Effect of arthrocentesis and hydraulic distension on the temporomandibularjoint disk position

Objective, Recent studies have suggested arthrocentesis and hydraulic diste nsion as an effective treatment modality in patients demonstrating clinical finding consistent with the diagnosis of disk displacement without reducti on, normal range of motion thereby being restored and pain of the temporoma ndibular joint reduced. In view of the fact that only a few studies have be en performed to verify the biologic concept of disk displacement without re duction as a diagnostic and therapeutic approach in patients with "closed-l ock" symptoms, the purpose of this study was to investigate whether temporo mandibular joint-related variable disk position might be linked to cessatio n of related signs and symptoms associated with the performance of arthroce ntesis and hydraulic distension. Study design. The study compared 15 patients, each of whom was assigned a c linical unilateral temporomandibular joint-related diagnosis of internal de rangement (ID) type III (disk displacement without reduction) in combinatio n with capsulitis/synovitis. Clinical diagnoses were made according to the Clinical Diagnostic Criteria for Temporomandibular Disorders. Bilateral sag ittal and coronal magnetic resonance images were obtained immediately preop eratively and at 2-month follow-up to establish the presence or absence of associated types of ID. Temporomandibular joint-related pain, level of func tion, and mandibular range of motion were assessed preoperatively and the d ata were compared with the respective 2-month follow-up findings. Results. Comparison of the pretreatment temporomandibular joint side-relate d data revealed the temporomandibular joint side with an ID-III in combinat ion with capsulitis/synovitis to be associated with significantly more magn etic resonance imaging diagnoses of ID than of an absence of ID (P < .001) and with significantly more disk displacement without reduction than disk d isplacement with reduction (P < .001). At the 2-month follow-up,, clinical evaluation showed a significant reduction in temporomandibular joint-relate d pain during function (P < .001), a significant reduction in the prevalenc e of temporomandibular joint-related diagnoses of capsulitis/synovitis (P < .001) and ID-III (P < .01), and a significant increase in mandibular range of motion (P < .01). There was no change in the prevalence rates of associ ated temporomandibular joint side-related IDs. Conclusions. The results confirm the concept of disk displacement as a diag nostic approach but not as a therapeutic approach for patients presenting w ith signs and symptoms of unilateral ID-III in combination with capsulitis/ synovitis. In terms of clinical decision-making in temporomandibular disord er-related instances of ID, magnetic resonance imaging may be used as a dia gnostic method for identifying the diagnostic validity of the variable "dis k-condyle relationship."