Biography
Dr. Amr Amin Ghanem, Surgeon Regional LEAD Africa, BDS, Msc, DDs, MRcsp-Glasgow
He is an OMFS surgeon and Professor of OMFS at Ain Shams University. His special interest in CMF Trauma, Orthognathic surgery, and Implantology. He is passionate about knowledge transfer and capacity development for surgeons globally. Head of the Department of OMFS at the British University in Egypt
Presentation Title
Intra-articular Analgesics Following Temporomandibular Joint Arthrocentesis: Is Nalbuphine a Promising Alternative to Morphine?
Abstract
Background
Temporomandibular joint (TMJ) arthrocentesis has become a well-established minimally invasive procedure for managing anterior disc displacement without reduction (closed lock). Although arthrocentesis effectively relieves pain and improves mandibular function, postoperative intra-articular medications may further enhance clinical outcomes. This study aimed to compare the effectiveness of intra-articular nalbuphine versus morphine following TMJ arthrocentesis.
Materials and Methods
Twenty-four female patients diagnosed with anterior disc displacement without reduction refractory to conservative treatment underwent TMJ arthrocentesis followed by random allocation into two equal groups. Group I received 10 mg intra-articular morphine, while Group II received 10 mg intra-articular nalbuphine. Clinical assessment included pain using the Visual Analogue Scale (VAS), maximum mouth opening (MMO), and mandibular lateral excursions. Patients were followed for six months.
Results
Both groups demonstrated significant improvements in pain reduction, mouth opening, and mandibular function throughout the follow-up period. No statistically significant differences were detected between the two medications. However, the nalbuphine group consistently demonstrated slightly superior clinical outcomes, including lower pain scores, greater mouth opening, and fewer patients requiring prolonged splint therapy.
Conclusion
Intra-articular nalbuphine is a safe and effective adjunct following TMJ arthrocentesis and provides clinical outcomes comparable to morphine. Given its favorable safety profile and comparable analgesic efficacy, nalbuphine may represent an attractive alternative opioid for intra-articular administration in the management of TMJ internal derangement.
Keywords: TMJ arthrocentesis; Temporomandibular disorders; Closed lock; Nalbuphine; Morphine; Internal derangement.