RU2325128C1 - Method of treatment of compression syndrome of temporomandibular joint and formation of articular cavity - Google Patents

Abstract

FIELD: medicine; maxillofacial surgery.

SUBSTANCE: first needle is placed 1.5-1.7 cm away from the front edge of the tragus and 4-8 ml of isotonic solution is injected in the joint cavity. The second needle is inserted in the joint cavity 2 - 2.5 cm away from the tragus. The joint is then lavaged with Ringer' s solution till waters run clear. An empty syringe is placed on the second needle with its hub on the zero mark. A syringe with isotonic solution is placed on the first needle and the solution is injected in the joint. Isotonic solution of sodium chloride is repeatedly injected in the joint. The level of decompression is measures by the height of abocclusion in the distal ends of the teeth rows and the difference in syringe volume.

EFFECT: joint function is restored without extensive surgery; lower risk of joint dystopia in the post-surgery period.

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Description

This invention relates to medicine, namely to maxillofacial surgery, and can be used in the treatment of patients with pathology of the temporomandibular joint (TMJ).

There is a method of eliminating compression syndrome of TMJ by installing decompression distraction occlusal splints on the dentition of the upper or lower jaw [Okeson G.P., 2003. Managment of Tempromandibular Disordeers and Occlusion p.507-550].

The disadvantage of this method is the impossibility of lysis of the adhesive process in the upper floor of the articular cavity and the possibility of relapse.

In addition, the disadvantage of this method is the temporary effect of eliminating the pain syndrome and degenerative inflammatory processes of the TMJ.

There is also a method of eliminating the inflammatory and degenerative processes of TMJ by injecting non-steroidal anti-inflammatory drugs at a point 1.5-1.7 cm apart from the tragus outwards along the cantharzal line, followed by an injection of the second needle into a point 2- apart from the tragus 2.5 cm outwards along the canto-tarsal line. After this, the joint cavity is washed with isotonic sodium chloride solution and Ringer's solution, followed by 1-2 ml of sodium hyaluronate solution and 0.5 ml of betamethasone solution and the installation of a stabilizing occlusal splint [Nitzan DW, Dolwick MF, Martinez GA, Tempromandibular joint artrocentesis: a simplified treatment for severe, limeted, mouth opening. J. oral and maxillofacial. Surgery 1991, 49, 1163-1667].

The disadvantage of this method is the lack of sufficient pressure for decompression in the upper floor of the joint space to remove adhesive syndrome and complete lysis of the upper floor and elimination of compression syndrome in the TMJ caused by a decrease in the vertical size of the occlusion, a change in the tone and coordination of the masticatory muscles, subsequently leading to dystopia of intraarticular structures and a decrease in the volume of articular space.

The technical result of this invention is the restoration of the function of the TMJ, the normalization of the trophism of the intraarticular disk and articular surfaces.

The technical result is achieved by the fact that in the method of eliminating the compression syndrome of the temporomandibular joint and the formation of the joint cavity, 4-8 ml of isotonic sodium chloride solution is injected into the joint cavity at a point 1.5-1.7 cm spaced from the front edge of the tragus of the canth-tarsal line, followed by injection of the syringe needle into the joint cavity at a point 2–2.5 cm from the front edge of the tragus along the canth-tarsal line, washing the joint cavity with Ringer's solution, filling it with isotonic chlorine solution sodium ide and determining the degree of decompression by open bite in the distal dentitions and the difference in the volume of syringes with the further formation of the cavity of the temporomandibular joint by repeatedly injecting an isotonic sodium chloride solution.

The method is as follows.

A patient under endotracheal anesthesia (ETN) (it is recommended to perform an ETN to achieve medical muscle relaxation of chewing muscles. Intubation is performed through the nose - transnasally - to control the occlusal relationship) after antiseptic treatment of the surgical field with an alcohol solution of chlorhexedine, departing from the anterior canal line from the anterior margin 1.5-1.7 cm outwards, the first needle was injected with a diameter of 0.8 mm. After that, an injection of 3-5 ml of isotonic sodium chloride solution is carried out in the upper part of the articular cavity, after entering an upper portion of the articular cavity, an additional portion of 1-3 ml of isotonic sodium chloride solution is introduced. Then, a second needle is injected - a syringe with a diameter of 0.8 mm, departing from the outer edge of the tragus by 2.0-2.5 cm to the upper part of the TMJ cavity, after the appearance of a drop-stream of isotonic sodium chloride solution from needle No. 2 (which are clinical a sign of fluid circulation in the joint cavity - in its upper section) is performed arthro-lavage with Ringer's solution of the cavity of the upper floor of the joint with a volume of 100-130 ml to obtain pure water. After that, an empty syringe with a volume of 5 ml with the piston position at the zero mark is inserted into the needle No. 2, a syringe with a volume of 10 ml is inserted into the needle No. 1, and syringe No. 2 is filled (a clinical sign of fluid circulation in the upper floor of the TMJ). After full filling of the syringe No. 2 (5 ml). additional stage-by-stage introduction of an isotonic sodium chloride solution into the joint is carried out by “training the upper floor of the TMJ”, which consists in alternately pumping the isotonic sodium chloride solution with syringe No. 2 for 10-15 minutes. On average, the difference between the volumes of syringes No. 2 and No. 1 with the initially filled syringe No. 1 as a result of “training of the upper floor of the TMJ” is 3-4.5 ml. The volume of decompression is determined by the formation of an open bite in the distal dentitions on the side of the decompression arthroplasty. The degree of decompression is determined by the height of the open bite in the distal sections (up to 3-5 cm) and the difference in the volume of liquids in syringes No. 1 and No. 2 (up to 5-7 ml). To fix the results of the operation and further physiological reconstruction of the chewing muscles, eccentric decompression occlusal splints can be installed. To relieve degenerative inflammatory processes, arthrocentesis is performed in the enlarged (formed) upper part of the TMJ, and they also inject 1 ml of diprospan solution, 2 ml of hyaluronate sodium solution - “ostenil, fermatron” - a liquid joint fluid implant.

Example

Patient O.E. Born in 1946, she contacted the Central Research Institute of Nuclear Medicine with complaints of persistent pain in the TMJ on the right, radiating to the parietal and temporal regions on the left, aggravated by chewing and talking, restricting the opening of the mouth, the appearance of a crunch and click in the TMJ on the right when moving the lower jaw. After consultation at the Central Scientific Research Institute of Patient Surgery, a complex of diagnostic measures was taken. The patient revealed compression syndrome, anterior displacement of the disc with a decrease in the articular space of the upper TMJ.

As a result of the laboratory-functional analysis of the relationship between the dentition during registration of the central ratio of central occlusion in the articulator system and X-ray data, the diagnosis was made: TMJ dysfunction, TMJ compression syndrome on the right, anterior disk displacement on the right, myofascial pain syndrome due to occlusal disorders. After conducting complex therapy, including drug therapy, manual reduction of the disc, physiotherapy, massage and myogymnastics, as well as the manufacture and installation of an eccentric distraction occlusal splint.

At the first stage, the patient under endotracheal anesthesia (the use of muscle relaxants of short and long action, which makes it possible to relax the chewing muscles and stretch it, allowing distraction and decompression in the TMJ with less resistance to the latter) after preliminary treatment of the surgical field with an alcohol solution of chlorhexedine 70% on the right, departing from the tragus outward by 1.5 cm, the first needle was injected with a diameter of 0.8 mm, after which an isotonic sodium chloride solution was injected - 4 ml, to determine the degree of decompression by the appearance of an open bite in the distal portions, the rest of the solution was introduced in the volume of 3 ml on the right, after which the second needle was injected with a diameter of 0.8 mm, 2.5 cm outward from the edge of the tragus, after the appearance of a drop-stream An isotonic solution of sodium chloride from a needle No. 2 (a clinical sign of fluid circulation in the joint cavity) was performed arthro lavage - rinsing with Ringer's solution in a volume of 100 ml. Turbid wash water was initially obtained, washed until clean water was obtained, after which a 5 ml syringe was inserted into needle No. 2 — empty with the piston position at zero — a 10 ml syringe filled with isotonic sodium chloride solution was inserted into needle No. 1. An injection of approximately 7 ml of isotonic sodium chloride solution was carried out while filling a 5 ml syringe No. 2. The volume of TMJ decompression was determined by the formation of an open bite in the distal dentitions on the right. After repeated “training” injections of syringe No. 1, they injected with isotonic sodium chloride solution up to 9.5 ml without visible infiltrate in the TMJ region on the right. The volume of decompression with the appearance of an open bite in the distal sections was about 3 mm and was controlled by the height of the open bite in the distal sections and the difference in the volume of liquids in syringes No. 1 and No. 2, after which the decompression distraction occlusal splint was installed and injection through the syringe No. 1 of the solution diprospan 2 ml and sodium hyaluronate solution - “ostenil” in a volume of 2 ml. Additionally, an eccentric decompression tire is installed.

Thus, the proposed method has several advantages, such as the ability to create sufficient pressure for decompression in the upper floor of the joint space to remove adhesive syndrome - arthrolysis, complete lysis of the upper floor and elimination of compression syndrome in the TMJ caused by a decrease in the vertical size of the occlusion, a change in the tone and coordination of the activity of the masticatory muscles, which subsequently leads to a dystopia of intraarticular structures and a decrease in volume authorized space.

The advantages of this method also include the fact that the elimination of adhesive syndrome of the upper part by “hydrotraining” the TMJ subsequently makes it possible to restore the physiological functions and activity of the functional part of the TMJ — the upper TMJ and the entire joint as a whole.

In addition, the method is carried out without open extensive surgical intervention in the TMJ.

Claims (1)

A method for eliminating the compression syndrome of the temporomandibular joint and the formation of the articular cavity, characterized in that the first needle is injected at a point 1.5-1.7 cm spaced from the front edge of the tragus along the canto-tragus line and injection of 4-8 ml of isotonic solution into the joint cavity, inject the second needle into the joint cavity at a point 2-2.5 cm spaced from the front edge of the tragus along the canto-tragal line, after the appearance of drops or a stream of isotonic solution from the second needle, arthro-lavage with Ringer's solution is performed until clean water, insert an empty syringe into the second needle with the piston position at zero, insert the syringe filled with an isotonic solution into the first needle and inject, then after filling the second syringe, the isotonic sodium chloride solution is repeatedly injected into the joint, while the degree of decompression determined by the height of the open bite in the distal dentitions and the difference in the volume of syringes.