral upper space injections of HA or physiological saline solution with 1 week apart . Efficacy was based on the following measurements : pain and sound intensity of the joint measured by visual analogue scale ( VAS ) , modified Helkimo 's clinical dysfunction index and the intensity of joint vibration during opening and closing the mouth measured by accelerometers . These measurements were performed before the first injection and 1 and 6 months after the last injection . In the treatment group ( n=19 ) , all measurements improved significantly at month 1 and at month 6 compared with the baseline ( P < 0.01 ) . The same measurements , in the placebo group ( n=19 ) , did not show any change , except for the pain intensity which improved at month 1 and month 6 ( P < 0.05 ) . The change in baseline measurements of all of the efficacy criteria at month 1 and at month 6 in the treatment group was significantly better compared with the change obtained with placebo at the same time intervals . This study demonstrates that intra-articular sodium hyaluronate ( Orthovisc ) injection into the TMJ is an effective treatment for a reducing displaced disc The short-term effect of intra-articular injections of sodium hyaluronate and a corticosteroid ( betamethasone ) was compared in a sample of 33 patients who had pain and tenderness to palpation in the temporom and ibular joint of at least six months duration that had not responded to previous conservative treatment . The two drugs were r and omly allocated to the patients . A volume of 0.5 ml of the drug was injected twice into the superior joint compartment of the TMJ with a two-week interval between injections . The effect on subjective symptoms , clinical signs , and bite force was assessed . Both drugs reduced the symptoms and signs significantly , and no statistically significant difference in effect could be found between drugs in this regard . The results indicate that the difference between the drugs in terms of short-term therapeutic effects is small , and that sodium hyaluronate could be used as an alternative to corticosteroid for patients who have signs of TMJ inflammation , especially for those who have symptomatic osteoarthrosis
INTRODUCTION In some cases , conservative treatment of internal derangements of the Temporom and ibular Joint ( TMJ ) is considered little responsive .
Thus , it is necessary to accomplish treatments that aim at reducing pain and improve function in patients who present arthrogenic temporom and ibular disorders .
OBJECTIVE This study , by means of a systematic review of the literature , aim ed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ .