Arthrocentesis Procedure: Using this Therapeutic Maneuver for TMJ Closed Lock Management George Soares Santos, DDS, MSc,* Rodrigo Calado Nunes E. Sousa, DDS, MSc,Þ Julio Bisinotto Gomes, DDS, MSc,* Jucele ´ia Maciel, DDS, MSc,|| Celso Koogi Sonoda, DDS, MSc,þ Idelmo Rangel Garcia Jr, DDS, MSc,¶ and Willian Morais de Melo, DDS, MSc*§ Abstract: Temporomandibular joint (TMJ) disorder is a term that encompasses a number of overlapping conditions, such as closed lock. Closed lock of the TMJ is considered a consequence of a nonreducing deformed disc acting as an obstacle to the sliding condylar head that usually causes a decrease in the maximum mouth opening and acute pain. The management of the TMJ is still con- troversial. Thus, arthrocentesis of the TMJ is a valuable modification of the traditional method of arthroscopic lavage, which consists of washing the joint in order to remove chemical inflammatory medi- ators and intra-articular adhesions, changing intra-articular pressure. TMJ disorder has always presented as a therapeutic challenge to maxillofacial surgeons. Therefore, this paper aimed to describe a clinical report of a closed lock of the left TMJ in a 19-year-old female subject who was successfully treated by arthrocentesis procedure. Key Words: Arthrocentesis, internal derangement, minimally invasive surgery, temporomandibular joint (J Craniofac Surg 2013;24: 1347Y1349) I nternal temporomandibular joint (TMJ) derangement is a term that encompasses a number of overlapping conditions, such as closed lock. It occurs in approximately 10% of the population, with a predisposition to younger females. 1 Limited mandibular movement in closed lock has usually been attributed to a nonreducible, ante- riorly displaced disc acting as an obstacle to the gliding condyle. 2 Clinical signs of closed lock of the TMJ are restriction of translator movements, absence of clicking, deviation in opening the mouth toward the affected side, limitation in lateral movement toward the contralateral side, and restriction in protrusive movements, with the mandible shifting toward the affected side. Furthermore, pain is present on palpation and during open movements. 3 Nitzan et al 4 proposed the ‘‘anchored disc phenomenon’’ as etiology for closed lock, considering it as an independent entity from a nonreducible anteriorly displaced disc. In the past, when the treatment for closed lock of the TMJ did not respond well to con- servative methods, surgical recontouring and repositioning of the disc was indicated. 5 In the last 10 years, arthrocentesis and hydraulic distension of the superior joint space of the TMJ has been described as an effective modality in decreasing joint pain and increasing the range of mouth opening in patients with closed lock of the TMJ. 5Y7 Internal TMJ derangement has always presented as thera- peutic challenge to the maxillofacial surgeons. Thus, this paper aimed to describe a case report of a closed lock of the left TMJ in a 19-year-old female subject who was successfully treated by arthrocentesis procedure. CLINICAL REPORT A 19-year-old female subject was referred to the Oral and Maxillofacial Surgery Department, ‘‘Dr. Mario Gatti’’ Municipal Hospital of Campinas, Brazil. The patient presented with complaint of decreasing of her maximum mouth opening over a period of 1 month. Clinically, the patient presented with 22 mm in maximum mouth opening, with pain on palpation of the left TMJ, and absence of clicking, with deviation in opening the mouth toward the left side (Fig. 1). Panoramic radiographic examination showed normal bone structure of both TMJs (Fig. 2). Thus, an occlusal appliance was FIGURE 1. Patient presented with 22 mm in maximum mouth opening (A), with deviation in opening the mouth toward the left side (B). TECHNICAL STRATEGY The Journal of Craniofacial Surgery & Volume 24, Number 4, July 2013 1347 From the *Oral & Maxillofacial Surgery Department, Anto ˆnio Dias Regional HospitalVFHEMIG/SUS, Belo Horizonte; †Oral & Maxillofacial Surgery Department, ‘‘Dr. Mario Gatti’’ Municipal Hospital of Campinas, Sa ˜o Paulo; ||Oral Implantology Post Graduate Program, Department of Surgery and Integrated Clinic, Arac ¸atuba Dental School, Univ Estadual Paulista Ju ´ lio de Mesquita Filho - UNESP, Arac ¸atuba, Sa ˜o Paulo;‡Surgery & Integrated Clinic Department, Arac ¸atuba Dental School, Sa ˜o Paulo State University, Sa ˜o Paulo; ¶ Department of Surgery and Integrated Clinic, Arac ¸atuba Dental School, Univ Estadual Paulista Ju ´ lio de Mesquita Filho - UNESP, Arac ¸atuba, Sa ˜o Paulo; and §Oral & Maxillofacial Surgery Department, Lavras Dental School, University Center of Lavras/UNILAVRAS, Lavras, Brazil. Received October 11, 2012. Accepted for publication January 2, 2013. Address correspondence and reprint requests to Willian Morais de Melo, DDS, MSc, PhD, Avenida Feijo ´ , 1309, Apto. 03, Centro, CEP 14801-140, Araraquara, Sa ˜o Paulo, Brazil; E-mail: wmoraismelo@yahoo.com.br The authors report no conflicts of interest. Copyright * 2013 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e3182869f6b Copyright © 2013 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.