Single-Puncture Versus Double-Puncture Technique Arthrocentesis in the Treatment of Internal Derangement of TM Joint-A Comparative Clinical Study

Abstract

Introduction: Tempormandibular Joint (TMJ) Disorders require early diagnosis with a prompt and effective treatment. Arthrocentesis has been found to be a valuable treatment aid for patients with early stage internal derangement of temporomandibular joints. The use of this procedure has been well documented in literature and had been performed for decades. Arthrocentesis under local anaesthesia can be performed in two different techniques i.e Single puncture and Double puncture techniques.

Aims and objectives: Our study was done to show the effectiveness of each of these techniques in aiding the patient as well as time taken to perform this procedure. Our study compares the two techniques to allow us to draw a proper conclusion on which can be put to use for better and less traumatic treatment of these patients.

Materials and method: For this study 50 patients with Internal Derangement, group A was 25 patients that were treated with Arthrocentesis of 200 ml RL using OnePrick TMJ Arthrocentesis System with Single Puncture technique and group B consisted of 25 patients who were treated with Arthrocentesis of 200 ml RL using Double Puncture technique.

Result: We found a significant increase in maximal mouth opening in patients undergoing arthrocentesis regardless of the technique. Comparison of mean duration of surgery performed among different groups were assessed using sample T test. Mean duration of technique A is around 17.18 minutes whereas for technique B is 20.90 minutes. The mean difference for two techniques performed is -3.722 with P value of 0.001. In technique A 24% of subjects needed additional lavage whereas in techniques B it is 20 %. On an average, total of 22 % of subjects needed additional lavage for better results. The resultant p value is around 0.733.

Discussion: The traditional double puncture technique involves the insertion of two needles into the upper joint space. Difficulties in accurate triangulation, positioning of the needle, and frequent intraoperative needle dislocations lead to longer operating times and are often encountered with the double puncture technique. On comparing the two arthrocentesis techniques in terms of easiness to operator a study done showed the group treated with single needle techniques found it easier than the double needle technique. The difference between groups was significant. The mean difference for two techniques performed was seen to be above three minutes in our study which was statistically significant.

Conclusion: Single needle technique is advantageous in the fact that it takes a shorter duration to perform, is less invasive and easier for the operator to complete successfully.

Keywords: Arthrocentesis; Internal Derangement; TMJ Disorders; Wilkies Classification.

Fig. 1

Diagnosis according to Wilkies classification

Fig. 2

A Pre-op of double cannula. B Intra-op of double cannula. C Pre-op of single cannula. D Intra-op of single cannula

Fig. 3

Mean MMO at different time intervals between the groups

Fig. 4

Mean vas scores at different time intervals between the groups