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