Source:Journal of Oral and Maxillofacial Surgery
Author(s): Carl Bouchard, Jean-Paul Goulet, Mehdi El-Ouazzani, Alexis Fournier-Turgeon
PurposeTo investigate the efficacy of temporomandibular joint (TMJ) lavage (arthrocentesis or arthroscopy) for the treatment of temporomandibular disorders (TMDs) in reducing pain and improve jaw motion.Patients and methodsWe performed a systematic review of the literature and meta-analysis of randomized-controlled trials (RCT) comparing TMJ lavage to conservative measures. Data sources were MEDLINE, EMBASE, CENTRAL (Cochrane), Scopus and Web of Science and reference lists of relevant articles. Two independent reviewers identified RCTs by using controlled vocabulary (MeSH, Emtree) and free text terms. Data extracted from the selected studies were: population characteristics, intervention, outcomes and funding sources. Risk of bias was assessed using the Cochrane collaboration risk assessment tool for RCTs.ResultsFive studies met inclusion criteria, for a total of 308 patients. Three studies were categorized as having a high risk of bias and 2 had a low risk. The summary effect of the five studies showed a reduction in pain in the intervention group at 6 months (-0.63, 95% CI [-0.90, -0.37], p < 0.00001, I2 = 88%) and 3 months (-0.47, 95% CI [-0.75, -0.19], p = 0.001, I2 = 85%). This was not the case at 1 month. No difference in mouth opening was observed at 6 months (-0.21, 95% CI [-1.82, 1.40], p < 0.80, I2 = 74%), 3 months (0.20, 95% CI [-1.81, 2.20], p = 0.85, I2 = 68%) and 1 month (-1.18, 95% CI [-2.90, 0.55], p = 0.18, I2 = 0%).ConclusionGiving the relatively small number of patients included in this meta-analysis, the high risk of bias in 3 studies and the statistical and clinical heterogeneity of the included studies, the use of TMJ lavage for the treatment of TMDs should be recommended with cautions giving the lack of strong evidence to support its use.
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