Sequential infiltration of sodium hyaluronate in the temporomandibular joint with different molecular weights. Case report

BACKGROUND AND OBJECTIVES: Temporomandibular disorders are diseases causing pain and dysfunction in joints and muscles controlling mandibular movements. Their etiology is multifactorial and multidisciplinary approaches are needed to reach a differential diagnosis and an adequate management plan. This case report proposes a management protocol, with monthly sodium hyaluronate infiltrations, with different molecular weights, to control such changes and promote improvement of temporomandibular joint biomechanics and pain. CASE REPORT: This study describes a case of a 48-year old patient with a 10-year history of temporomandibular pain with function loss since 2001. Patient has classified her pain as 9 according to analog visual scale. In addition, history and detailed physical evaluation have shown different signs and symptoms, such as localized pain (right side), and right temporomandibular joint arthralgia with noise. Diagnosis was disc displacement with reduction and possible synovitis/ capsulitis to the right. Right temporomandibular joint osteoarthritis was also diagnosed by cone beam CT-scan. Initially, a flat upper splint with total coverage and contact with all antagonist teeth was used. In the attempt to decrease temporomandibular arthralgia, non-steroid anti-inflammatory drugs and muscle relaxants were used. Since right temporomandibular joint pain was not effectively managed, we decided to use intra-joint sodium hyaluronate injections with different molecular weights, per month, in a total of four applications. At treatment completion, clinical evaluation has shown normal Sequential infiltration of sodium hyaluronate in the temporomandibular joint with different molecular weights. Case report Infiltração sequencial de hialuronato de sódio com diferentes pesos moleculares na articulação temporomandibular. Relato de caso Eduardo Grossmann1, Roberta Fonseca2, Camila Almeida-Leite2, Rafael Tardin Gonçalves3, Pedro Gonçalves de Oliveira4, Eduardo Januzzi3 1. Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil. 2. Universidade Federal de Minas Gerais, MG, Brasil. 3. Ciodonto, Belo Horizonte, MG, Brasil. 4. Universidade Anhembi, São Paulo, SP. Brasil. Submitted in July 27, 2015. Accepted for publication in October 13, 2015. Conflict of interests: none – Sponsoring sources: none. Correspondence to: Eduardo Grossmann Rua Coronel Corte Real, 513, Bairro Petrópolis. 90630-080 Porto Alegre, RS,Brasil. E-mail: [email protected] © Sociedade Brasileira para o Estudo da Dor function, no pain with visual analog scale = zero, in addition to adequate interincisal distance. CONCLUSION: This report has suggested that viscosupplementation cycles with sodium hyaluronate of different molecular weights may provide excellent results in the long run, to control joint temporomandibular disorder symptoms. Therapeutic benefits were maintained for four years with no need for annual maintenance cycles.