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This study aimed to assess and compare the efficacy of two distinct single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for managing disk displacement without reduction (DDwoR). Sixty patients with DDwoR were randomly and blindly assigned to two treatment groups (n = 30 each): group 1 - TMJ arthrocentesis with the classic concentric needle; and group 2 - TMJ arthrocentesis with the concentric needle-cannula system. The following variables were recorded and compared across the groups: patient's pain perception (visual analog scale - VAS, 0-10); maximal interincisal distance (MID, mm); facial edema (FE, presence or absence); and operation duration (OP, minutes). Patients in group 2 presented significantly lower values of VAS score and presence of FE (p < 0.05) when examining the data at 24 and 48 h after the arthrocentesis. They also showed an increase in MID values (p = 0.024) after 6 months. With regard to OP, no significant difference was observed between the groups. Performing a single-puncture TMJ arthrocentesis using a concentric needle-cannula system significantly reduced the patients' pain perception, and mitigated the presence of facial edema during the immediate postoperative period (at 24 and 48 h). Furthermore, it resulted in a notable increase in the MID after 6 months.

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OBJECTIVE: To perform a scoping review to identify the available evidence regarding intra-articular injections in the inferior joint space (IJS) of the temporomandibular joint (TMJ). METHODS: An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: "Arthrocentesis", "injection", "joint injection", "technique", "Temporomandibular joint", "Temporomandibular joint disorder". Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. Only articles with full-text access were included. RESULTS: Thirteen articles were included for analysis-one technical note, three cadavers studies, one animal study, two case reports, five randomised clinical trials and one retrospective study; studies were classified as 'patients-based studies' and 'non-patients-based studies'. Most 'patients-based studies' show moderate or high risk of bias. Techniques were categorised as 'anatomical technique' and 'image-guided technique'. Most 'patients-based studies' show favourable outcomes such as pain reduction, increase in maximum mouth opening, improvement in quality of life and improvement in TMJ dysfunction indexes for the treatment of arthrogenic TMDs. Comparisons between superior and IJS injections are scarce. On the other hand, 'non-patients-based' studies show that image-guided or ultrasound-checked injection techniques achieved a higher effectiveness for needle location than anatomical (or blind) techniques. CONCLUSION: The amount of available evidence is scarce, heterogeneous in design, and most 'patients-based studies' show moderate or high risk of bias, which demands the generation of new research to obtain definitive conclusions. The tendency observed suggests that intra-articular injections for the IJS of the TMJ are able to relieve TMJ pain, increase mouth opening and improve TMJ dysfunction, and image-guided injection techniques seem to be more effective than anatomical techniques to locate the needle in the IJS.

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PURPOSE: To assess the impact of different types of anesthesia on the outcomes of arthrocentesis of the TMJ. METHODS: Electronic databases were searched to identify peer-reviewed studies, followed by reference list search and further hand-searching. Randomized clinical trials and controlled studies were considered for inclusion when comparing at least two anesthetic approaches. The risk of bias was assessed using the Cochrane risk of bias tool. RESULTS: Of a total of 506 potentially eligible studies, only a randomized controlled clinical trial and an observational study were included. The former compared some outcomes of arthrocentesis under local and general anesthesia and the latter under sedation and general anesthesia. Moreover, both studies were judged as "high risk of bias." CONCLUSIONS: In general, there appears to be a slight trend toward better outcomes of arthrocentesis for internal TMJ derangements (Wilkes grades I to III) when performed under general anesthesia; however, given that the available evidence is remarkably limited and a high risk of bias was detected within the included studies, a definitive statement cannot be made.

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Ultrasound (US) is a widely available, low-cost, non-invasive, and safe medical imaging method that enables real-time observation. Ultrasound offers several advantages for dentomaxillofacial images, such as portability, the possibility of dynamic and repeated examinations, patient comfort, and availability. It is a useful tool for recognizing the temporomandibular joint (TMJ) structures and their involvement during the course of different pathological processes, such as articular disk displacement, joint effusion and cortical erosion. In addition to its diagnostic use, US has been proposed as an auxiliary tool in minimally invasive procedures for arthrogenic temporomandibular disorders (TMD) to achieve an accurate puncture, recognize joint spaces and reduce surgical trauma. While US is widely used for large joints to visualize internal structures and guide the injection, this technique has only recently gained popularity for the TMJ procedures. Hence, the literature on this topic is scarce. The present review describes the potential advantages and the clinical technique of US guidance for TMJ arthrocentesis and intra-articular injection (IAI).

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OBJECTIVES: This systematic review compared minimally and invasive surgical procedures to manage arthrogenous temporomandibular joint (TMJ). MATERIALS AND METHODS: The review included clinical trials assessing surgical procedures of arthrogenous temporomandibular disorder (TMD) management by carrying out comparisons within the same surgical procedure (pre- and post-treatment) as well as between different surgical procedures. Meta-analyses were conducted only for similar comparison reporting the same outcome measures, visual analog scale (VAS) values to evaluate pain and maximum incisal opening (MIO) values. RESULTS: Of the 1,015 studies identified by the search strategy, 26 were selected for full-text reading, and 19 were included in the review. Of these, 16 studies were included in the meta-analysis and 3 in the qualitative analysis. The VAS scores showed significantly lower values after discectomies (p < 0.001) and discoplasties (p < 0.001) in the within-group comparison. Moreover, significantly lower VAS scores and higher MIO values were observed after discectomy compared to arthroscopy, eminectomy, and discoplasty (p < 0.05). CONCLUSION: The findings of this systematic review suggest that although significantly lower VAS scores and higher MIO values were observed after discectomy, the currently available scientific evidence is unclear, and the use of invasive surgical procedures should not be implemented as an efficient first-line treatment option for arthrogenous TMD management. CLINICAL SIGNIFICANCE: VAS and MIO outcomes could be insufficient to describe the success or failure of open surgical procedures like discectomy and discoplasty.

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OBJECTIVE: To compare clinical and imaging results of two needles arthrocentesis (TNA) versus double-needle cannula arthrocentesis (DNCA) in the treatment of temporomandibular joint disc displacement (DD). METHODS: Twenty patients with DD were randomly divided into two groups: TNA and DNCA. Clinical data (pain scores; maximal interincisal distance [MID], and protrusion and laterality movements) were evaluated before and 24 months after the arthrocentesis. Disc and condyle position and joint effusion (JE) were evaluated by magnetic resonance exams. RESULTS: Both groups presented improvement in the MID, including pain reduction, modifications in disc and condyle positions, and reduction of the presence of JE, without difference between groups (p > 0.05). The DNCA was performed significantly faster (p = 0.0001). CONCLUSION: Both TNA and DNCA are efficient in promoting improvement in the MID: reduction in pain, modifications in disc and condyle positions, and, in part, may account for less JE, without difference between techniques.

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Septic arthritis (SA) is an emergency orthopedic condition that carries significant patient morbidity and mortality. Clinical data and blood test analyses are fairly unreliable in making the diagnosis and, therefore, utilizing a feasible and reliable diagnostic tool is desirable, particularly in emergency settings where rapid diagnosis is pivotal. Here, we report the case of a 58-year-old male presenting to the emergency department with a swollen elbow. After demonstration of a large articular effusion with point-of-care ultrasound, the synovial fluid analysis was compatible with SA. The patient was treated with elbow arthrotomy and systemic antibiotics and discharged shortly thereafter, uneventfully. Finally, we discuss the impact of ultrasound in diagnosing SA and the many advantages that make it the first-line tool in urgent care.

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Primary meningococcal septic arthritis (PMSA) is an extremely rare local infection by Neisseria meningitidis in the absence of meningitis or meningococcaemia syndrome. A 30-year-old healthy, immunocompetent man presented with arthralgia, fever, chest rash, and significant swelling of the right knee. On admission, a disseminated maculopapular and purpuric rash, oligoarthritis, neutrophilia, and elevated acute phase reactants were documented. Following arthrocentesis of the right knee, isolation of N. meningitidis and the presence of calcium oxalate crystals in the synovial fluid were reported. The diagnosis of PMSA was made. Histological analysis of the skin lesion showed leucocytoclastic vasculitis. He was treated with intravenous ceftriaxone plus open surgical drainage and ambulatory cefixime with adequate response. After 1 month, he presented resolution of the pathological process. We performed an extensive review of the literature, finding that the key elements supporting the diagnosis of PMSA are prodromal upper respiratory tract symptoms and skin involvement prior to or synchronous with the arthritis. Also, the most frequently involved joint is the knee. This report is the first case of a patient presenting with PMSA associated with calcium oxalate crystals in the synovial fluid. Herein, we discuss the most frequent clinical manifestations, the unusual histological features, the recommended treatment, and the reported prognosis of this rare entity.

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Introducción: La artritis séptica es considerada una emergencia en ortopedia. Se define como el proceso inflamatorio desproporcionado, desencadenado por la colonización de algún microorganismo en el espacio articular que con los cambios fisiopatológicos ocasionados degradan el cartílago y aumentan la morbimortalidad, la prolongación de la estancia hospitalaria, las secuelas irreversibles, así como los costos para el sistema de salud. Por tal razón, es vital que el médico general, quien tiene el primer contacto con el paciente, sea capaz de reconocer las manifesta-ciones, e instaure un tratamiento para evitar complicaciones y secuelas del paciente. Objetivo: Identificar los aspectos importantes de la artritis séptica y proporcionar al lector información relevante de forma práctica y concreta para su actuar médico diario. Método: Búsqueda de artículos originales en bases de datos, empleando términos MeSH y DeCS, consulta de textos guía, en el periodo 2010-2022. Resultados: Con mayor frecuencia se ven afectados pacientes en extremos de edad, como los mayores de 60 años y los menores de 20 años, y la rodilla es la principal articulación afectada. La fiebre no es un criterio necesario para el diagnóstico de artritis séptica y el principal factor de riesgo es la enfermedad articular previa. Conclusiones: El análisis del líquido sinovial y la tinción de Gram, junto con el cultivo, permiten hacer el diagnóstico. El tratamiento antibiótico empírico es guiado por los factores de riesgo del paciente y, posteriormente, por los resultados del cultivo

Introduction: Septic arthritis is considered an emergency in orthopedics, it is defined as the dispro-portionate inflammatory process triggered by the colonization of some microorganism in the joint space, causing pathophysiological changes that degrade the cartilage causing increased morbidity and mortality, prolongation of hospital stay, irreversible sequelae, as well as increased costs for the health system, for this reason it is of vital importance that the general practitioner who has the first contact with the patient can recognize the manifestations, and establish treatment to avoid compli-cations and sequelae of the patient.Objective: To identify the important aspects of septic arthritis and provide the reader with relevant information in a practical and concrete way for his daily medical practice.Method: We searched for original articles in databases using MeSH and DeCS terms, consulting guide texts, with a search period from 2010 to 2022. Results: Patients in extremes of age are more frequently affected, such as patients older than 60 years and younger than 20 years, being the knee the main affected joint. Fever is not a necessary criterion for the diagnosis of septic arthritis and the main risk factor is previous joint disease. Conclusions: Synovial fluid analysis and Gram stain together with culture allow making diagnosis. Empirical antibiotic treatment is guided by the patient's risk factors, then by the culture results.

Introdução: a artrite séptica é considerada uma emergência na ortopedia. É definida como um processo inflamatório desproporcional, desencadeado pela colonização de um microrganismo no espaço arti-cular que, com as mudanças fisiopatológicas causadas, degrada a cartilagem e aumenta a morbidade e a mortalidade, a permanência hospitalar prolongada, sequelas irreversíveis, assim como os custos para o sistema de saúde. Por esta razão, é vital que o clínico geral, que tem o primeiro contato com o paciente, seja capaz de reconhecer as manifestações, e instituir tratamento para evitar complicações e sequelas para o paciente. Objetivo: Identificar os aspetos importantes da artrite séptica e fornecer ao leitor informações relevan-tes de uma forma prática e concreta para a prática médica diária. Método: Pesquisa de artigos originais em bancos de dados, usando termos MeSH e DeCS, consulta de textos guias, no período de 2010-2022. Resultados: Os mais frequentemente afetados são os pacientes em extremos de idade, como aqueles com mais de 60 anos e menos de 20 anos, e o joelho é a principal articulação afetada. A febre não é um critério necessário para o diagnóstico de artrite séptica e o principal fator de risco é a doença articular prévia. Conclusões: A análise do líquido sinovial e a coloração de Gram, junto com a cultura em meios espe-cíficos, permitem que o diagnóstico seja feito. O tratamento antibiótico empírico é orientado pelos fatores de risco do paciente e, posteriormente, pelos resultados da cultura

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Objetivo: El objetivo de este reporte de caso es presen- tar a la artrocentesis como una alternativa quirúrgica mínima- mente invasiva en el tratamiento de la artritis séptica tempo- romandibular. Caso clínico: Un paciente hombre de 26 años con an- tecedente de flegmón perimandibular derecho tratado, acude a la Unidad Hospitalaria de Cirugía Maxilofacial por dolor articular temporomandibular, impotencia funcional y trismus, a un mes de haber sido dado de alta de un primer cuadro infec- cioso. Luego de los exámenes clínicos y complementarios, se diagnostica artritis séptica de articulación temporomandibular derecha, la cual fue tratada quirúrgicamente mediante dos ar- trocentesis acompañadas de terapia farmacológica (AU)

Aim: The aim of this case report is to present arthrocen- tesis as a minimally invasive surgical alternative in the treat- ment of temporomandibular septic arthritis. Clinical case: A 26-year-old male patient, with a his- tory of treated right perimandibular phlegmon, came to the Maxillofacial Surgery Hospital Unit due to temporomandibu- lar joint pain, functional impairment and trismus, one month after having recovered from his first infectious process. After clinical and complementary examinations, septic arthritis of the right temporomandibular joint was diagnosed, which was treated surgically by means of two arthrocenteses and phar- macological therapy (AU)

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Objetive: The degenerative diseases of the tempo-romandibular joint (TMJ) are characterized by a progressive destruction of the articular tissues of the condyle and the glenoid fossa. The main aim of this review is to describe the effectiveness of the hyaluronic acid (HA) in the treatment of degenerative diseases of the TMJ in accordance with the available scientific evidence. Material and Methods: A literature search was made in the following databases EBSCO, Pubmed, Cochraneand Trip Database, using the keywords hyaluronic, hyaluronan, NaH, hyaluronate, TMJ, TMD, CMD, craniomandibular, orofacial pain and temporomandibular. There were no date or language restrictions applied. Results: After applying inclusion and exclusion criteria, 14 studies were included in this review (11 randomized controlled clinical trials and 3 non-randomized clinical trials). Conclusion: The studies reported a decrease in pain and improvement in functional parameters after treatment of TMJ osteoarthritis with HA . The use of arthrocentesis associated with the administration of HA provides effects synergistic, reaching a superiority the protocols with multiple injections with respect to those of a single session. The adverse effects related to the injection of HA with or without associated arthrocentesis were minor and transitory.

Resumen: Objetivo: Las enfermedades degenerativas de la articulación temporomandibular (ATM) se caracterizan por una destrucción progresiva de tejidos articulares en el cóndilo y la fosa glenoidea. El objetivo principal de esta revisión es describir la efectividad del uso de ácido hialurónico en el tratamiento de enfermedades degenerativas de la articulación temporomandibular de acuerdo con la evidencia científica disponible. Material y Métodos: Se realizó una búsqueda de la literatura en las bases de datos electrónicas EBSCO, PubMed, Cochrane y Trip Database, utilizando las palabras claves hyaluronic, hyaluronan, NaH, hyaluronate, tmj, tmd, cmd, craniomandibular, orofacial pain y temporomandibular, sin límite de fecha ni de idioma hasta Mayo del año 2020, complementada con una búsqueda retrógrada. Resultados: Con base en los criterios de inclusión y exclusión, 14 estudios fueron incluidos en esta revisión (11 ensayos clínicos controlados aleatorizados y 3 ensayos clínicos controlados no aleatorizados). Conclusión: Los estudios reportaron una disminución del dolor y mejora en los parámetros funcionales luego del tratamiento de osteoartritis de la ATM con AH. El uso de artrocentesis asociada a la administración del AH provee efectos sinérgicos, alcanzando una superioridad los protocolos con múltiples inyecciones con respecto a aquellos de una sola sesión. Los efectos adversos relacionados con la inyección de AH con o sin artrocentesis asociada fueron menores y transitorios.

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PURPOSE: To evaluate the technical success of conventional TMJ arthrocentesis in cadavers, using the tragal-lateral canthus line as an anatomical reference for the puncture points. METHODS: Ten formalin-treated and 8 fresh cadavers were submitted to the arthrocentesis. A point located 10 mm anteriorly and 2 mm inferiorly to the beginning of the tragal-lateral canthus line (A) and another point 20 mm anteriorly and 10 mm inferiorly (B) were demarked on the cadavers' skin. Following, 1 mL of methylene blue solution was injected through the needle at point A, and then another needle was placed at point B. Saline solution was injected through the first needle, identifying a free flow of bluish solution. RESULTS: Concerning the formalin-treated cadavers, TMJ arthrocentesis was not successfully performed in any case (0%). In the fresh cadavers, the procedure was properly conducted bilaterally in only one case (12.5%) and unilaterally in 3 cases (37.5%), 2 on the left side (25.0%) and one on the right (12.5%). CONCLUSION: The traditional points related to the tragal-lateral canthus line seemed not to be accurate references for the insertion of the needles in conventional TMJ arthrocentesis when 1 mL of solution is used initially and the maximum mouth opening is not achieved.

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Objetive: This study was to compare the effectiveness of arthrocentesis versus the insertion of anterior repositioning splint (ARS) in improving the mandibular range of motion (MRM) for patients with the temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Methods: 36 patients diagnosed as ADDwR were recruited and divided randomly into two groups. The first group (G1) was treated by arthrocentesis, and the second (G2) was treated using ARS. All patients were reexamined after six months. Results: Except that for protrusive movement, there were significant differences between the two groups for the percentage changes of the MRM as measured by the amount of pain free opening, unassisted opening, maximum assisted opening, right lateral and left lateral movements (p < 0.05). Conclusion: Within the context of the current study, the non-invasive, lower cost ARS, provided better results in improving the MRM when managing ADDwR cases. (AU)

Objetivo: O presente estudo comparou a eficácia da Artrocentese em relação à inserção da Placa Reposicionadora Anterior (PRA) na melhoria da Amplitude de Movimento Mandibular (AMM) para pacientes que apresentam Deslocamento de Disco Anterior com Redução (DDAcR) da Articulação Temporomandibular (ATM). Método: 36 pacientes diagnosticados como DDAcR foram recrutados e divididos aleatoriamente em dois grupos. O primeiro grupo (G1) foi tratado através da Artrocentese e o segundo (G2), tratado com a PRA. Todos os pacientes foram reexaminados após seis meses. Resultados: Com exceção do movimento protrusivo, houve diferenças significativas entre os dois grupos para as mudanças percentuais das medidas de AMM pela quantidade de abertura sem dor, abertura sem assistência, abertura máxima com assistência, movimentos laterais direitos e laterais esquerdos (p < 0,05). Conclusão: Dentro do contexto do estudo atual, a PRA, não invasiva e de menor custo, proporcionou melhores resultados na melhoria da AMM no gerenciamento de casos de DDAcR (AU)

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OBJECTIVES: Arthrocentesis is the simplest surgical intervention for the temporomandibular joint (TMJ). It can be performed on an outpatient basis at a low cost and with low morbidity. The objective is to release the articular disc by disrupting the adhesion formed between its surfaces and the mandibular fossa through hydraulic pressure generated by irrigation of the upper compartment of the TMJ. Viscosupplementation with hyaluronic acid during or after arthrocentesis improves clinical outcomes, increases mouth opening, and reduces pain levels. The aim of this study was to evaluate the efficiency of arthrocentesis plus hyaluronic acid viscosupplementation through clinical examination and preoperative magnetic resonance imaging in patients with unilateral disc displacement without reduction (DDwoR). METHODS: This analytical retrospective cross-sectional study clinically and radiologically evaluated 72 patients of both sexes with unilateral DDwoR. The following data were collected: sex, pain, age, duration of pain, maximum mouth opening, and patient pain perception on a visual analog scale. TMJ arthrocentesis was performed only once for each of the indicated joints. Data were collected before arthrocentesis (baseline) and at 7, 14, 30, 60, 90, and 180 days after the procedure (final evaluation). RESULTS: Between the baseline and final evaluation, there was a significant reduction in pain (p=0.001) and restoration of articular function. In addition, there was a significant increase in maximum mouth opening (p=0.001). CONCLUSION: Patients with DDwoR undergoing arthrocentesis combined with hyaluronic acid injection showed significant improvement in the perceived pain and maximum mouth opening in the mid-term follow-up periods.

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PURPOSE: Arthrocentesis of the temporomandibular joint (TMJ) is a minimally invasive surgical procedure that provides good clinical results such as the improvement of jaw movements. It also helps to balance the synovial liquid viscosity and relieve TMJ pain by the washout of inflammatory components from the upper compartment. The purpose of this study is to report a case series of patients submitted to a clinical-based protocol of diagnosis of TMJ joint open lock and treatment with arthrocentesis. MATERIAL AND METHODS: Patients suffering from a recurrent unilateral open lock of the TMJ were submitted to one arthrocentesis of the affected TMJ and all of them reported that the open lock was caused by daily stomatognathic activities. To decide the arthrocentesis as the initial treatment of these patients, the authors followed a rational protocol of diagnosis. RESULTS: Ten patients were included in the present study. No complications occurred during arthrocentesis. Immediately, 1 week, 1 month, and 6 months after arthrocentesis, patients did not suffer from open lock or disc click anymore. They also reported no more pain because it was strictly related to the disc click. CONCLUSIONS: All patients of the present study improved from the open lock and disc click of the affected TMJ for 6 months after arthrocentesis. The clinical-based protocol of diagnosis of TMJ open lock reported in the present study, followed by the treatment with arthrocentesis is a reasonable, low-cost, and safe method to treat patients with the acute open lock.

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OBJECTIVE: To evaluate joint effusion and positioning of the articular disc through magnetic resonance imaging (MRI) before and after two different arthrocentesis techniques. METHODS: Twenty-six patients with dislocation of the articular disc without reduction (ADDwoR) were included and randomly divided into two groups: single needle arthrocentesis with distention of the upper compartment of the TMJ (A1) and conventional arthrocentesis with 2 needles (A2). RESULTS: A statistically significant difference was observed between the different effusion categories (p = 0.009). No differences were found comparing both treatment modalities concerning the position of the mandibular condyle and the articular disc. CONCLUSION: Conventional arthrocentesis was able to change the effusion variable, whereas the single needle arthrocentesis was not. Both techniques were responsible for altering the position of the mandibular head or the disc-head complex, projecting them to a more anterior position related to the increase in the final maximum interincisal distance.

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Objective: This study evaluated the clinical efficacy of arthrocentesis when varying the irrigation volume in patients with disc displacement without reduction (DDWOR). Methods: Thirty DDWOR patients were equally divided into two groups: G1 (50 mL) and G2 (200 mL). Information was compared for pain, the maximum interincisal distance (MID), protrusion, and right and left laterality. Results: Arthrocentesis was able to reduce the pain and increase the MID, protrusion, and both laterality values significantly one year after the procedure (p < 0.001) in both groups. However, comparisons between the groups revealed no significant difference (p > 0.05). Furthermore, changes in volume did not affect the arthrocentesis results (p = 0.626, odds ratio = 1.625; 95% confidence interval = 0.230-11.461). Conclusion: Arthrocentesis techniques using 50- and 200-mL irrigation volumes were both effective, with no significant differences between techniques observed after one year of follow-up.

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ABSTRACT BACKGROUND AND OBJECTIVES: Arthrocentesis is an effective treatment to reduce or eliminate pain, increase maximal interincisal distance, and to eliminate joint effusion in patients with disc displacement without reduction. This study aims to expose and to discuss a new technique proposal of temporomandibular joint arthrocentesis applied in the treatment of a single case of disc displacement without reduction. CASE REPORT: Female patient, 18-year-old patient sought treatment due to joint pain and mouth opening limitation. The maximal interincisal distance was 30.28mm. Magnetic resonance imaging confirmed the diagnosis of disc displacement without reduction with signs of joint effusion in the right temporomandibular joint. Temporomandibular joint arthrocentesis was performed under selective sensory nerve block of the auriculotemporal, the masseteric and posterior deep temporal nerves. Two needles were inserted in the upper compartment of the temporomandibular joint. In the second needle, a transparent catheter was connected into a vacuum pump. Clinically, after the arthrocentesis, the maximal interincisal distance increased to 46.25mm, and the patient referred no more pain. After six months, a magnetic resonance imaging was performed to observe the results, and there were no more signs of joint effusion. CONCLUSION: Temporomandibular joint arthrocentesis was an effective treatment for this patient with disc displacement without reduction. The aspect of this technique that is particularly relevant for clinical practice was the connection of a transparent catheter to a vacuum pump. In fact, it allowed the visualization of the solution fluidity, as well as guides the flow of the solution used for joint washing, optimizing the irrigation. However, new studies are necessary to compare different protocols of irrigation with and without the associated use of a vacuum pump.

RESUMO JUSTIFICATIVA E OBJETIVOS : A artrocentese e um tratamento eficaz para diminuir ou abolir a dor, aumentar a máxima distância interincisal e eliminar o derrame articular em pacientes com deslocamento de disco sem redução. O objetivo deste estudo foi expor e discutir uma nova proposta técnica de artrocentese da articulação temporomandibular aplicada no tratamento de um caso de deslocamento de disco sem redução. RELATO DO CASO : Paciente do sexo feminino, 18 anos procurou tratamento devido a dor na articulação temporomandibular e limitação da abertura da boca. A distância interincisal máxima foi de 30,28mm. A ressonância magnética confirmou o diagnóstico de deslocamento de disco sem redução com sinais de derrame articular na articulação temporomandibular direita. A artrocentese foi realizada com o bloqueio anestésico do nervo auriculotemporal, masseterino e temporal profundo posterior. Depois disso, duas agulhas foram inseridas no compartimento superior da articulação temporomandibular. Na segunda agulha foi conectado um cateter transparente e nesse uma bomba de vácuo. Clinicamente, após a artrocentese, a distância interincisal máxima aumentou para 46,25mm e não houve mais dor. Na nova ressonância magnética realizada 180 dias após, não havia mais sinais de derrame articular. CONCLUSÃO : A artrocentese da articulação temporomandibular foi eficaz no tratamento do paciente com deslocamento do disco sem redução. O aspecto dessa técnica, que é particularmente relevante para a prática clínica, foi a conexão de um cateter transparente a uma bomba de vácuo. Isso permitiu a visão da solução, sua fluidez, além de orientar o fluxo da solução utilizada para lavagem, otimizando a irrigação. No entanto, novos estudos são necessários para comparar diferentes protocolos de irrigação com e sem o uso associado de uma bomba de vácuo.

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INTRODUCTION: Arthrocentesis has been used in the temporomandibular joint (TMJ) to analyze components of the synovial fluid or as a therapeutic procedure associated or not with the administration of a drug. The rabbit is one of the most commonly used animal species as a model for pathologies that affect the TMJ. The aim of this study was to propose a specific technique to perform arthrocentesis on the rabbit TMJ, emphasizing descriptions of reference points and measurements for a successful puncture without complications. MATERIALS AND METHODS: Fourteen adult rabbits (Oryctolagus cuniculus) were used. The project was approved by the Scientific Ethics Committee of the Universidad de La Frontera (File Nº083/2016). RESULTS: The description of the technique was divided into three steps: 1) Location of the rabbit TMJ, 2) Positioning of the needles in the TMJ, and 3) Passage of fluid through the TMJ. CONCLUSIONS: This arthrocentesis technique could help to simplify the procedure and give the investigator a guide for joint washing and extraction of synovial fluid in the rabbit TMJ.

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INTRODUCCIÓN. La artritis séptica aguda de rodilla puede provocar daño grave en las articulaciones o sepsis, si no se logra un diagnóstico y tratamiento precoz, lo que incluye drenaje de la articulación, cobertura adecuada de antibióticos y reposo de rodilla. Clásicamente, el drenaje de la rodilla se realiza con múltiples artrocentesis o con artrotomía. El abordaje artroscópico es cada vez más aceptado, pues permite el drenaje adecuado del material purulento y el desbridamiento con la sinovectomía parcial o total de la articulación. OBJETIVO. Evaluar las diferencias entre la artroscopia y la artrotomía en los resultados clínicos y la tasa de recurrencia en pacientes con artritis séptica de la articulación de rodilla. MATERIALES Y MÉTODOS. Revisión de 20 artículos científicos de los últimos 5 años de publicación. Además se analizó los artículos seleccionados para este estudio, como criterios de inclusión se revisaron los que contenían recomendaciones acerca de artrotomía vs artroscopia en el tratamiento de la artritis séptica aguda, excluyendo otro tipo de procedimientos quirúrgicos. RESULTADOS. Se hizo una selección aleatoria de artículos científicos. No existió diferencia en la efectividad del tratamiento en ambos grupos. El dolor fue más alto en los sometidos a tratamiento por artrotomía a los 7 y 14 días postoperatorios. El regreso a las actividades de la vida diaria tomó un promedio de 5,7 días para ambos grupos: 7,1 días para el grupo de artrotomía y 4,3 días para el grupo de artroscopia. CONCLUSIÓN. Esta revisión recolectó información sin evidencia concluyente que demuestre que la artroscopia es más efectiva en el manejo de la artritis séptica. La artrotomía se mantiene como terapéutica estándar en el tratamiento de la artritis séptica de rodilla.

INTRODUCTION. Acute knee septic arthritis can cause serious joint damage or sepsis if early diagnosis and treatment is not achieved, including drainage of the joint, adequate antibiotic coverage and knee rest. Classically, the knee is drained with multiple arthrocentesis or arthrotomy. The arthroscopic approach is increasingly accepted, since it allows adequate drainage of purulent material and debridement with partial or total synovectomy of the joint. OBJECTIVE. To assess the differences between arthroscopy and arthrotomy in clinical outcomes and the recurrence rate in patients with septic arthritis of the knee joint. MATERIALS AND METHODS. Review of 20 scientific articles of the last 5 years of publication. In addition, the articles selected for this study were analyzed, as inclusion criteria were reviewed, which included recommendations about arthrotomy vs arthroscopy in the treatment of acute septic arthritis, excluding other types of surgical procedures. RESULTS A random selection of scientific articles was made. There was no difference in the effectiveness of the treatment in both groups. The pain was highest in those undergoing arthrotomy treatment at 7 and 14 days postoperatively. The return to activities of daily life took an average of 5,7 days for both groups: 7,1 days for the arthrotomy group and 4,3 days for the arthroscopy group. CONCLUSION. This review collected information without conclusive evidence demonstrating that arthroscopy is more effective in the management of septic arthritis. Arthrotomy remains the standard therapy in the treatment of septic knee arthritis.

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