Temporomandibular Eklem Artrosentezi
Özet
Temporomandibular eklem (TME), mandibular kondil ile temporal kemik arasında yer alan, fibrokartilaj yapısı ve kompleks ginglimoartroidal hareketleriyle vücuttaki diğer sinoviyal eklemlerden ayrılan özel bir yapıdır. Çiğneme kasları, artiküler disk, eklem bağları ve sinoviyal sıvı ile desteklenen bu eklemde en sık gözlenen patoloji, kondil-disk ilişkisinin bozulmasıyla karakterize, multifaktöriyel kökenli iç düzensizliklerdir (internal derangement). Başlangıç aşamasında diyet, fizik tedavi, farmakoloji ve oklüzal splint gibi konservatif yöntemler uygulansa da, tedaviye dirençli vakalarda minimal invaziv bir cerrahi alternatif olan artrosentez ön plana çıkmaktadır. İlk olarak üst eklem boşluğuna iki iğne yerleştirilmesi prensibine dayanan klasik yöntemle tanımlanan bu prosedür, eklem içindeki inflamatuar medyatörleri yıkayarak uzaklaştırmayı, disk yapışıklıklarını açmayı ve hidrolik basınçla eklem içi basıncı düşürerek ağrıyı azaltıp ağız açıklığını artırmayı amaçlar. Zamanla çift iğne tekniğindeki yerleştirme zorluklarını, operasyon süresini ve fasiyal sinir hasarı gibi travma risklerini azaltmak amacıyla tek girişli (tek kanallı veya iki kanallı) modifikasyonlar geliştirilmiştir. Akut enfeksiyon, osteomiyelit veya ankiloz gibi durumlarda kontrendike olan TME artrosentezi; lokal anestezi altında uygulanabilen, özel ekipman gerektirmeyen, düşük komplikasyon oranına sahip, ucuz ve etkili bir tedavi seçeneğidir.
Temporomandibular joint (TMJ) is a distinct structure separated from other synovial joints in the body by its fibrocartilage texture and complex ginglymoarthrodial movements, located between the mandibular condyle and the temporal bone. In this joint, which is supported by masticatory muscles, articular disc, joint ligaments, and synovial fluid, the most common pathology is internal derangement characterized by the disruption of the condyle-disc relationship arising from multifactorial origins. Although conservative methods such as diet, physical therapy, pharmacology, and occlusal splints are applied in the initial phase, arthrocentesis stands out as a minimally invasive surgical alternative in cases resistant to treatment. This procedure, initially described by the classical method based on the principle of inserting two needles into the superior joint space, aims to wash out and remove inflammatory mediators within the joint, release disc adhesions, and reduce pain while increasing mouth opening by lowering intra-articular pressure with hydraulic force. Over time, single-puncture (single-channel or double-channel) modifications have been developed to reduce insertion difficulties, operation time, and trauma risks such as facial nerve injury encountered in the double-needle technique. Contrainidicated in cases such as acute infection, osteomyelitis, or ankylosis, TMJ arthrocentesis remains an inexpensive, low complication-rated, and effective treatment option that requires no specialized equipment and can be performed under local anesthesia.
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