Treatment of Temporomandibular Joint Internal Derangement Using MESNA Injection

Overview

Journal BMC Oral Health

Publisher Biomed Central

Specialty Dentistry

Date 2024 Aug 4

PMID 39098893

Authors

Ahmed A Mosleh

Affiliations

Soon will be listed here.

Abstract

Introduction: The development of temporomandibular disorders specifically emphasizes the biochemical changes occurring in the synovial fluid at different stages of temporomandibular joint disease. Research has indicated that inflammation may be a primary reason behind the pain and dysfunction in temporomandibular joint diseases. Since its clearance several years ago, MESNA (sodium 2-mercaptoethanesulfonate) has been used in various formulations as a mucolytic drug in the respiratory domain. It operates by disrupting the disulfide bonds present between polypeptide chains within mucus. MESNA exhibits minimal tissue distribution, with the material being swiftly and thoroughly eliminated via the kidneys.

Objectives: To assess the efficacy of injecting MESNA directly into the Temporomandibular Joint to treat internal derangement.

Materials And Methods: A randomized clinical trial was conducted on sixty patients who exhibited non-responsiveness to conventional treatment and were diagnosed with TMJ anterior disc displacement with reduction. The patients were chosen from the outpatient clinic of the Oral and Maxillofacial Surgery Department at Tanta University Faculty of Dentistry. Two equal groups of patients were randomly assigned to each other. Group I (Mesna group) received intra-articular injection with MESNA solution. Group II (Standard group) received arthrocentesis with lactated ringer solution followed by injection of Hyaluronic Acid (HA). The data was gathered by functional examinations such as maximum interincisal opening (MIO) and clicking. A Visual Analogue Scale (VAS) assessed pain severity before and after treatments.

Results: Both MESNA and HA showed significant improvement up to six months of the follow-up compared to preoperative status, as evidenced by better mouth opening, lateral excursion, lower clicking, and reduced pain score in patients with TMDs. MESNA showed significant improvement during follow-up compared to HA.

Conclusion: Compared to HA, MESNA showed a more noticeable improvement during the follow-up period.

References

Pannucci C, Wilkins E . Identifying and avoiding bias in research. Plast Reconstr Surg. 2010; 126(2):619-625. PMC: 2917255. DOI: 10.1097/PRS.0b013e3181de24bc. View

Dolwick M, Katzberg R, Helms C . Internal derangements of the temporomandibular joint: fact or fiction?. J Prosthet Dent. 1983; 49(3):415-8. DOI: 10.1016/0022-3913(83)90287-1. View

Gencer Z, Ozkiris M, Okur A, Korkmaz M, Saydam L . A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints. J Craniomaxillofac Surg. 2014; 42(7):1117-21. DOI: 10.1016/j.jcms.2014.01.041. View

Charan J, Biswas T . How to calculate sample size for different study designs in medical research?. Indian J Psychol Med. 2013; 35(2):121-6. PMC: 3775042. DOI: 10.4103/0253-7176.116232. View

Atali O, Ozcelik E, Gonul O, Garip H . Evaluation of Patient Comfort and Impact of Different Anesthesia Techniques on the Temporomandibular Joint Arthrocentesis Applications by Comparing Gow-Gates Mandibular Block Anesthesia with Auriculotemporal Nerve Block. Pain Res Manag. 2022; 2022:4206275. PMC: 9453085. DOI: 10.1155/2022/4206275. View

Westesson P, BRONSTEIN S, Liedberg J . Internal derangement of the temporomandibular joint: morphologic description with correlation to joint function. Oral Surg Oral Med Oral Pathol. 1985; 59(4):323-31. DOI: 10.1016/0030-4220(85)90051-9. View

Bjornland T, Gjaerum A, Moystad A . Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. J Oral Rehabil. 2007; 34(8):583-9. DOI: 10.1111/j.1365-2842.2007.01759.x. View

Farrar W . Characteristics of the condylar path in internal derangements of the TMJ. J Prosthet Dent. 1978; 39(3):319-23. DOI: 10.1016/s0022-3913(78)80103-6. View

Ghoneim N, Mansour N, Elmaghraby S, Abdelsameaa S . Treatment of temporomandibular joint disc displacement using arthrocentesis combined with injectable platelet rich fibrin versus arthrocentesis alone. J Dent Sci. 2022; 17(1):468-475. PMC: 8739728. DOI: 10.1016/j.jds.2021.07.027. View

10.

Nitzan D, Dolwick M, Martinez G . Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg. 1991; 49(11):1163-7; discussion 1168-70. DOI: 10.1016/0278-2391(91)90409-f. View

11.

Faul F, Erdfelder E, Lang A, Buchner A . G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39(2):175-91. DOI: 10.3758/bf03193146. View

12.

Alpaslan G, Alpaslan C . Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements. J Oral Maxillofac Surg. 2001; 59(6):613-8; discussion 618-9. DOI: 10.1053/joms.2001.23368. View

13.

Eversole L, Machado L . Temporomandibular joint internal derangements and associated neuromuscular disorders. J Am Dent Assoc. 1985; 110(1):69-79. DOI: 10.14219/jada.archive.1985.0283. View

14.

Chisnoiu A, Picos A, Popa S, Chisnoiu P, Lascu L, Picos A . Factors involved in the etiology of temporomandibular disorders - a literature review. Clujul Med. 2016; 88(4):473-8. PMC: 4689239. DOI: 10.15386/cjmed-485. View

15.

Egilmez O, Kokten N, Baran M, Kalcioglu M, Ekici I, Tekin M . Electrophysiological and Histopathological Evaluation of Effects of Sodium-2 Mercaptoethanesulfonate Used for Middle Ear Surgery on Facial Nerve Functions. J Int Adv Otol. 2017; 14(2):239-244. PMC: 6354450. DOI: 10.5152/iao.2017.3888. View

16.

Walters S, Jacques R, Dos Anjos Henriques-Cadby I, Candlish J, Totton N, Xian M . Sample size estimation for randomised controlled trials with repeated assessment of patient-reported outcomes: what correlation between baseline and follow-up outcomes should we assume?. Trials. 2019; 20(1):566. PMC: 6743178. DOI: 10.1186/s13063-019-3671-2. View

17.

Wilkes C . Internal derangements of the temporomandibular joint. Pathological variations. Arch Otolaryngol Head Neck Surg. 1989; 115(4):469-77. DOI: 10.1001/archotol.1989.01860280067019. View

18.

Kerstein R, Radke J . Average chewing pattern improvements following Disclusion Time reduction. Cranio. 2016; 35(3):135-151. DOI: 10.1080/08869634.2016.1190526. View

19.

Yoda T, Imai H, Shinjyo Y, Sakamoto I, Abe M, Enomoto S . Effect of arthrocentesis on TMJ disturbance of mouth closure with loud clicking: a preliminary study. Cranio. 2002; 20(1):18-22. DOI: 10.1080/08869634.2002.11746185. View

20.

Ajmal N, Riordan C, Cardwell N, Nanney L, Shack R . Chemically assisted capsulectomy in the rabbit model: a new approach. Plast Reconstr Surg. 2003; 112(5):1449-54. DOI: 10.1097/01.PRS.0000081069.87802.98. View