الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Many therapeutic modalities have been developed for treatment of TMJ-osteoarthrosis, evolving from a nonsurgical era of observation and conservative therapy to an often surgically aggressive approach. Nevertheless, the treatment is still empirical directed toward reducing factors that predispose patients to this condition, reducing pain and increasing mouth opening. The research efforts have not yet identified the evidence-based rational treatment with adequate results. Therefore, the null hypothesis of the present double-blind, randomized study was that intra-articular injection of dexamethasone 21-palmitate (Lipotalon®) at the end TMJ arthrocentesis procedures will enhance the clinical outcome.
Sixteen female-patients out of 36 patients (44%) with a diagnosis of TMJ osteoarthrosis did not respond to the used conservative therapy. Their ages ranged from 18-50 years, with an average of 28 years. After accepting to be enrolled in the present study, each patient was randomly assigned into 1 of 2 equal groups. This group assignment was kept blinded to the supervisors and research candidate.
Group I:
At the end of the arthrocentesis procedure, intra-articular injection of 1ml of lipotalon* (4mg/ml) was performed.
Group II:
At the end of the arthrocentesis procedure, intra-articular injection of 1 ml of isotonic saline was performed.
The outcome measures include assessment of the TMJ pain due to arthrocentesis manipulation at 2 and 24 hours postoperatively as measured by the number of the used analgesic tablets and NRS for intensity of pain. The patients’ response to treatment at 1 week and 3 months postoperatively was assessed clinically by evaluating the patients’ subjective pain experience at rest and during function using NRS, MMO and mandibular dysfunction using Helkimo’s index.
TMJ pain due to arthrocentesis manipulation during the 1st postoperative week as assessed by evaluating TMJ pain at rest using NRS and the number of analgesics intake showed significant decrease in NRS values of pain at rest after 24 hours and after one week and in the number of analgesics intake after 5 and 7days in Lipotalon group and Placebo group respectively. By the end of the study, all the evaluated parameters in both groups showed significant improvement.
All the evaluated parameters showed insignificant differences between the two groups throughout the study intervals with the exception that lipotalon group showed significantly lower number of analgesic intake at the 6th postoperative day and significant decrease in NRS values of pain at rest and on function after 3months than placebo group values.
There is weak negative correlation between mouth opening and pain scale at function (-0.333). Statistically significant negative correlation exists between mouth opening and Helkimo index (-0.504). There is statistically significant positive correlation between helkimo index and pain scale at function (0.574).
Success rate According to our success criteria, the Lipotalon group showed 50%success while 3out of 8 cases (37.5%) were successful in the Placebo group. The remaining cases showed postoperative improvement but beyond our success criteria.
Conclusion
Based on the results of the present study, the following conclusions could be made:-
•Conservative therapy is very important as an initial treatment of TMJ-osteoarthrosis.
•Arthrocentesis remains the standard option, cost effective, very successful and highly efficient treatment choice for TMJ OA when other conservative nonsurgical options failed.
•The null hypothesis of the present study that intra-articular injection of Lipotalon® at the end TMJ arthrocentesis procedures enhances the clinical outcome is accepted.