Signs and symptoms after temporomandibular joint washing and cannula placement assessed by cone beam computerized tomography

Abstract

Objective. Analyses of temporomandibular joint synovial fluid using the hydroxocobalamin push–pull technique are increasingly used. However, objective complications and subjective experiences from this procedure have not been described. Firstly, this study aimed to describe discomfort and potential side-effects of this method with special emphasis on symptoms related to the arthrocentesis to be used for future patient information and Ethical Committee applications. Secondly, this study aimed to evaluate the use of cone beam computed tomography (CBCT) as control of intra-capsular cannula placement. Methods. Twenty healthy, young adult volunteers were included. Extensive objective and subjective questionnaires were completed before and 14 days after the synovial fluid sampling. With the cannula inside the joints a CBCT was done to investigate if this procedure can be used to verify intra-capsular cannula position. Results. The subjective findings: Most subjects did experience mild pain or discomfort post-operatively. In 12 of 20 subjects symptoms had resolved after 2 days and no subjects had symptoms for more than a week. The longer lasting symptoms were mainly transient joint sounds on mandibular movement. Objective findings: 14 days after the sampling mandibular protrusion had improved 1 mm, but all other objective measures were equal compared to baseline. CBCT showed a large variation in cannula position and no conclusions could be drawn from this. Conclusion. The hydroxocobalamin push–pull synovial fluid sampling may cause minor, transient symptoms. CBCT does not seem to provide any clinical benefits concerning the correct cannula position in relation to the upper joint compartment and disc.

Key Words:

• arthrocentesis
• temporomandibular joint
• symptoms
• signs
• cone beam computerized tomography

Declaration of interest: The authors report no conflict of interest. This work was supported by the Danish Rheumatism Association [Grant Number R80-1269]; and the Danish Association for Public Health Dentists.