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A comparative study between use of arthroscopic lavage and arthrocentesis of temporomandibular joint based on computational fluid dynamics analysis.

Xu Y, Lin H, Zhu P, Zhou W, Han Y, Zheng Y, Zhang Z - PLoS ONE (2013)

Bottom Line: In the current study, we aimed to explore the biomechanical influence and explain the diverse clinical outcomes of these two approaches with computational fluid dynamics.Four types of finite volume models, featuring irrigation needles of different diameters, were constructed based on computed tomography images.Our results demonstrated that the size of outflow portal was the critical factor in determining irrigated flow rate, with a larger inflow portal and a smaller outflow portal leading to higher intra-articular pressure.

View Article: PubMed Central - PubMed

Affiliation: Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT
Arthroscopic lavage and arthrocentesis, performed with different inner-diameter lavage needles, are the current minimally invasive techniques used in temporomandibular joint disc displacement (TMJ-DD) for pain reduction and functional improvement. In the current study, we aimed to explore the biomechanical influence and explain the diverse clinical outcomes of these two approaches with computational fluid dynamics. Data was retrospectively analyzed from 78 cases that had undergone arthroscopic lavage or arthrocentesis for TMJ-DD from 2002 to 2010. Four types of finite volume models, featuring irrigation needles of different diameters, were constructed based on computed tomography images. We investigated the flow pattern and pressure distribution of lavage fluid secondary to caliber-varying needles. Our results demonstrated that the size of outflow portal was the critical factor in determining irrigated flow rate, with a larger inflow portal and a smaller outflow portal leading to higher intra-articular pressure. This was consistent with clinical data suggesting that increasing the mouth opening and maximal contra-lateral movement led to better outcomes following arthroscopic lavage. The findings of this study could be useful for choosing the lavage apparatus according to the main complaint of pain, or limited mouth opening, and examination of joint movements.

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Graphs showing the mean values of improvements.Maximal inter-incisal opening (MIO), maximal contra-lateral movement (ML) and joint pain using visual analogue scale (VAS) in patients are subjected to arthroscopy or arthrocentesis. Standard deviation values are presented as error bars. (†P<0.05; ns, not significant.).
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pone-0078953-g002: Graphs showing the mean values of improvements.Maximal inter-incisal opening (MIO), maximal contra-lateral movement (ML) and joint pain using visual analogue scale (VAS) in patients are subjected to arthroscopy or arthrocentesis. Standard deviation values are presented as error bars. (†P<0.05; ns, not significant.).

Mentions: The IAP during lavage was 14.883 ± 0.860 kPa and 13.012 ± 1.021 kPa for the arthroscopic and arthrocentesis groups, respectively. The clinical variables before and after the surgical procedures are shown in Table 1. Both the improvement in MIO (P=0.018) and ML (P=0.04) after arthroscopic lavage was significantly better than the improvement obtained after arthrocentesis, but pain reduction in the two groups was not statistically different (P=0.306). The comparative results of the two groups in terms of MIO and pain improvement are presented in Figure 2. A total of three complications were seen in the entire study group. In the arthroscopic group, one patient presented with a transient frontal palsy (duration 3 months), and one patient developed cervico-facial oedema. In the arthrocentesis group, one cervico-facial oedema was observed. The oedema was probably caused by leakage of the irriagtion fluid from the joint capsule into the deep cervicofascial space. This led to the prolonged intubation (12 h) in order to prevent subsequent post-operative respiratory distress.


A comparative study between use of arthroscopic lavage and arthrocentesis of temporomandibular joint based on computational fluid dynamics analysis.

Xu Y, Lin H, Zhu P, Zhou W, Han Y, Zheng Y, Zhang Z - PLoS ONE (2013)

Graphs showing the mean values of improvements.Maximal inter-incisal opening (MIO), maximal contra-lateral movement (ML) and joint pain using visual analogue scale (VAS) in patients are subjected to arthroscopy or arthrocentesis. Standard deviation values are presented as error bars. (†P<0.05; ns, not significant.).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3815200&req=5

pone-0078953-g002: Graphs showing the mean values of improvements.Maximal inter-incisal opening (MIO), maximal contra-lateral movement (ML) and joint pain using visual analogue scale (VAS) in patients are subjected to arthroscopy or arthrocentesis. Standard deviation values are presented as error bars. (†P<0.05; ns, not significant.).
Mentions: The IAP during lavage was 14.883 ± 0.860 kPa and 13.012 ± 1.021 kPa for the arthroscopic and arthrocentesis groups, respectively. The clinical variables before and after the surgical procedures are shown in Table 1. Both the improvement in MIO (P=0.018) and ML (P=0.04) after arthroscopic lavage was significantly better than the improvement obtained after arthrocentesis, but pain reduction in the two groups was not statistically different (P=0.306). The comparative results of the two groups in terms of MIO and pain improvement are presented in Figure 2. A total of three complications were seen in the entire study group. In the arthroscopic group, one patient presented with a transient frontal palsy (duration 3 months), and one patient developed cervico-facial oedema. In the arthrocentesis group, one cervico-facial oedema was observed. The oedema was probably caused by leakage of the irriagtion fluid from the joint capsule into the deep cervicofascial space. This led to the prolonged intubation (12 h) in order to prevent subsequent post-operative respiratory distress.

Bottom Line: In the current study, we aimed to explore the biomechanical influence and explain the diverse clinical outcomes of these two approaches with computational fluid dynamics.Four types of finite volume models, featuring irrigation needles of different diameters, were constructed based on computed tomography images.Our results demonstrated that the size of outflow portal was the critical factor in determining irrigated flow rate, with a larger inflow portal and a smaller outflow portal leading to higher intra-articular pressure.

View Article: PubMed Central - PubMed

Affiliation: Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT
Arthroscopic lavage and arthrocentesis, performed with different inner-diameter lavage needles, are the current minimally invasive techniques used in temporomandibular joint disc displacement (TMJ-DD) for pain reduction and functional improvement. In the current study, we aimed to explore the biomechanical influence and explain the diverse clinical outcomes of these two approaches with computational fluid dynamics. Data was retrospectively analyzed from 78 cases that had undergone arthroscopic lavage or arthrocentesis for TMJ-DD from 2002 to 2010. Four types of finite volume models, featuring irrigation needles of different diameters, were constructed based on computed tomography images. We investigated the flow pattern and pressure distribution of lavage fluid secondary to caliber-varying needles. Our results demonstrated that the size of outflow portal was the critical factor in determining irrigated flow rate, with a larger inflow portal and a smaller outflow portal leading to higher intra-articular pressure. This was consistent with clinical data suggesting that increasing the mouth opening and maximal contra-lateral movement led to better outcomes following arthroscopic lavage. The findings of this study could be useful for choosing the lavage apparatus according to the main complaint of pain, or limited mouth opening, and examination of joint movements.

Show MeSH
Related in: MedlinePlus