الفهرس 
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Abstract
The objective of this study was to evaluate the efficacy of intra-articular injection of viscosupplement made of a cross-linked hyaluronic acid (HA) combined with mannitol after Arthrocentesis for treatment of tempromandibular joint internal derangement. The present study was conducted on 18 patients selected from those attending the outpatient clinic of Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Suez Canal University. The selected patients presented with impaired jaw movements, limited joint function, limited mouth opening, Pain with movement of the temporomandibular joint and TMJ noise (Clicking at the affected joint). All selected patients were informed about the details of the study and signed an informed consent. Pre-operative assessment was carried out including measurement of maximum mouth opening, measurement the lateral jaw movement, protrusive movement, assessment of pain, and clicking sound. These measurements were considered to be the base-line values.
Patients who met the criteria of selection were prepared to undergo arthrocentesis procedure under complete aseptic precautions. After complete lavage of the joint, Patients were divided randomly into two equal groups:
group I: (study group): consisted of 9 (2 male and 7 female) patients underwent arthrocentesis followed by single intra-articular injection of 1ml of HAppyMini (Cross-linked Hyaluronic Acid 16 mg and mannitol 35 mg. The product of LABRHA SAS, Lyon, France).
group II: (control group): Composed of 9 female patients. They were undergo arthrocentesis followed by single intra-articular injection of 1ml of saline.
All pre-operative measurement were done after one week, one month, three months and six months postoperatively. Statistical analysis was performed using a commercially available software program (SPSS 19; SPSS, Chicago, IL, USA).
Analysis of the data, revealed no significant differences between the two groups regarding the preoperative measurements for all clinical parameters. While postoperative results showed highly significant differences between the two groups and between the preoperative and postoperative measurements in each group. In the control group, mouth opening gradually increased one week and 1 month post-operatively, then gradually decreased after 3 and 6 months, to a level still significantly higher than the pre-operative value. In the study group, mouth opening gradually increased post-operatively one week, 1 month 3 and 6 months, to a level significantly higher than the pre-operative value. Comparing the two groups, One week post-operatively, a higher mean value was recorded in study group, with no significant difference (p=0.082). One month post-operatively, a higher mean value was recorded in study group, with a significant difference (p=0.026). At three and six months post-operatively, a higher mean value was recorded in study group, with a highly significant difference (p=0.00).
Pain score after one week post-operatively, recorded a higher mean value and mean rank was recorded in control group, with no significant difference between the two groups (p=0.136). At one month, three months and six months post-operatively, a higher mean value and mean rank was recorded in control group, with a highly significant difference (p=0.00).
TMJ tenderness one week post-operatively, recorded a higher mean value and mean rank was recorded in control group, with no significant difference (p=0.89). At one month post-operatively, a higher mean value and mean rank was recorded in control group, with a highly significant difference (p=0.003). Three months and Six months post-operatively, a higher mean value and mean rank was recorded in control group, with a highly significant differences compared with study group (p=0.065), (p=0.014).
Protrusive movement one week post-operatively, a higher mean value was recorded in the study group, with highly significant difference (p=0.005). One month, 3 months and 6 months post-operatively, a higher mean value was recorded in the study group, with highly significant difference (p=0.007, P=0.001 and P=0.00 respectively), Right side lateral movement at one week post-operatively, the same mean value was recorded in both groups, with no significant difference (p=1). One month, 3 months and 6 months post-operatively, a higher mean value was recorded in study group, with no significant difference (p=0.684, P=0.185 and P=0.185 respectively). Left side lateral movement at one week post-operatively showed a higher mean value in control group, with no significant difference (p=0.784). At one month, 3 months and 6 months post-operatively, a higher mean value was recorded in study group, with no significant difference (p=0.919, P=0.185 and P=0.185 respectively).
In the control group, the incidence of clicking increased after the first week, then gradually decreased to reach 66.7% after 3 and after 6 months, with no significant difference (p=0.317). While, the incidence of clicking in the study group significantly decreased starting from one week post-operatively, to reach 0% after 3 and after 6 months which was found highly significant reduction (p<0.0001).
On conclusion, intra-articular injection of viscosupplement made of a cross-linked hyaluronic acid combined with mannitol after arthrocentesis was a safe and effective line of treatment for patients with temporomandibular joint internal derangement, which produced rapid improvement of symptoms from the first week and lasted for 6 months.