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Relationship between the success of arthrocentesis and preoperative magnetic resonance imaging findings

Year 2025, Volume: 8 Issue: 6, 1049 - 1054, 25.10.2025

Abstract

Aims: This study aimed to investigate the relationship between preoperative magnetic resonance imaging (MRI) findings and clinical outcomes following arthrocentesis in patients with temporomandibular joint disorders.
Methods: A total of 67 patients who had been diagnosed with disc position abnormalities and degenerative temporomandibular joint conditions based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), had preoperative MRI scans, and were treated with arthrocentesis were included in the study. The recorded preoperative variables included age, sex, pain, and maximum mouth opening (MMO). Degree of disc displacement and joint effusion were assessed using preoperative magnetic resonance images. Bone changes were evaluated using both preoperative magnetic resonance and panoramic radiography images. Arthrocentesis was considered successful when the MMO exceeded 35 mm and the pain score was less than 3.
Results: At the 1-week and 3-month follow-ups, clinical examinations showed a significant reduction in temporomandibular joint (TMJ) pain and an increase in MMO (p<0.001). The total success rate increased from 19.4% at the 1-week follow-up to 44.8% at 3 months, indicating a significant improvement over time. MRI findings, including disc displacement, effusion, and bone changes, showed no statistically significant association with treatment success. Although patients without effusion showed lower VAS scores at 1 week, this difference did not persist at 3 months.
Conclusion: Arthrocentesis is a successful intervention for treating TMD, resulting in significant reductions in pain and functional limitation. However, commonly evaluated preoperative MRI features do not appear to predict clinical success.

References

  • Guo C, Shi Z, Revington P. Arthrocentesis and lavage for treating temporomandibular joint disorders. Cochrane Database Syst Rev. 2009; (4):CD004973. doi:10.1002/14651858.CD004973.pub2
  • Jagur O, Kull M, Leibur E, et al. The associations of TMJ pain and bone characteristics on the activities of daily living. Open J Stomatol. 2012; 2(4):237-243.
  • Paesani D, Westesson PL, Hatala M, Tallents RH, Kurita K. Prevalence of temporomandibular joint internal derangement in patients with craniomandibular disorders. Am J Orthod Dentofacial Orthop. 1992; 101(1):41-47. doi:10.1016/0889-5406(92)70080-T
  • Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group. J Oral Facial Pain Headache. 2014;28(1):6-27. doi:10.11607/jop.1151
  • Ahmad M, Hollender L, Anderson Q, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(6):844-860. doi:10.1016/j.tripleo.2009.02.023
  • Sano T, Westesson PL. Magnetic resonance imaging of the temporomandibular joint. Increased T2 signal in the retrodiskal tissue of painful joints. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79(4):511-516. doi:10.1016/s1079-2104(05)80138-6
  • Hosgor H, Bas B, Celenk C. A comparison of the outcomes of four minimally invasive treatment methods for anterior disc displacement of the temporomandibular joint. Int J Oral Maxillofac Surg. 2017;46(11): 1403-1410. doi:10.1016/j.ijom.2017.05.010
  • Wieckiewicz M, Boening K, Wiland P, Shiau YY, Paradowska-Stolarz A. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain. 2015;16:106. doi:10. 1186/s10194-015-0586-5
  • Milam SB, Schmitz JP. Molecular biology of temporomandibular joint disorders: proposed mechanisms of disease. J Oral Maxillofac Surg. 1995;53(12):1448-1454. doi:10.1016/0278-2391(95)90675-4
  • Zardeneta G, Milam SB, Lee T, Schmitz JP. Detection and preliminary characterization of matrix metalloproteinase activity in temporomandibular joint lavage fluid. Int J Oral Maxillofac Surg. 1998; 27(5):397-403. doi:10.1016/s0901-5027(98)80072-6
  • Reston JT, Turkelson CM. Meta-analysis of surgical treatments for temporomandibular articular disorders: a reply to the discussants. J Oral Maxillofac Surg. 2003;61(6):737-738. doi:10.1053/joms.2003.50169
  • Nitzan DW, Dolwick MF, Martinez GA. Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg. 1991;49(11):1163-1170. doi:10.1016/0278-2391(91) 90409-f
  • Ekberg E, Hansson LG, List T, Eriksson L, Sahlström LE, Petersson A. Can MRI observations predict treatment outcome of lavage in patients with painful TMJ disc displacement without reduction? J Oral Maxillofac Res. 2015;6(1):e5. doi:10.5037/jomr.2014.6105
  • Güler N, Uçkan S, Imirzalioğlu P, Açikgözoğlu S. Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid. Dentomaxillofac Radiol. 2005;34(3):175-181. doi:10.1259/dmfr/49181266
  • Bas B, Yuceer E, Kazan D, Gurbanov V, Kutuk N. Clinical and intra-operative factors affecting the outcome of arthrocentesis in disc displacement without reduction: a retrospective study. J Oral Rehabil. 2019;46(8):699-703. doi:10.1111/joor.12808
  • Larheim TA, Westesson PL, Sano T. MR grading of temporomandibular joint fluid: association with disk displacement categories, condyle marrow abnormalities and pain. Int J Oral Maxillofac Surg. 2001;30(2): 104-112. doi:10.1054/ijom.2000.0017
  • Nitzan DW, Naaman HL. Athrocentesis: what, when, and why? Atlas Oral Maxillofac Surg Clin North Am. 2022;30(2):137-145. doi:10.1016/j.cxom.2022.06.008
  • Hu Y, Liu S, Fang F. Arthrocentesis vs conservative therapy for the management of TMJ disorders: a systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2023;124(1S):101283. doi:10.1016/j.jormas.2022.09.004
  • Alpaslan C, Dolwick MF, Heft MW. Five-year retrospective evaluation of temporomandibular joint arthrocentesis. Int J Oral Maxillofac Surg. 2003;32(3):263-267. doi:10.1054/ijom.2003.0371
  • Goudot P, Jaquinet AR, Hugonnet S, Haefliger W, Richter M. Improvement of pain and function after arthroscopy and arthrocentesis of the temporomandibular joint: a comparative study. J Craniomaxillofac Surg. 2000;28(1):39-43. doi:10.1054/jcms.1999.0103
  • Nitzan DW, Price A. The use of arthrocentesis for the treatment of osteoarthritic temporomandibular joints. J Oral Maxillofac Surg. 2001; 59(10):1154-1160. doi:10.1053/joms.2001.26716
  • Alpaslan GH, Alpaslan C. Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements. J Oral Maxillofac Surg. 2001;59(6): 613-619. doi:10.1053/joms.2001.23368
  • Emshoff R. Clinical factors affecting the outcome of arthrocentesis and hydraulic distension of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(4):409-414. doi:10.1016/j.tripleo.2004.12.024
  • Nishimura M, Segami N, Kaneyama K, Suzuki T. Prognostic factors in arthrocentesis of the temporomandibular joint: evaluation of 100 patients with internal derangement. J Oral Maxillofac Surg. 2001;59(8): 874-878. doi:10.1053/joms.2001.25019
  • Emshoff R, Rudisch A. Are internal derangement and osteoarthrosis linked to changes in clinical outcome measures of arthrocentesis of the temporomandibular joint? J Oral Maxillofac Surg. 2003;61(10):1162-1170. doi:10.1016/s0278-2391(03)00676-1
  • Iwase H, Sasaki T, Asakura S, et al. Characterization of patients with disc displacement without reduction unresponsive to nonsurgical treatment: a preliminary study. J Oral Maxillofac Surg. 2005;63(8):1115-1122. doi:10.1016/j.joms.2005.04.005
  • Smolka W, Iizuka T. Arthroscopic lysis and lavage in different stages of internal derangement of the temporomandibular joint: correlation of preoperative staging to arthroscopic findings and treatment outcome. J Oral Maxillofac Surg. 2005;63(4):471-478. doi:10.1016/j.joms.2004.07.021
  • Sato J, Segami N, Kaneyama K, Nishimura M, Suzuki T. Importance of the changes in joint effusion shown by magnetic resonance imaging before and after arthroscopic lysis and lavage of the temporomandibular joint. Br J Oral Maxillofac Surg. 2002;40(1):72-75. doi:10.1054/bjom. 2001.0737
  • Emshoff R, Rudisch A. Temporomandibular joint internal derangement and osteoarthrosis: are effusion and bone marrow edema prognostic indicators for arthrocentesis and hydraulic distention? J Oral Maxillofac Surg. 2007;65(1):66-73. doi:10.1016/j.joms.2005.11.113
  • Honda K, Yasukawa Y, Fujiwara M, Abe T, Urade M. Causes of persistent joint pain after arthrocentesis of temporomandibular joint. J Oral Maxillofac Surg. 2011;69(9):2311-2315. doi:10.1016/j.joms.2011.02.025

Artrosentez başarısı ve preoperatif manyetik rezonans görüntüleme bulguları arasındaki ilişkinin değerlendirilmesi

Year 2025, Volume: 8 Issue: 6, 1049 - 1054, 25.10.2025

Abstract

Amaç: Bu çalışma, temporomandibular eklem bozukluğu olan hastalarda preoperatif manyetik rezonans görüntüleme (MRG) bulguları ile artrosentez sonrası klinik sonuçlar arasındaki ilişkiyi araştırmayı amaçlamaktadır.
Yöntem: Bu retrospektif çalışmaya DC/TMD kriterlerine göre disk deplasmanı (reduksiyonlu veya reduksiyonsuz) ve dejeneratif eklem hastalığı tanısı konulan, artrosentez uygulanmış ve preoperatif MRG’si bulunan 67 hasta dahil edilmiştir. Cinsiyet, yaş, ağrı şiddeti ve maksimum ağız açıklığı (MMO) işlem öncesi klinik değişkenler olarak kaydedildi. Preoperatif manyetik rezonans görüntüleri değerlendirilerek disk deplasman derecesi ve efüzyon derecesi belirlendi. Kemik değişikliği derecesi ise preoperatif manyetik rezonans ve panoramik radyografi görüntüleri değerlendirilerek belirlendi. Artrosentez işleminin başarısı için, 35 mm'den fazla MMO ve 3'ten düşük ağrı şiddeti kriter olarak belirlendi.
Bulgular: Hastaların 1 haftalık ve 3 aylık takip sonuçları temporomandibular eklem (TME) ağrısında belirgin bir azalma ve MMO'da belirgin bir artış olduğunu gösterdi (P <0.001). Toplam başarı oranı 1. haftada %19.4 iken 3. ayda %44.8’e yükselmiştir. Disk deplasmanı, effüzyon ve kemik değişiklikleri ile tedavi başarısı arasında istatistiksel olarak anlamlı bir ilişki bulunmamıştır. Effüzyon olmayan hastalarda 1. haftada VAS skorları daha düşük olsa da, bu fark 3. ayda devam etmemiştir.
Sonuç: Artrosentez, TMB tedavisinde etkili bir yöntemdir. Ancak sık değerlendirilen MRG bulgularının tedavi başarısını öngörme açısından sınırlı değeri olduğu görülmektedir.

References

  • Guo C, Shi Z, Revington P. Arthrocentesis and lavage for treating temporomandibular joint disorders. Cochrane Database Syst Rev. 2009; (4):CD004973. doi:10.1002/14651858.CD004973.pub2
  • Jagur O, Kull M, Leibur E, et al. The associations of TMJ pain and bone characteristics on the activities of daily living. Open J Stomatol. 2012; 2(4):237-243.
  • Paesani D, Westesson PL, Hatala M, Tallents RH, Kurita K. Prevalence of temporomandibular joint internal derangement in patients with craniomandibular disorders. Am J Orthod Dentofacial Orthop. 1992; 101(1):41-47. doi:10.1016/0889-5406(92)70080-T
  • Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group. J Oral Facial Pain Headache. 2014;28(1):6-27. doi:10.11607/jop.1151
  • Ahmad M, Hollender L, Anderson Q, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(6):844-860. doi:10.1016/j.tripleo.2009.02.023
  • Sano T, Westesson PL. Magnetic resonance imaging of the temporomandibular joint. Increased T2 signal in the retrodiskal tissue of painful joints. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79(4):511-516. doi:10.1016/s1079-2104(05)80138-6
  • Hosgor H, Bas B, Celenk C. A comparison of the outcomes of four minimally invasive treatment methods for anterior disc displacement of the temporomandibular joint. Int J Oral Maxillofac Surg. 2017;46(11): 1403-1410. doi:10.1016/j.ijom.2017.05.010
  • Wieckiewicz M, Boening K, Wiland P, Shiau YY, Paradowska-Stolarz A. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain. 2015;16:106. doi:10. 1186/s10194-015-0586-5
  • Milam SB, Schmitz JP. Molecular biology of temporomandibular joint disorders: proposed mechanisms of disease. J Oral Maxillofac Surg. 1995;53(12):1448-1454. doi:10.1016/0278-2391(95)90675-4
  • Zardeneta G, Milam SB, Lee T, Schmitz JP. Detection and preliminary characterization of matrix metalloproteinase activity in temporomandibular joint lavage fluid. Int J Oral Maxillofac Surg. 1998; 27(5):397-403. doi:10.1016/s0901-5027(98)80072-6
  • Reston JT, Turkelson CM. Meta-analysis of surgical treatments for temporomandibular articular disorders: a reply to the discussants. J Oral Maxillofac Surg. 2003;61(6):737-738. doi:10.1053/joms.2003.50169
  • Nitzan DW, Dolwick MF, Martinez GA. Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg. 1991;49(11):1163-1170. doi:10.1016/0278-2391(91) 90409-f
  • Ekberg E, Hansson LG, List T, Eriksson L, Sahlström LE, Petersson A. Can MRI observations predict treatment outcome of lavage in patients with painful TMJ disc displacement without reduction? J Oral Maxillofac Res. 2015;6(1):e5. doi:10.5037/jomr.2014.6105
  • Güler N, Uçkan S, Imirzalioğlu P, Açikgözoğlu S. Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid. Dentomaxillofac Radiol. 2005;34(3):175-181. doi:10.1259/dmfr/49181266
  • Bas B, Yuceer E, Kazan D, Gurbanov V, Kutuk N. Clinical and intra-operative factors affecting the outcome of arthrocentesis in disc displacement without reduction: a retrospective study. J Oral Rehabil. 2019;46(8):699-703. doi:10.1111/joor.12808
  • Larheim TA, Westesson PL, Sano T. MR grading of temporomandibular joint fluid: association with disk displacement categories, condyle marrow abnormalities and pain. Int J Oral Maxillofac Surg. 2001;30(2): 104-112. doi:10.1054/ijom.2000.0017
  • Nitzan DW, Naaman HL. Athrocentesis: what, when, and why? Atlas Oral Maxillofac Surg Clin North Am. 2022;30(2):137-145. doi:10.1016/j.cxom.2022.06.008
  • Hu Y, Liu S, Fang F. Arthrocentesis vs conservative therapy for the management of TMJ disorders: a systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2023;124(1S):101283. doi:10.1016/j.jormas.2022.09.004
  • Alpaslan C, Dolwick MF, Heft MW. Five-year retrospective evaluation of temporomandibular joint arthrocentesis. Int J Oral Maxillofac Surg. 2003;32(3):263-267. doi:10.1054/ijom.2003.0371
  • Goudot P, Jaquinet AR, Hugonnet S, Haefliger W, Richter M. Improvement of pain and function after arthroscopy and arthrocentesis of the temporomandibular joint: a comparative study. J Craniomaxillofac Surg. 2000;28(1):39-43. doi:10.1054/jcms.1999.0103
  • Nitzan DW, Price A. The use of arthrocentesis for the treatment of osteoarthritic temporomandibular joints. J Oral Maxillofac Surg. 2001; 59(10):1154-1160. doi:10.1053/joms.2001.26716
  • Alpaslan GH, Alpaslan C. Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements. J Oral Maxillofac Surg. 2001;59(6): 613-619. doi:10.1053/joms.2001.23368
  • Emshoff R. Clinical factors affecting the outcome of arthrocentesis and hydraulic distension of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(4):409-414. doi:10.1016/j.tripleo.2004.12.024
  • Nishimura M, Segami N, Kaneyama K, Suzuki T. Prognostic factors in arthrocentesis of the temporomandibular joint: evaluation of 100 patients with internal derangement. J Oral Maxillofac Surg. 2001;59(8): 874-878. doi:10.1053/joms.2001.25019
  • Emshoff R, Rudisch A. Are internal derangement and osteoarthrosis linked to changes in clinical outcome measures of arthrocentesis of the temporomandibular joint? J Oral Maxillofac Surg. 2003;61(10):1162-1170. doi:10.1016/s0278-2391(03)00676-1
  • Iwase H, Sasaki T, Asakura S, et al. Characterization of patients with disc displacement without reduction unresponsive to nonsurgical treatment: a preliminary study. J Oral Maxillofac Surg. 2005;63(8):1115-1122. doi:10.1016/j.joms.2005.04.005
  • Smolka W, Iizuka T. Arthroscopic lysis and lavage in different stages of internal derangement of the temporomandibular joint: correlation of preoperative staging to arthroscopic findings and treatment outcome. J Oral Maxillofac Surg. 2005;63(4):471-478. doi:10.1016/j.joms.2004.07.021
  • Sato J, Segami N, Kaneyama K, Nishimura M, Suzuki T. Importance of the changes in joint effusion shown by magnetic resonance imaging before and after arthroscopic lysis and lavage of the temporomandibular joint. Br J Oral Maxillofac Surg. 2002;40(1):72-75. doi:10.1054/bjom. 2001.0737
  • Emshoff R, Rudisch A. Temporomandibular joint internal derangement and osteoarthrosis: are effusion and bone marrow edema prognostic indicators for arthrocentesis and hydraulic distention? J Oral Maxillofac Surg. 2007;65(1):66-73. doi:10.1016/j.joms.2005.11.113
  • Honda K, Yasukawa Y, Fujiwara M, Abe T, Urade M. Causes of persistent joint pain after arthrocentesis of temporomandibular joint. J Oral Maxillofac Surg. 2011;69(9):2311-2315. doi:10.1016/j.joms.2011.02.025
There are 30 citations in total.

Details

Primary Language English
Subjects Oral and Maxillofacial Surgery
Journal Section Original Article
Authors

Ezgi Yüceer Çetiner 0000-0003-4393-9440

Dilara Kazan 0000-0002-7471-8758

Burcu Baş Akkor 0000-0003-0593-3400

Publication Date October 25, 2025
Submission Date September 8, 2025
Acceptance Date October 15, 2025
Published in Issue Year 2025 Volume: 8 Issue: 6

Cite

AMA Yüceer Çetiner E, Kazan D, Baş Akkor B. Relationship between the success of arthrocentesis and preoperative magnetic resonance imaging findings. J Health Sci Med / JHSM. October 2025;8(6):1049-1054.

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