Short Term Clinical Outcomes of Ultrasound-Guided Injection of 50% Hypertonic Prolotherapy in Temporomandibular Joint Internal Derangement: Comparative Study

To compare and evaluate the clinical efficacy of ultrasound-guided versus nonguided intraarticular injection of 50% hypertonic dextrose as a single injection in patients with internal derangement. This prospective comparative clinical study was conducted at the Department of Maxillofacial Surgery, Al-Shaheed Ghazi Al-Hariri Hospital, Baghdad Medical City. Fifty patients with unilateral internal derangement unresponsive to conservative management were included. Patients were equally allocated into 2 groups: nonguided injection group (n=25) and ultrasound-guided injection group (n=25). Each patient received a single intraarticular injection of 2 mL of 50% dextrose into the superior joint space using a 21-gauge needle. Pain intensity was measured using the Visual Analog Scale, and maximum mouth opening was assessed preoperatively and at 4, 8, and 12 weeks postinjection. The results were not normally distributed and presented as median (IQR). Both groups presented a statistically significant reduction in pain intensity and a significant increase in maximum mouth opening at 4, 8, and 12 weeks postinjection (P<0.05). Within-group analysis demonstrated significant pain reduction in the nonguided group, 8.64 (1.30) to 0.60 (0.86), and the ultrasound-guided group, 8.28 (1.56) to 0.52 (0.50) (P=0.001). A single injection of 50% hypertonic dextrose is an effective treatment, reducing pain and improving mouth opening. Ultrasound guidance did not provide an advantage over the nonguided technique, but it may reduce discomfort during injection by using a single needle instead of a double-needle approach.