Evaluation of Intra-articular Injection of Simvastatin versus Hyaluronic Acid in Treatment of Internal Derangement of Temporomandibular Joint

Mahmoud, Mohamed Ashraf; El Sharrawy, Eman Abdelhalim; El Desouky, Gehan Gamal Eldin; Abdel Mabood, Abdel Badee Abdall

doi:10.21608/dsu.2021.31287.1037

Evaluation of Intra-articular Injection of Simvastatin versus Hyaluronic Acid in Treatment of Internal Derangement of Temporomandibular Joint

Document Type : Original Article

Authors

¹ Hearing and Speech Institute, General Organization for Teaching Hospitals and Institutes

² Oral and Maxillofacial surgery department, Faculty of Dentistry, Suez Canal University

³ vice Dean of Faculty of Dentistry, Suez Canal University

⁴ Oral and Maxillofacial Surgery, Faculty of Dentistry ,Zagazig University

10.21608/dsu.2021.31287.1037

Abstract

ABSTRACT
Introduction: TMJ Internal Derangement is a common form of temporomandibular
joint disorder. Almost 80% of adult symptomatic patients with TMD have some form of
ID. Temporomandibular joint arthrocentesis consists of lavage of upper joint space of
TMJ done with no direct vision, aiming primarily to remove necrotic tissue, blood
and pain mediators from the joint. One of these therapeutic substances is hyaluronic
acid; which is a polysaccharide of the family of glycosaminoglycans, which can be
found in many extracellular tissues, including synovial fluid and cartilage. Simvastatins
are group of drugs which have good results in regeneration of degenerated TMJ.
Aim: This study aimed to evaluate the intra-articular injection of simvastatin versus
sodium hyaluronate following arthrocentesis for management of internal derangement
(ID) of the temporomandibular joint(TMJ). Patients and methods: Thirty patients with
internal TMJ derangement were included in this study. All patients were subjected to
preoperative clinical examination and preoperative magnetic resonance imaging (MRI)
for the affected joints. Arthrocentesis was performed firstly for the affected joints in
all patients followed by intra-articular injection of 1ml. simvastatin twice a month (in
group I) and sodium hyaluronate twice a month ( in group II).Clinical follow up were
done at 24 hours post-operatively, one week, one month,and six months. Then, after six
months MRI was repeated to compare with preoperative images. Results: Better results
were recorded with simvastatin group in comparison to sodium hyaluronate group; at 1
week, 1 month,and six months intervals; which was superior to arthrocentesis followed
by sodium hyaluronate intra-articular injection. Patients in group I showed better MRI
findings in comparison to group II where the position of the disc was almost returned
to its normal anatomical position. Conclusion: Arthrocentesis followed by simvastatin
intra-articular injection was superior to the combination of arthrocentesis and sodium
hyaluronate intra-articular injection for management of TMJ internal derangements
symptoms.

Keywords