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A Journal on Dentistry and Maxillofacial Surgery
Minerva Stomatologica 2002 January-February;51(1-2):21-8
Treatment of temporo-mandibular joint closed-lock using intra-articular injection of mepivacaine with immediate resolution durable in time (six months follow-up)
Guarda Nardini L., Tito R., Beltrame A.
Background. The purpose of this study was to assess the value of intra-articular fluid injection under pressure, as a technique suggested for temporo-mandibular joint (TMJ) closed-lock treatment, and to determine if there is a persisting lock resolution in time.
Methods. Twelve patients were studied at our centre, with a diagnosis of TMJ closed-lock, not amenable with conventional therapies. All patients underwent a MRI scan, confirming the presence of anteriorly displaced disk. This technique is based on intra-articular injection of anaesthetic (mepivacaine cloridrate) under pressure, using the so called ''pumping technique'', that allows an inferior distraction of the condyle. The study has a six months follow-up. After closed-lock resolution all patients underwent physiotherapy with guided mouth opening, for one month.
Results. Mandibular function (maximal mouth opening) increased on average of 20.2 mm after treatment, and of 21.1 mm six months later (p=0.00000; with p<0.005). Pain decreased on average from VAS=6.75 to VAS=0.3 (p=0.00001; with p<0.005). The masticatory efficiency improved from VAS=5.25 to VAS=8.75 (p=0.002; p<0.005). Functional TMJ limitation level is significately increased (p=0.002; p<0.005). Also, patient's efficacy judgement (mean value 3.58= good) and tolerability judgement (mean value 2.92=good) indicate that this therapy is well accepted.
Conclusions. This technique is easy to perform, well tolerated and does not need specific instruments: it permits the resolution of TMJ closed-lock, decreases the pain and improves masticatory efficiency. All these effects persist in time. Subjects with recent closed-lock have an immediate and complete functional recovery while patients with cronic closed-lock do not.