RESUMO

Background: We evaluated the comparative effectiveness of all intra-articular injection corticosteroids for treating internal temporomandibular joint (TMJ) disorders. Methods: We searched MEDLINE, CENTRAL, EMBASE, SCOPUS, and LILACS through December 2023. We included randomized clinical trials (RCTs) enrolling patients with symptomatic internal disorders of the TMJ comparing any type of intra-articular corticosteroid therapy against another or to another minimally invasive therapy. The outcomes of interest were pain, range of mandibular motion (RoM), quality of life (QoL) and adverse effects at 1, 3, 6, and 12 months. We assessed the risk of bias using the Cochrane Collaboration's tool. We conducted a frequentist network meta-analysis and assessed the certainty of the evidence (CoE) using GRADE. Results: We included 20 RCTs enrolling 810 participants, which assessed five corticosteroids alone or combined with arthrocentesis or hyaluronic acid. Based on moderate CoE, betamethasone is among the most effective corticosteroids for reducing pain at one (mean difference compared to arthrocentesis [MD], -3.80; 95% confidence interval [CI], -4.55 to -3.05) and three months (MD, -2.74; 95%CI, -3.42 to -2.06), and arthrocentesis plus dexamethasone at six months (MD, -0.80; 95%CI, -1.57 to -0.03). There was no convincing evidence that any intervention was better than arthrocentesis for improving the RoM and QoL at any follow-up time. Methylprednisolone may be more harmful than arthrocentesis for adverse effects. Discussion: Betamethasone and arthrocentesis plus dexamethasone are the most effective in managing pain in the short and medium term compared to arthrocentesis (moderate CoE). Decisions about their use should consider other factors, such as costs, feasibility, and acceptability. Future research should consider QoL as an outcome and assess participants at longer follow-up periods.

RESUMO

SUMMARY: The salivary glands in pathological conditions produce countless different clinical presentations, and due to their complex neuroanatomy, their pain symptoms vary widely. However, in the literature to date, few studies characterize salivary gland pain. The aim of this study was to conduct a literature review concerning the clinical characteristics of pain in various salivary gland pathologies. A literature review was done through a systematic search of scientific articles in the Web of Science (WoS), MEDLINE, Scopus, and Elton B. Stephens Company (EBSCO) databases. The free terms "salivary gland", "parotid gland", "submaxillary gland", "sublingual gland", and "pain" were used along with the Boolean operators OR and AND. The search yielded a total of 1896 articles, of which 60 fulfilled the inclusion criteria and were ultimately included in this review. It is described that pain is a nonspecific symptom of a glandular pathology and is characterized mainly by the location of the pain, which is correlated with the anatomical location of the affected salivary gland. Among the painful salivary gland pathologies, we found inflammatory disorders, including infections, obstructions, disorders secondary to hyposalivation; systemic autoimmune diseases; neoplasms, and neuropathic pain disorders. The diagnosis and management of salivary gland pain require knowledge of the causes and mechanisms of the pain, and it is to recognize the signs and symptoms of salivary gland disorders to be able to diagnose and treat them.

Las glándulas salivales en condiciones patológicas producen un sinfín de presentaciones clínicas diferentes, y debido a su compleja neuroanatomía generan variaciones en su sintomatología dolorosa. Sin embargo, en la literatura hasta ahora son escasos los estudios que caracterizan el dolor de glándulas salivales. El objetivo de este estudio fue realizar una revisión de la literatura respecto a las características clínicas del dolor en diversas patologías de glándulas salivales. Se realizó una revisión de la literatura, a través de la búsqueda sistemática de artículos científicos en las bases de datos Web of Science (WoS), MEDLINE, Scopus y Elton B. Stephens Company (EBSCO). A través de los términos libres: "salivary gland", "parotid gland", "submaxillary gland", "sublingual gland", "pain", junto con los operadores booleanos OR y AND. La búsqueda arrojó un total de 1896 artículos, de los cuales 60 cumplieron los criterios de inclusión y fueron finalmente incluidos en esta revisión. Se describe que el dolor es un síntoma poco específico para la patología glandular y está caracterizado principalmente por la localización del dolor, el cual se correlaciona con la ubicación anatómica de la glándula salival afectada. Dentro de las patologías dolorosas de glándulas salivales encontramos los trastornos inflamatorios, incluidas infecciones, obstrucciones, trastornos secundarios a hiposalivación; enfermedades sistémicas autoinmunes; neoplasias y trastornos de dolor neuropático. El diagnóstico y manejo del dolor de glándulas salivales requiere del conocimiento de las causas y mecanismos del dolor, siendo necesario reconocer los signos y síntomas de los trastornos de glándulas salivales para ser capaces de diagnosticarlos y tratarlos.

Assuntos

RESUMO

The aim was to compare the effect between a single intra-articular infiltration (1i) and two infiltrations (2i) of medium molecular weight hyaluronic acid (MMW-HA) of high viscosity (HV) and low viscosity (LV) on the histopathological characteristics of temporomandibular joint (TMJ) osteoarthritis (OA) induced in rabbits. An experimental study was conducted on Oryctolagus cuniculus rabbits, including 42 TMJs, distributed between (1) TMJ-C, control group; (2) TMJ-OA, group with OA; (3) TMJ-OA-wt, group with untreated OA; (4) group treated with HA-HV-1i; (5) group treated with HA-HV-2i; (6) group treated with HA-LV-1i; and (7) group treated with HA-LV-2i. The results were evaluated using the Osteoarthritis Research Society International (OARSI) scale and descriptive histology considering the mandibular condyle (MC), the articular disc (AD), and the mandibular fossa (MF). The Kruskal-Wallis test was used for the statistical analysis, considering p < 0.05 significant. All treated groups significantly decreased the severity of OA compared to the TMJ-OA-wt group. The HA-HV-2i group showed significant differences in the degree of OA from the TMJ-OA group. The degree of OA in the HA-HV-2i group was significantly lower than in the HA-LV-1i, HA-LV-2i, and HA-HV-1i groups. The protocol that showed better results in repairing the joint was HA-HV-2i. There are histological differences depending on the protocol of the preparation used: two infiltrations seem to be better than one, and when applying two doses, high viscosity shows better results.

Assuntos

RESUMO

SUMMARY: One of the most important minimally invasive treatments today in temporomandibular joint osteoarthritis (TMJ- OA) is the intra-articular exogenous hyaluronic acid (HA) injection, which has yielded good results in pain relief and improves mandibular function with few side effects. However, the effectiveness of HA continues to be controversial, partly due to the heterogeneity in the injection protocols in their molecular weight, viscosity and frequency of infiltration, among other properties. The aim of this review is to identify the differences in the histological and clinical effects of the different types of HA and the frequency of infiltration on TMJ-OA treatment. Materials and methods: A bibliographic search was performed in the PubMed, Web of Science and Scopus databases. The search was limited up to September 2022. Search terms included "osteoarthritis", "hyaluronic acid, "molecular weight", "concentration", "viscosity", "dose" and "temporomandibular", using AND/OR as Boolean terms. Results: Exogenous HA in its different molecular weights offers an improvement in histological and clinical characteristics. Apparently, low and medium molecular weight HA presents better results. No clinical studies related to the degree of HA viscosity were found. Respect to the frequency of infiltration, single injection, weekly injections for 3 weeks, weekly injections for 5 weeks and other protocols are used. However, their comparison is complex. There seems to be differences in the effects of the different HA preparations for the treatment of TMJ-OA, mainly in their molecular weight. However, the evidence remains scant.

Uno de los tratamientos mínimamente invasivos más importantes en la actualidad en la artrosis de la articulación temporomandibular (OATM) es la inyección intraarticular de ácido hialurónico (AH) exógeno, que ha dado buenos resultados en el alivio del dolor y mejora la función mandibular con pocos efectos secundarios. Sin embargo, la efectividad del AH continúa siendo controversial, en parte debido a la heterogeneidad en los protocolos de inyección en cuanto a su peso molecular, viscosidad y frecuencia de infiltración, entre otras propiedades. El objetivo de esta revisión fue identificar las diferencias en los efectos histológicos y clínicos de los diferentes tipos de HA y la frecuencia de infiltración en el tratamiento de TMJ-OA. Se realizó una búsqueda bibliográfica en las bases de datos PubMed, Web of Science y Scopus. La búsqueda se limitó hasta septiembre de 2022. Los términos de búsqueda incluyeron "osteoartritis", "ácido hialurónico", "peso molecular", "concentración", "viscosidad", "dosis" y "temporomandibular", utilizando AND/OR como términos booleanos. El HA exógeno en sus diferentes pesos moleculares ofrece una mejora en las características histológicas y clínicas. Aparentemente, el AH de bajo y medio peso molecular presenta mejores resultados. No se encontraron estudios clínicos relacionados con el grado de viscosidad del HA. Respecto a la frecuencia de infiltración, se utilizan inyecciones únicas, inyecciones semanales durante 3 semanas, inyecciones semanales durante 5 semanas y otros protocolos. Sin embargo, su comparación es compleja. Parece haber diferencias en los efectos de las diferentes preparaciones de HA para el tratamiento de la OA-TMJ, principalmente en su peso molecular. Sin embargo, la evidencia sigue siendo escasa.

Assuntos

RESUMO

SUMMARY: The aim of this systematic review was to assess the histological effects of platelet-rich plasma (PRP) on temporomandibular joint osteoarthritis (TMJ-OA) in animal models. A systematic search was performed using PubMed, WoS, EMBASE, Science Direct and SCOPUS databases. The inclusion criteria were experimental studies in animal models that evaluated the use of PRP as a treatment for TMJ-OA with or without arthrocentesis/arthroscopy. Comparison was made to a healthy control group or to other treatment. The variables evaluated were the histological effects of the treatments, characteristics of the primary articles, characteristics of the sample studied and the risk of bias. The systematic search identified 120 studies. Eventually 5 studies were included in the analysis. Four of the studies showed a statistically significant repair in joint tissues and improvement of cartilage thickness in animals treated with PRP. The global risk of bias was unclear. The results of this systematic review suggest that PRP treatment in TMJ-OA has benefits at the histological level in cartilage, articular disc and articular bone tissue in animal models. However, due to the low number of studies and the risk of bias, further research is needed to recommend its use.

El objetivo de esta revisión sistemática fue evaluar los efectos histológicos del plasma rico en plaquetas (PRP) en la osteoartritis de la articulación temporomandibular (ATM-OA) en modelos animales. Se realizó una búsqueda sistemática en las bases de datos PubMed, WoS, EMBASE, Science Direct y SCOPUS. Los criterios de inclusión fueron estudios experimentales en modelos animales que evaluaran el uso de PRP como tratamiento para la ATM-OA con o sin artrocentesis/ artroscopia. La comparación se realizó con un grupo de control sano o con otro tratamiento. Las variables evaluadas fueron los efectos histológicos de los tratamientos, las características de los artículos primarios, las características de la muestra estudiada y el riesgo de sesgo. La búsqueda sistemática identificó 120 estudios. Finalmente se incluyeron 5 estudios en el análisis. Cuatro de los estudios mostraron una reparación estadísticamente significativa en los tejidos articulares y una mejora del grosor del cartílago en los animales tratados con PRP. El riesgo global de sesgo fue incierto. Los resultados de esta revisión sistemática sugieren que el tratamiento con PRP en la ATM-OA tiene beneficios a nivel histológico en el cartílago, el disco articular y el tejido óseo articular en modelos animales. Sin embargo, debido al escaso número de estudios y al riesgo de sesgo, se necesitan investigaciones adicionales para recomendar su uso.

Assuntos

RESUMO

OBJECTIVE: To compare the effect between intra-articular infiltration of low molecular weight (LMW-HA) and high molecular weight hyaluronic acid (HMW-HA) on the histopathological characteristics of the cartilage and disc of the temporomandibular joint (TMJ) osteoarthritis (OA) induced in rabbits. MATERIAL AND METHODS: An experimental study was conducted on 38 rabbit TMJs. The effect of different hyaluronic acids was compared at 30 and 135 days. Histopathological analysis was performed. Cartilage damage was assessed with the OARSI scale. RESULTS: The severity of the induced OA according to OARSI was 3.4 degrees in the mandibular condyle (MC) and 3.2 in the mandibular fossa (MF); the articular disc (AD) presented disorganization of the collagen fibers, with randomly arranged hypertrophic chondrocytes. At 30 days, untreated TMJs worsened. TMJ treated with LMW-HA reduced its severity to 1.5 degrees in MC and 1.6 in MF, the AD presented histological aspects within normal limits. TMJ treated with HMW-HA presented 2.4 degrees in MC and 2.2 in MF, the AD maintained characteristics similar to the group with OA. At 135 days, all groups worsened. CONCLUSION: Exogenous HA is effective in the management of TMJ-OA induced in rabbits, showing cartilage and articular disc repair at 30 days. The LMW-HA group had better effects on joint tissue than HMW-HA 30 days after treatment. However, at 135 days, both groups presented regression of joint tissue repair. CLINICAL RELEVANCE: HA is effective in the anti-arthritic treatment of TMJ-OA induced in rabbits; LMW-HA shows better results in cartilage and articular disc repair than HMW-HA.

Assuntos

RESUMO

RESUMEN: La percepción del dolor resulta de múltiples y dinámicos mecanismos en el sistema nervioso central (SNC) y periférico que inhiben o facilitan el estímulo y respuesta nociceptiva. Sin embargo, la principal capacidad de modulación esta a cargo del SNC. Los estímulos nociceptivos son detectados por terminaciones nerviosas libres de neuronas periféricas que sinaptan con neuronas aferentes secundarias de la médula espinal. Luego estas fibras decusan para formar las vías nociceptivas ascendentes. Una vez alcanzadas las estructuras subcorticales, se activan las neuronas del tálamo, quienes envían el estímulo hacia la corteza somatosensorial, desencadenando la percepción consciente del dolor y activando el sistema inhibitorio descendente. Para que la modulación nociceptiva se realice, es necesaria la participación de diversas sustancias o neurotransmisores que conectan áreas del SNC especializadas. Por lo tanto, el objetivo de este estudio fue realizar una revisión de la literatura respecto de los mecanismos que participan en los procesos de modulación central del dolor.

SUMMARY: Pain perception results from multiple and dynamic mechanisms in the central nervous system (CNS) and peripheral nervous system that inhibit or facilitate stimulation and nociceptive response. However, neuromodulation is mainly a function of the CNS. Nociceptive stimulus is detected by peripheral neurons receptors that synapse with the secondary afferent neurons of the spinal cord. These fibers cross to conform the ascending nociceptive pathways. Once the subcortical structures are reached, the thalamus`s neurons are activated; the thalamus send the stimulus to the somatosensory cortex, triggering the conscious perception of pain and activating the descending inhibitory system. For the nociceptive modulation to be carried out, the participation of various substances or neurotransmitters that connect specialized CNS areas is necessary. Therefore, the aim of this study was to review the literature regarding the mechanisms involved in central pain modulation processes.

Assuntos

RESUMO

INTRODUCTION: Internal temporomandibular joint (TMJ) disorders are present in approximately 80% of patients with symptomatic temporomandibular disorders. Among the minimally invasive therapies, we find the intra-articular infiltration of substances, such as corticosteroids, hyaluronic acid or platelet-rich plasma accompanied or not by an arthrocentesis. There are several studies on minimally invasive therapy for internal TMJ disorders; however, none compares the effectiveness of the different intra-articular corticosteroids to each other.The purpose of this study is to evaluate the effectiveness of the different intra-articular corticosteroids for the treatment of internal disorders of the TMJ and compare them to each other or to other minimally invasive therapies. METHODS AND ANALYSIS: A systematic search will be carried out up to December 2019 in the electronic databases: Medline, Cochrane Library, EMBASE, SCOPUS and LILACS.Randomised clinical trials evaluating patients with internal disorders of the TMJ, with intra-articular corticosteroid therapy and comparing these to each other and/or to other minimally invasive therapy will be included. The main outcomes will be pain and range of motion measured through validated scales.Two review authors will independently screen search results, extract data from included studies and assess the risk of bias in those studies using the Revised Cochrane Risk of Bias Tool (RoB 2.0). In the case of any discrepancy and failure to reach consensus, this will be resolved by a third reviewer.A network meta-analysis will be conducted based on direct comparisons to generate indirect comparisons of the different treatments. Data will be combined in a meta-analysis using a random effects model.The principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system will be used to assess the overall quality of the body of evidence associated with the main results. ETHICS AND DISSEMINATION: This protocol will not require ethical approval. The results of this review will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER: CRD42019129014.

Assuntos

RESUMO

The study of the temporomandibular joint (TMJ) through imaging, is useful for the analysis of intra-articular procedures in view of its complex anatomy. Precise knowledge of the depth at which the TMJ is located is required to achieve an ideal puncture technique. The aim of this study was to measure the depth of the TMJ through magnetic resonance imaging (MRI) in patients with temporomandibular disorders (TMD). A cross-sectional study was conducted, selecting 150 MRI of patients who attended the Polyclinic for TMD and Orofacial Pain. The variables analyzed were: 1) Depth of the right and left TMJ; 2) Age of the patients; and 3) Sex of the patients. Of the total MR, 114 corresponded to women with a median age of 23 years. The median depth of the right TMJ was 17.16 mm and median on the left side was 16.98 mm, there was no statistically significant difference (p> 0.05) but there was a strong correlation (r = 0.842). There were no differences between the depths and the sex of the patients in both the right and left TMJ. There was no correlation between age and depth of TMJ. In conclusion the depth of the right and left condyle are highly correlated, being approximately 17 mm according to the population studied. There is no association between patient age and condylar depth, and there are no differences in average according to sex.

El estudio por imágenes de la articulación temporomandibular (ATM) es útil para el análisis de procedimientos intra-articulares debido a la compleja anatomía que presenta. Se requiere un conocimiento preciso de la profundidad a la cual se encuentra la ATM para una adecuada técnica de punción. El objetivo de este estudio fue medir la profundidad de laATM en relación a la piel a través de resonancia magnética (RM) en pacientes con trastornos temporomandiblaes (TTM). Se realizó un estudio transversal, seleccionando 150 RM de pacientes que asistieron al Policlínico de TTM y Dolor Orofacial. La variables analizadas fueron: 1) Profundidad de la ATM derecha e izquierda; 2) Edad de los pacientes; y 3) Sexo de los pacientes. Del total de RM, 114 correspondían a mujeres con una mediana de edad de 23 años. La mediana de la profundidad de la ATM derecha fue de 17,16 mm y la mediana del lado izquierdo fue de 16,98 mm, no hubo una diferencia estadísticamente significativa (p>0,05) pero si una fuerte correlación (r=0,842). No hubo diferencias entre las profundidades y el sexo de los pacientes tanto en la ATM derecha como en la izquierda. No hubo correlación entre la edad y la profundidad de la ATM. La profundidad de los cóndilos derecho e izquierdo están altamente correlacionados, siendo 17 mm aproximadamente en la población estudiada. No existe asociación entre la edad de los pacientes y la profundidad condilar, y no hay diferencias en promedios por sexo.

Assuntos

RESUMO

RESUMEN: El objetivo de este estudio fue realizar una revisión de la literatura respecto de la importancia del líquido sinovial en la articulación temporomandibular y sus implicancias en la patología articular. El líquido sinovial corresponde a un fluido viscoso y filante de color amarillento claro, compuesto principalmente por proteínas plasmáticas, componentes celulares, moléculas lubricantes, citoquinas, factores de crecimiento y enzimas. Es producido por la membrana sinovial y se encuentra en relación directa con las superficies articulares y la membrana sinovial, mediando las interacciones entre los tejidos de las articulaciones sinoviales. En la articulación temporomandibular desempeña un papel fundamental en el mantenimiento y regulación de la fisiología, a través de funciones lubricantes, reguladoras y metabólicas, disminuyendo el roce de las superficies articulares durante todos sus movimientos. En los trastornos temporomandibulares, la composición y función del líquido sinovial se puede ver alterada por cambios en los tejido de la articulación temporomandibular, estos cambios pueden resultar en una disminución en la capacidad de lubricar las superficies articulares y generar un ambiente catabólico en el interior de la articulación, contribuyendo conjuntamente al deterioro de éstas.

SUMMARY: The aim of this study was to conduct a review of the literature on the value of synovial fluid in the temporomandibular joint and its implications in joint pathology. The synovial fluid is a viscous and filamentous fluid of a light yellow color, composed mainly of plasma proteins, cellular components, lubricating molecules, cytokines, growth factors and enzymes. It is produced by the synovial membrane and is in direct relation with the joint surfaces and the synovial membrane, mediating the interactions between the tissues of the synovial joints. In the temporomandibular joint it plays a fundamental role in the maintenance and regulation of physiology, through lubricating, regulating and metabolic functions, decreasing the friction of the joint surfaces during all its movements. In temporomandibular disorders, synovial fluid function can be altered by changes in the tissues of the temporomandibular joint, these changes can result in a decrease in the ability to lubricate the joint surfaces and generate a catabolic environment inside the joint, contributing together to the deterioration of these.

Assuntos