Oral and maxillofacial surgery
Short-term therapeutic outcome of intra-articular high molecular weight hyaluronic acid injection for nonreducing disc displacement of the temporomandibular joint

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In a patient with temporomandibular disorder who does not respond to conservative treatment, treatment with intra-articular injection of high molecular weight sodium hyaluronate can be suggested. In our study, 27 patients with nonreduced disc displacement were diagnosed clinically and confirmed by magnetic resonance imaging. The age range was from 21 to 63 years old, with a mean of 39.3 years. Two cycles of injection of high molecular weight sodium hyaluronate was performed on alternative weeks. Pain intensity was measured by the visual analog scale. Maximal mouth opening, clicking joint noise, and lateral movement were measured before and after injection for more than 6 months. Reduction of pain intensity and improvement in the maximum mouth opening parameter was statistically significant. In conclusion, this intra-articular injection using high molecular weight sodium hyaluronate looks very positive for patients affected by nonreduced disc displacement and is encouraged to be used as a primary treatment of temporomandibular joint dysfunction.

Section snippets

Materials and methods

From a large pool of patients attending the outpatient clinic at the department of Oral and Maxillofacial Surgery, University of Hong Kong, those clinically diagnosed with TMD and who were unsuccessfully treated by conservative therapy (soft diet, jaw exercises, splint therapy) were considered for recruitment into this study.

From the above large group, patients who still complained of any one of the following: pain on mastication, joint clicking, joint noise, or limited MMO, were approached to

Preinjection findings

A total of 27 patients, 7 males and 20 females, male-to-female ratio 1:2.9, received intra-articular injection in 34 temporomandibular joints. The age range was 21 to 63 years (mean age 39.3 years) and the majority (mean 48.1%) of patients were from the age group of 40 to 49 years (Fig. 3). All patients did not have diabetes and none of them was on steroid therapy. Five patients were smokers.

The diagnoses of the joint condition based on the MRI in these 27 patients are shown in Table I.

Discussion

The use of sodium hyaluronate was first described in the 1970s by Rydell and Balazs40 and by Helfet41 in the treatment of osteoarthrosis of the knee. Many studies conducted since then on osteoarthrosis of the knee demonstrated that sodium hyaluronate helps to alleviate pain, improve knee function, and reduce knee joint crepitus.42, 43 In the treatment of TMJ disorders, this substance presents a therapeutic opportunity either as an adjunct medication after arthrocentesis or as a therapeutic

Conclusion

Based on this observational study, intra-articular TMJ injection of high molecular weight hyaluronic acid appears to be a safe and effective therapeutic method with a long-lasting effect (6 months to 1 year) in patients with nonreducing disc displacement.

The authors recommend the use of 2 injections of high molecular weight hyaluronic acid given at 2-week intervals. This therapeutic option is in our opinion preferable to the use of nonsteroidal anti-inflammatory drugs and corticosteroids, which

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