I-PRF After Arthrocentesis Plus Botox Injection to Lateral Pterygoid Muscle in Treatment of Anterior Disc Displacement

Does Intra-articular Injection of Platelet-Rich Fibrin After Arthrocentesis Followed by Lateral Pterygoid Muscle Injection With Botulinum Toxin Type A Improve Clinical Outcomes for Anterior Disc Displacement?

Aim of Study : To evaluate the efficacy of TMJ arhtrocentesis followed by injection of liquid platelet rich fibrin (I-PRF ) in addition to intramuscular injection of lateral pterygoid muscle with botulinum toxin on clinical outcomes of painful TMJ , maximum mouth opening , joint sounds and range of lateral movement in patients with TMJ anterior disc displacement with reduction

Hypothesis : Intramuscular injection of lateral pterygoid muscle with botulinum toxin plus TMJ intra-articular injection of liquid platelet rich fibrin after arthrocentesis are more effective than TMJ arthrocentesis followed by intra-articular injection of ( I-PRF ) or TMJ arthrocentesis only .

Inclusion Criteria:

• Patients with painful tmj during jaw movements
• Patients with joint sounds ( clicking ) during jaw opening and mastication
• Patients age range from 16 years old to 45 years old
• Patients with Class I maxillo-mandibular relationship
• Patients with reduced mouth opening
• All patients diagnosed clinically and radiographically by MRI as TMJ anterior disc displacement with reduction

Exclusion Criteria:

• Patient with history of recent trauma
• Patients with malocclusion
• Patients with systematic condition that affect bone and joints such as osteoarthritis , systemic lupus and epilepsy .
• Patients allergic to botox injection
• Pregnant or lactating females
• Patients with non-reducible disc on MRI
• Patients contraindicated to exposure to MRI
• Patients with previous tmj arthrocentesis , arthroscopy or TMJ surgery
• Significant mechanical obstruction that prevents mouth opening, acute capsulitis, benign or malignant temporomandibular joint lesions.
• Patients with blood diseases, and coagulation disorders