Autologous blood injection as a new treatment modality for chronic recurrent temporomandibular joint dislocation

doi:10.1016/j.tripleo.2009.08.002

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 109, Issue 1, January 2010, Pages 31-36

https://doi.org/10.1016/j.tripleo.2009.08.002 Get rights and content

Purpose

Many different surgical and nonsurgical techniques have been used to treat patients with chronic recurrent temporomandibular joint (TMJ) dislocation. The nonsurgical techniques consist of injecting different substances into the TMJ area. This study was carried out to assess autologous blood injection to the TMJ for treatment of chronic recurrent TMJ dislocation.

Patients and methods

Thirty patients having chronic recurrent TMJ dislocation were randomly divided into 2 equal groups (15 patients in each). Group A was treated only by autologous blood injection into the superior joint space (SJS), whereas group B received autologous blood injections to the SJS and the pericapsular tissues (PT).

Results

At the end of the follow-up period of 1 year, the results of the current study have showed that injection of autologous blood to the SJS and PT gave a higher success rate (80%) than its injection only into the SJS (60%). Moreover, the patients of group B had an average decrease in their maximal mouth opening (5.3 ± 2.1) higher than that of group A (3.6 ± 1.5). Also, the digital radiographic imaging of the joints in group B only showed the condylar head posterior to the articular eminence, in open position, instead of being anterior to it before the injection. In both groups, no destructive changes to the bony components of the joint have been observed.

Conclusions

We could conclude from this study that the injection of autologous blood into the TMJ in patients with chronic recurrent dislocation is a simple, safe and cost-effective technique. So, we encourage injection of autologous blood to the SJS and PT for treatment of patients with chronic recurrent TMJ dislocation, as it has shown better clinical and radiographic results than its injection only to the SJS.

Section snippets

Patients and Methods

Thirty patients coming to the Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University complaining of bilateral chronic recurrent dislocation were included in this study. They were diagnosed as having chronic recurrent TMJ dislocation based on the clinical and radiographic criteria of Nitzan.² The patients were 12 males and 18 females, with an average age of 34 years (range from 20 to 56 years). Their maximal mouth opening, measured between maxillary

Results

In general, all patients tolerated the arthrocentesis procedures and the autologous blood injections without any serious complications either during the injection or later on during the follow-up period. The postoperative pain was tolerable in all patients and lasted only for few days after the injections. It was easily controlled by taking the previously prescribed nonsteroidal anti-inflammatory drugs.

At 2 weeks after the autologous blood injection, 11 patients (73%) of group A and 13 patients

Discussion

Hypermobility of the mandible is a condition characterized by an excessive looseness of the TMJ that permits excessive mandibular movements. The hypermobility is divided into subluxation and dislocation. During subluxation, the condyles ride over the articular eminence without staying locked there.²⁰ This situation usually does not concern the patients. However, in dislocation the patient seeks treatment because the mandible locks while opening the mouth. This condition interferes with the

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In AWBI, blood is drawn by venipuncture and is re-administered to the same individual at a different site. Small amounts, usually up to 10 ml, are injected by various routes- intravenously, intra-articularly [25], into tendons [26,27], ligaments, peri-ligament sites [28], insertion points [25], fascia [29], intraocularly [30], into lesions and wounds [31], and most commonly - intramuscularly, whether into injured or diseased muscle [32] or into an unrelated muscle for ease of access and compliance to injection, in the aim of affecting a different bodily system [33-35]. Treatment with AWBI is especially prevalent in the fields of dermatology, orthopedics, and ophthalmology (Table 1).
Autologous blood-derived products (ABP) are the focus of growing scientific interest and are investigated and used for multiple medical indications. ABPs hold promise thanks to their availability, ease of preparation, and low risk of adverse allogenic reaction, hypersensitivity, and contamination. Compositional analysis of ABPs reveals a diverse mixture of cellular components, cytokines and growth factors that play roles in healing processes such as tissue proliferation and angiogenesis, modulation of the local environment through chemotaxis and regulation of inflammation and the extracellular matrix, as well as several immunomodulatory actions. Thus, the administration of ABP induces supraphysiological levels of components necessary for orchestrating reparative efforts in currently difficult-to-treat medical conditions. In this article, we review the variety of autologous blood-derived products, their composition, current clinical uses, regulatory climate, and mechanisms of action.
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The aim of this study was to investigate the effectiveness of platelet-rich plasma (PRP) injection after arthrocentesis or arthroscopy in patients with temporomandibular joint osteoarthritis.
Electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched for reports up to July 30, 2018. We included all published or unpublished randomized controlled trials (RCTs). The primary outcome was pain reduction, and the secondary outcome was the improvement of maximal mouth opening. Weighted mean differences were utilized for random-effect meta-analysis.
Five RCTs were enrolled in the meta-analysis, comparing PRP injection to placebo (hyaluronic acid [HA] injection, saline injection, or no injection). The results revealed that PRP injection was more effective than placebo in pain reduction, but no in the improvement of maximal mouth opening, in the long term. In the subgroup analysis, PRP injection yielded better outcome only in pain reduction comparing to HA injection (Weighted mean difference 1.34, 95% confidence interval [CI] 0.95–1.73).
This meta-analysis demonstrated that PRP injection provided adjuvant efficacy to arthrocentesis or arthroscopy in pain reduction for temporomandibular joint osteoarthritis in the long term. Furthermore, PRP injection significantly reduced pain better compared with HA injection, saline injection, or no injection.
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We investigated the prognosis after three years of treatment for recurrent dislocation of the temporomandibular joint with autologous blood given intravenously in 21 patients with a mean (range) age 64 (17-92) years of whom 16 had coexisting systemic disease. The mean (range) follow up from the first injection was 64 (41-99) months. Eighteen patients had no recurrence during the first 36 months after their first injection, which showed that this minimally-invasive treatment was effective, particularly for those who had conditions that made a mouthpiece or operation unsuitable.
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Oral and maxillofacial surgeryAutologous blood injection as a new treatment modality for chronic recurrent temporomandibular joint dislocation

Purpose

Patients and methods

Results

Conclusions

Section snippets

Patients and Methods

Results

Discussion

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

J Craniomaxillofac Surg

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Temporomandibular joint ‘open lock’ versus condylar dislocationSigns and symptoms, imaging, treatment and pathogenesis

J Oral Maxillofac Surg

Reduction of a chronic bilateral temporomandibular joint dislocation with intermaxillary fixation and botulinum toxin A

Br J Oral Maxillofac Surg

Recurrent temporomandibular joint dislocation treated with botulinum toxin: report of 3 cases

J Oral Maxillofac Surg

Oral and maxillofacial surgery
Autologous blood injection as a new treatment modality for chronic recurrent temporomandibular joint dislocation