Evaluation of intraarticular injection of hyaluronic acid with platelet rich plasma for treatment of temporomandibular joint anterior disc displacement with and without reduction

Abstract

Background For patients who failed to respond to conservative measures for temporomandibular joint (TMJ) internal derangement after arthrocentesis, several intraarticular injections have been shown to be an effective treatment modality to reduce pain, improve joint movement and range of motion. Purpose Our study aim was to evaluate the efficacy of intraarticular injection of hyaluronic acid (HA) and platelet rich plasma (PRP) in the treatment of TMJ anterior disc displacement with (DDwR) and without (DDwoR) reduction after arthrocentesis. Patients and methods This prospective clinical study involved 20 patients with TMJ anterior disc displacement, assigned into two equal groups. Group 1 included 10 patients with DDwR and group 2 included 10 patients with DDwoR. Both groups were treated with arthrocentesis and intraarticular injection of 1 ml of equal amount of HA and PRP into the superior joint space. Visual analog scale (VAS), maximum mouth opening (MMO), lateral jaw movements and joint clicking sounds were assessed at each follow up period (1 week, 1 month, 3 months, and 6 months) for both groups. The collected data was then statistically analyzed. Results Pain intensity decreased in both groups; in group 1, mean VAS decreased from 6.9 to 0.6 while in group 2, VAS decreased from 6.8 to 0.8. MMO mean for group 1 increased from 32.4 to 44.9 mm. In group 2, MMO increased from 24 to 34.6 mm. TMJ lateral movement for group 1 increased from 6 to 8.7 mm and for group 2, it increased from 5.5 to 7.2 mm. Number of patients with TMJ clicking in group 1 decreased from 8 to 1 while in group 2, patients had no clicking sounds from the start. MRIs showed no change before and after study in both groups as disc remained at same position. Conclusions Intraarticular injection of HA and PRP mixture was found to be clinically effective in the treatment of TMJ disorders in both anterior DDwR and DDwoR groups; however, no significant difference was noticed on the disc position on the MRI.