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1. INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. 
Treatment for closed lock of the TMJ that did not
respond to the conservative measures was surgical
recontouring and repositioning of the disc.

But with a introduction of arthroscopy for the TMJ
simple lysis and lavage and use of hydraulic pressure
in the upper joint space were found to be highly
effective in establishing normal MMO.

The technique was first described as Simple means of
releasing the Stuck disc from the fossa by simple
irrigation of the superior joint space under L.A.

The purpose of this study is to evaluate the efficacy
of this technique.
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3.  Preparation
of preauricular skin over TMJ
with antiseptic solution.
 Pretragal
line is drawn 1-2cms in front of the
tragus along the canthotragus line.
 Auriculotemoporal
nerve is blocked 2ml L.A.
 20guaze
needle is introduced into superior
joint space at posterior mark.
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4.  Ringer’s
 Second
 50
solution is introduced.
needle – to distend the joint space.
– 100ml of solution is used to lavage.
 At
the end of procedure patient jaw is
manipulated in vertical protrusive and lateral
excursions.
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5.  46
patients – 44 female.
2 male.
 Average
age – 25 - 39 yrs.
 Duration
– 1month – 7yrs.
 Patient
selection is based on sudden and
persistent limited mouth opening less than
30mm.
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6.  Baseline
data is in the form of MMO and Two
VAS relating to pain and mandibular
dysfunction ranging from 0 – 15.
 Follow-up
upto 6 – 30 months (mean 21
months).
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7. MMO
24.6mm ± 5.2mm
42.3mm ± 6.1mm
VAS 1
8.8 mm± 2.0mm
2.2mm ± 0.6mm
VAS 2
10mm ± 2.1mm
2.7mm ± 2.0mm
One patient failed to demonstrate any significant improvement
after arthrocentesis
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8. 
The technique of TMJ arhrocentesis and lavage
with manipulation has gained wide spread
acceptance in north america as a simple and
effective technique.

This theory was first proposed by Nitzen and
Dolwick.

The theory states the sudden, severe limited
mouth opening is not caused by abnormal disc
shape or position but it is in result of restricted
gliding or forward translation of the condyle
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9. 
The first clinical trial was done on 17 patients,
10 from the Hadassah Hebrew University in
Jerusalem Israel and 7 from the University of
Florida In Gainsville, USA.

The average follow-up of 9 months with mean
improvement in MMO is 18.6mm (19.5 in Israel
group & 14.6 in USA group).

This study compared with present study, whose
results has confirmed the findings of initial study
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10.  In
addition to the treatment of locked jaw it
can be used for management of
osteoarthritis, early rheumatoid arthritis and
hemarthrosis.
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11.  Extravasation
of fluid into surrounding tissue.
 Hematoma.
 Broken
 Facial
catheter tip.
nerve palsy.
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12.  TMJ
Arthrocentesis and lavage is
recommended as a simple alternative to
more invasive TMJ procedures as an effective
technique for the treatment of acute
persistent closed lock of the TMJ.
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13. THANK YOU
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