{"id":2538,"date":"2015-04-26T07:00:32","date_gmt":"2015-04-26T07:00:32","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=2538"},"modified":"2020-04-26T08:54:38","modified_gmt":"2020-04-26T08:54:38","slug":"usage-of-ringers-lactate-treatment-in-temporomandibular-joint-disorder","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol5no2\/usage-of-ringers-lactate-treatment-in-temporomandibular-joint-disorder\/","title":{"rendered":"Usage of Ringer\u2019s Lactate Treatment in Temporomandibular Joint Disorder"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

The temporomandibular joint is a movable diarthroid synovial joint which is formed by mandibular condyle and temporal bone. The joint space is divided into two compartments by articular disc. The upper compartment allows translation of the condyle. The lower compartment allows rotation movement of the jaw around its axis, through both the condylar heads \u2013 a hinge joint. Various etiology have been described for the TMJ disorders, posing a challenge to the clinicians treating them. The treatment modalities ranging from non – surgical to surgical interventions have been advocated for variety of diseases. The important progress in the treatment of TMJ disorder is the use of arthroscopy. Arthroscopy is found useful for both diagnostic purpose and therapeutic procedures by the use of TMJ arthroscopic lysis and lavage.1<\/sup><\/p>\n

Arthrocentesis is a simple and cheapest alternative to arthroscopic surgery2,3<\/sup>. This procedure can easily be done in outpatient under Local Anesthetic without using any arthroscope. This technique is very specialized and patients have a very good and quick recovery phase. 4<\/sup>Brennan (2006) advocated that the use of intra articular morphine injection with arthrocentesis have given good results. 5<\/sup>Ercument Onder (2009) have conclude that long term cure using arthrocentesis was found to be useful . The idea is to wash out the joint inflammatory cells in the jaw joint which causes the pain & restricted jaw 6<\/sup> . Steroids may also be instilled into the jaw joint depending on the severity of the condition.<\/p>\n

Arthrocentesis is a simple and a specialized technique using sterile needles and sterile irrigants to carry out the joint wash out. Ringer’s lactate is one of the \u00a0irrigants used for this purpose. Since Ringer’s lacate is comparitively closer to human serum it is preferred to other irrigants used for this purpose. The patients with TMJ disorders present with sudden onset of pain in TMJ region, presence or absence of clicking with jaw movements, limited jaw movements because of pain associated with temporomandibular joint.<\/p>\n

Discussion<\/strong><\/p>\n

The use of Ringer’s Lactate in arthroscopic lysis and lavage of the superior joint space in reestablishing the normal jaw function has gained much recognition in recent times and it is thought that the concept of arthrocentesis evolved from these procedures. This mode of treatment has shown remarkable success rate despite not using major surgical interventions. This minimally invasive surgical procedure has gained much recognition in the recent times. Murakami et al(1995),7<\/sup> while being the first to document a systematic description of the procedure, also reported a high success rate in treating patients with temporomandibular joint disorders using this procedure.<\/p>\n

2<\/sup>Nitzan et al (1991) described this as a simplified form of arthroscopic lavage and lysis of the joint . The studies conducted by Nitzan et al., (1991)2<\/sup> and 8<\/sup>Frost, (1999) showed a success rate of 91% in 17 cases while Forst et al., suggested that this procedure is safe with minimal complications. The procedure proved reliable in patients with acute TMJ locking, others with chronic or osteoarthiritic cases as well as patients with a history of jaw joint surgeries, did not show such satisfactory results.<\/p>\n

1<\/sup>Ohisini, (1975) described the use of the arthroscopy of the TMJ disorder. Since then various modifications and improvement in the techniques have refined the treatment of the TMJ disorders. 9<\/sup>Hosaka et al. (1996) have reported 78.9% success rate with arthrocentesis in patients with painful closed lock of TMJ while Murakami et al in 1995 have reported a 70% success rate in their study. 10<\/sup>Dimitroulis et al (1995) also have reported a significant improvement in such patients.<\/p>\n

Internal derangement of Temporomandibular Joint varies from, clicking accompanied with normal mouth opening to clicking with restricted mouth opening (closed lock).<\/p>\n\n\n\n
\u00a0\"Figure<\/td>\n\n

Figure 1: Showing TMJ Closed Lock\u00a0<\/strong><\/p>\n

Click here to View figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

11<\/sup>Nitzan, (1994) has reported that arthrocentesis is a turning point in treating TMJ disorders. He attributes the success of the procedure to arthroscopic lysis and lavage and hydraulic pressure used in the upper joint compartment. This procedure was found to be highly effective in restoring the normal jaw function and maximum mouth opening. 1<\/sup>Ohisini, (1975) have suggested that the effectiveness of this approach was due to release of the trapped, anteriorly displaced disc by the basic arthroscopic instrumentation, thereby enabling its repositioning.<\/p>\n

Changes in the upper joint compartment may be a causative factor in limitations in condylar movements, which causes this closed lock 11,12,13<\/sup>. This restriction in translation of the upper joint space may just be secondary to articular surface disturbances itself. Although a variety of TMJ disorders can be treated with the arthrocentesis, documented data is mostly available in favor of closed lock 12.<\/sup><\/p>\n

14<\/sup>Alkan and Etoz (2010) and 15<\/sup>Al Belsay (2007) described that the insertion of needles for arthrocentesis is similar to arthroscopic procedure. The posterior extent of the joint space is marked 10mm forward and 2 mm down from the tragus canthal line, whereas the anterior extent is marked 10mm further forward and 10mm down from this line.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sterile irrigation solution like ringer’s lactate, normal saline or hartmann’s solution is used for this purpose,<\/sup> 16,17<\/sup>. The composition of the solution has no effect in influencing the result of the procedure. The idea of this procedure is to distend the joint and cause lavage without altering the structure or position of the disc.\u00a0 Release of the negative forces, reduction in the surface friction and release of the stuck disc phenomenon also, have been attributed to the possible correction of the jaw joint disorder.<\/p>\n

18<\/sup>Christopher schott (2010) has been reported Ringer’s Lactate is isotonic with blood and generally used for intravenous administration. It grouped under Crystalloids. The osmolarity is 273mOsm\/L. The solution contains calcium chloride , potassium chloride sodium chloride and sodium lactate<\/p>\n

Table 1: Comparison of irrigants to human serum<\/strong><\/p>\n

Parameters \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Human serum \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 (0.9%)NaCl\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ringer\u2019s lactate\u00a0\u00a0\u00a0\u00a0 Albumin%<\/p>\n\n\n\n
 <\/p>\n

Na+<\/sup> (mmol\/l)<\/p>\n

K+<\/sup>(mmol\/l)<\/p>\n

Ca2<\/sub>+<\/sup>(mmol\/l)<\/p>\n

Cl–<\/sup>(mmol\/l)<\/p>\n

HCo3<\/sub>–<\/sup>-(mmol\/l)<\/p>\n

Albumin (g\/l)<\/p>\n

Na+<\/sup>\/ Cl–<\/sup> ratio<\/p>\n

pH<\/p>\n

Osmolality<\/p>\n

( mOsm\/kg)<\/td>\n

 <\/p>\n

154<\/p>\n

——–<\/p>\n

———-<\/p>\n

154<\/p>\n

——–<\/p>\n

———-<\/p>\n

1:1<\/p>\n

5.4<\/p>\n

308<\/td>\n

 <\/p>\n

131<\/p>\n

5<\/p>\n

2<\/p>\n

111<\/p>\n

29<\/p>\n

———–<\/p>\n

1.8: 1<\/p>\n

6<\/p>\n

276<\/td>\n

 <\/p>\n

140<\/p>\n

—-<\/p>\n

——<\/p>\n

128<\/p>\n

——-<\/p>\n

50g\/l<\/p>\n

1.09:1<\/p>\n

———–<\/p>\n

265<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Table<\/td>\n\n

Table 2: Showing Ringer\u2019s Lactate Composition and Ionic Composition<\/strong><\/p>\n

Click here to View\u00a0table<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

(NaCl -Sodium Chloride, SL – Sodium Lactate, KCl – Potassium Chloride, CaCl- Calcium Chloride, Na – Sodium, K – Potassium, Ca – calcium, Cl – Chloride, Lact- Lactate, LA. Lactated, RL. Ringer\u2019s Lactate, IUSP. Injection USP)<\/p>\n

Since Ringer’s lactate in comparision to other irrigants is close to Human serum so, it is considered to be better tolerated by the tissues 16<\/sup>. \u00a019<\/sup>Howard A Israle, (1999) has reported that both procedures have shown to be effective in reducing the pain and improving the mandibular movements in patients with intra articular pathological conditions.<\/p>\n

Efficacy of the arthroscopic lysis and lavage has been described by Holmlund et al., (1994) 20<\/sup>. All the patients showed a significant improvement in the Maximum Mouth Opening (MMO) after the procedure. The overall success rate with MMO and the chewing ability has shown a remarkable improvement. Arthrocentesis is aimed at reducing the symptoms by removing the inflammatory cells by joint wash out21<\/sup>. Thereby allowing the normal cellular inflow and expediting joint repair.<\/p>\n

Conclusion<\/strong><\/p>\n

The improvement in chewing ability and clicking of the joint post procedurally has given remarkable results. We therefore conclude that athrocentesis is helpful for those who fail to respond to the conservative treatment. There is a clear improvement in the mouth opening and pain score which encourages us to offer this treatment to the patients. Based on our review. Arthrocentesis of TMJ with Ringer’s lactate is easy, cost effective and less invasive procedure with minimal morbidity. This can be offered safely and effectively before doing more invasive procedures.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. ,.\u201d Arthroscopy of temoromandibular joint.\u201d Journal of Japanese Stomotology<\/em>, 42: 207 \u2013 13(1975)<\/li>\n
  2. Nitzan, D.W., Dolwick, M. F., Martinez, G.A.\u201dTemporomandibular joint arthrocentesis: A Simplifid traetment for sever, limited mouth opening.\u201d Journal of Oral and Maxillofacial Surg<\/em>, 49: 1163- 70 . (1991)<\/li>\n
  3. Stein, J. I. \u201cTMJ arthrocentesis. A surgical alternative\u201d. New york state Dental Journal<\/em>, 61 (9): 68 \u2013 76.(1995)<\/li>\n
  4. Brennan, P.A.\u201d Arthrocentesis for temporomandibular pain dysfunction syndrome\u201d. J Oral Maxillofac Surg<\/em>., 64: 949 \u2013 951(2006)<\/li>\n
  5. Ercument Onder,\u201dLong term results of arthrocentesis in degenerative temporomandibular disorder\u201d. Oral Surg Oral med Oral pathol Oral Radiol Endod<\/em>, 107: e1- e5. (2009)<\/li>\n
  6. Sinan Tozoglu et al. \u201cA review of techniques of lysis and lavage of the TMJ\u201d. British<\/em> Journal of Oral and Maxillofacial Surgery<\/em>, Volume 49, Pages 302-309.(2011)<\/li>\n
  7. Murakami et al,\u201dShort-term treatment outcome study for the management of temporomandibular joint closed lock: A comparison of arthrocentesis to nonsurgical therapy and arthroscopic lysis and lavage\u201d. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology<\/em>.Volume 80, Pages 253\u2013257. (1995)<\/li>\n
  8. , D.E. \u201cThe use of arthrocentesis for treatment of temporomandibular joint disorders\u201d. J oral Maxillofac Surg<\/em>., 57; 583 \u2013 587. (1999)<\/li>\n
  9. Hideo Hosaka,KenIchiro Murakami, Kazuhisa Goto, Tadahiko Iizuka. \u201cOutcome of arthrocentesis for temporomandibular joint with closed lock at 3 years follow-up\u201d. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology<\/em>.Volume 82, Issue 5, November, Pages 501\u2013504 .(1996)<\/li>\n
  10. Dimitroulis, G,F Dolwick, A Martinez.\u201d Temporomandibular joint arthrocentesis and lavage for the treatment of closed lock: a follow up study\u201d. BJOMS<\/em>, 33:23 \u2013 27. (1995)<\/li>\n
  11. \u201d.Arthrocentesis for the management of severe closed lock of the temporomandibular Joint\u201d. Oral and maxillofacial Surgery clinics of N. America<\/em>, 6:2: 245.(1994)<\/li>\n
  12. Moses, Sartoris, Glass, Tanaka.. \u201cThe effects of arthroscopic surgical lysis and lavage of the superior joint space on TMJ disc position and mobility\u201d. Journal of Oral and Maxillofacial Surgery<\/em>, 47: 674 \u2013 78. (1989)<\/li>\n
  13. McCain, P. \u201cArthroscopy of the human temporomandibular joint\u201d. Jounal of Oral and Maxillofacial Surg<\/em>, 40: 648 \u2013 55. (1988)<\/li>\n
  14. A., Etoz, O. \u201cA new anatomical landmark to simplify Temporomandibular Joint arthrocentesis\u201d. Br. Journal of Oral and Maxillofacial Surgery<\/em>., 48: 310 \u2013 1(2010)<\/li>\n
  15. Al Belsay, F.A. \u201cArthrocentesis for thr temporomandibular Joint closed lock: A review article\u201d. Internaltional Journal of Oral Maxillofacial Surg<\/em>. 36: 773 \u2013 782. (2007)<\/li>\n
  16. Shinj, O.H., Nakata, K., Shino, K., et al. \u201d Effects of irrigation solution for arthroscopic surgery on intraarticular tissue. Comparision on human meniscus \u2013 primary cell culture between lactate ringer\u2019s and saline solution\u201d. J orthop Res<\/em>, 20: 305 \u2013 10. (2002)<\/li>\n
  17. Arciero,R.A., Little,J.S., Liebenberg,S.P., Parr, T.J. \u201cIrrigating solution used in arthroscopy and their effects on articular cartilage. An in vivo study\u201d. Orthopedics <\/em>9(11); 1511-5. (1986)<\/li>\n
  18. Christopher Schott. \u201cFluid Resuscitation: 0.9% Normal Saline vs Lactated Ringer\u2019s vs Albumin\u201d. EVMS, Journal Club Review<\/em>, January 25,( 2010)<\/li>\n
  19. Howard A Israle.,. \u201cThe use of arthroscopic surgery for treatment of temporomandibular joint disorders\u201d. oral and maxillofacial surgery.<\/em> 57 ;579 \u2013 582( 1999)<\/li>\n
  20. Holmmund, A., Gynther., Axelsson.. \u201cEfficacy of arthroscopic lysis and lavage in chronic locking of the temporomandibular joint\u201d International Journal of Oral and Maxillofacial surgery<\/em>,\u00a0 23: 262 \u2013 6.(1994)<\/li>\n
  21. Quinn, H., Nicolas., \u201cIdentification of prostaglandin , E2, leukoterins, B2 in the synovial fluid of painful dysfunction of TMJ.\u201d Oral and maxillofacial surg<\/em>, 48: 968 \u2013 71.(1990).<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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