抄録
In the present review article, the clinical significance of temporomandibular joint (TMJ) irrigation (Arthrocentesis and visually guided TMJ irrigation [VGIR]) and arthroscopic surgery for chronic closed lock with/without osteoarthritis (OA) was discussed. Based on the published researches on the TMJ irrigation, it is suggested that the TMJ irrigation can significantly reduce the levels of matrix-metalloproteinase (MMP) -3 and vascular endothelial growth factor (VEGF) in the synovial fluid, and improve the severity of arthroscopically observed synovitis. Regardless of the clinical results after TMJ irrigation, however, the severity of OA does not significantly change, and intra-articular fibrous adhesions become worse. Moreover, investigated several pro-inflammatory cytokines in the synovial fluid do not always disappear even after a clinically successful TMJ irrigation. Therefore, the possibility of exacerbation is considered to subsist even in the successful-group patients. On the other hand, since it was suggested that intra-articular fibrous adhesions are not main cause of the symptoms of chronic closed lock, and that the clinical efficacy of simple TMJ irrigation is almost equal to that of arthroscopic surgery, we have made light of the therapeutic significance of arthroscopic surgery. However, it is much useful as a diagnostic modality, and the accumulation of arthroscopic findings could lead to the clinical researches to clarify the pathology of chronic closed lock and to develop the novel therapeutic strategies. Therefore, it would be important that the arthroscopy is applied to the treatment plan at appropriate timing, and VGIR could be a model of clinical application as a useful modality for arthroscopic examination.
