Temporomandibular Lavage Versus Nonsurgical Treatments for Temporomandibular Disorders: A Systematic Review and Meta-Analysis

Purpose: To investigate the efficacy of temporomandibular joint (TMJ) lavage (arthrocentesis or arthroscopy) for the treatment of temporomandibular disorders in reducing pain and improving jaw motion. Patients and Methods: We performed a systematic review of the literature and meta-analysis of randomized controlled trials (RCTs) comparing TMJ lavage with conservative measures. The data sources were MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus, Web of Science, and reference lists of relevant articles. Two independent reviewers identified RCTs by using controlled vocabulary (MeSH, Emtree) and free text terms. Data extracted from the selected studies included population characteristics, interventions, outcomes, and funding sources. Risk of bias was assessed with the Cochrane Collaboration risk assessment tool for RCTs. Results: Five studies met the inclusion criteria, for a total of 308 patients. Of these studies, 3 were categorized as having a high risk of bias and 2 had a low risk. The summary effect of the 5 studies showed a reduction in pain in the intervention group at 6 months (-0.63; 95% confidence interval [CI], -0.90 to -0.37; P < .00001; I-2 = 88%) and 3 months (-0.47; 95% CI, -0.75 to -0.19; P = .001; I-2 = 85%). This was not the case at 1 month. No difference in mouth opening was observed at 6 months (-0.21; 95% CI, -1.82 to 1.40; P < .80; I-2 = 74%), 3 months (0.20; 95% CI, -1.81 to 2.20; P = .85; I-2 = 68%), and 1 month (-1.18; 95% CI, -2.90 to 0.55; P = .18; I-2 = 0%). Conclusions: Given the relatively small number of patients included in this meta-analysis, the high risk of bias in 3 studies, and the statistical and clinical heterogeneity of the included studies, the use of TMJ lavage for the treatment of temporomandibular disorders should be recommended with caution because of the lack of strong evidence to support its use. (C) 2016 American Association of Oral and Maxillofacial Surgeons