Glucocorticosteroid Injection In the Temporomandibular Joint

Abstract: Local injection of glucocorticosteroid (GCS) is an effective treatment of painful conditions in the temporomandibular joint (TMJ). GCS can be administered using anatomical landmarks for orientation or by the use of simultaneous radiographic imaging. In the image guided technique the corticosteroid is mixed with a contrast medium and the injection visualized using radiography. The aim of this prospective pilot study was to compare the treatment effect of intra-articular GCS injection in the TMJ with- and without the use of simultaneous radiographic imaging. 13 patients (9 women and 4 men) with TMJ arthralgia received injection either with or without simultaneous radiographic imaging. Treatment effect was evaluated based on changes in clinical signs and symptoms before and 4-6 weeks after treatment. The symptoms included pain at rest and at jaw function, joint locking, pain index and global improvement. Clinical observations involved TMJ pain to palpation, maximal mouth opening, pain at maximal opening and joint sounds. The main findings were significant decreases in pain index and relief of familiar pain before and after treatment as well as a positive effect on global improvement regardless of administration technique. There were no significant differences between the two methods in treatment outcome. The results suggest that both administration techniques are comparable in treatment effect and should therefore rather be evaluated based on cost-effectiveness and radiation dose. It may be reasonable to apply the image-guided technique mainly when further diagnostic information is needed.