An image-guided technique for puncture of the superior temporomandibular joint cavity: clinical comparison with the conventional puncture technique

Retrospective analysis of ideal needle puncture angles and depths for temporomandibular joint arthrocentesis using CBCT data

BACKGROUND

This study aimed to investigate the range of angles and depths necessary for effective entry into the TMJ using CBCT images, focusing on classical Holmlund Hellsing points and a two-needle approach.

METHODS

A retrospective cohort of CBCT images from January 2020 to November 2023 was analysed using 3D analysis to determine the variance in the required angles and depths.

RESULTS

The average age of the 68 participants included in the study was 29.5 ± 11.1, 58.8% of the participants were female and 41.2% were male. The anterior needle measurements showed a relatively low standard deviation(SD) in depth(SD:3.6) with a low variance coefficient(12.5%), whereas the axial and coronal angles exhibited greater variability(SD:9.1 and 7.6, respectively). For the posterior needles, moderate SDs in depth(SD:3.5) and greater variabilities in axial and coronal angles(SD:9.6 and 5.3, respectively) were observed. A weak negative correlation was observed between the axial angle of the posterior needle and age(p: 0.028, Pearson r: -0.29) Anterior needle depth (p:0.037) and posterior needle axial angle(p:0.014) were greater in males than females. The anterior needle depth in patients with temporamandibular disease was greater than in those without(p:0,03).

CONCLUSION

There were significant differences in the angle measurements for both anterior and posterior needles, but lower variance in depth. The depths and angles of the needles did not correlate with age.

Complications of arthroscopic lysis and lavage in internal derangement of the temporomandibular joint - A single institutional experience with review of literature

PURPOSE

To evaluate the complications of arthroscopic lysis and lavage with joint sweep (ALL) procedure in the management of disc derangement of the temporomandibular joint.

METHODS

Patients with internal derangement of the TMJ who were treated by ALL in a tertiary institution from July 2018 to December 2021 were studied retrospectively.

RESULTS

The study included 39 patients (males, n = 14; females, n = 25) and 50 joints. The complications observed in the study were classified into intra and post operative complications. Post operative complications such as pain (16%), swelling (6%), reduced mouth opening (22%) and neurological complications were the most commonly observed ones. Rare complications such as ipsilateral palatal swelling (6%), parapharyngeal swelling (4%), and post operative malocclusion (2%) were also observed.

CONCLUSION

Although the complications of ALL are entirely unavoidable, their incidence can be reduced by strict adherence to standard techniques. Three-dimensional awareness and orientation of the dangerous angles and depth around the TMJ region is mandatory to reduce the complications.

Efficacy of computer-guided versus conventional sodium hyaluronate injection in superior joint space in treatment of temporomandibular joint (TMJ) internal derangement: Comparative randomized controlled trial

OBJECTIVES

evaluate the feasibility and clinical outcomes of computer-guided sodium hyaluronate injection in superior joint space compared to conventional injection for the treatment of TMJ Internal Derangement (TMJ-ID).

PATIENTS AND METHODS

Randomized controlled trial conducted on 40 patients diagnosed with bilateral TMJ-ID divided into two groups. Group A treated with four computer-guided sodium hyaluronate injections in superior TMJ space with one-week intervals. Group B received similar injections but with the conventional method. The intraoperative assessment included total procedural time and patient convenience during the injection. The postoperative evaluation included maximum unassisted mouth opening (MUMO), modified Helkimo's clinical dysfunction index, and pain intensity on a visual analog scale (VAS).

RESULTS

Group A showed better improvement in maximum mouth opening and pain intensity than group B after a week of the second, third and fourth injection. At the six months, group A continued to show better improvement regarding maximum mouth opening, while improvement in pain and TMJ dysfunction was similar in both groups. There were differences between both groups regarding procedural time and patient convenience across the study except the time of the first injection, which was similar in both groups CONCLUSION: Using the virtual planning and injection guide for intra-articular TMJ injection is considered promising to increase the accuracy and efficacy of injectable material securing faster results besides rendering the procedure easily reproducible and simpler to both clinicians and patients. However, the authors could not ensure the long-term superiority of the computer-guided injection technique over the conventional one in light of the results of this study.

Ultrasound-guided vs conventional arthrocentesis for management of temporomandibular joint disorders: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to compare outcomes between ultrasound (US)-guided arthrocentesis and conventional arthrocentesis for the management of temporomandibular joint disorders (TMDs).

METHODS

PubMed, Embase, Scopus, BioMed Central, CENTRAL, and Google scholar databases were searched up to April 1 2020 for randomized control trials (RCTs) comparing US-guided and conventional arthrocentesis.

RESULTS

Four RCTs were included. Pooled analysis did not demonstrate any statistically significant difference in pain or maximal mouth opening (MMO) scores after 1 week and 1 month of follow-up between US-guided and conventional arthrocentesis. Studies also reported data on intra-operative needle relocations and operating time but with conflicting results.

CONCLUSION

This study indicates that the use of US during arthrocentesis may not improve postoperative pain and MMO in the short term. Data on intra-operative outcomes are scarce and conflicting for any definitive conclusions. Further high-quality adequately powered RCTs are required to strengthen current evidence.

Computer-Guided Arthrocentesis Using Patient-Specific Guides: A Novel Protocol for Treatment of Internal Derangement of the Temporomandibular Joint

PURPOSE

The aim of the present study was to evaluate the accuracy of 3-dimensionally (3D) printed patient-specific guides (PSGs) to direct the passage of inlet and outlet needles into the superior joint spaces of the temporomandibular joint (TMJ) in preparation for arthrocentesis.

PATIENTS AND METHODS

The present study included 10 patients with 14 TMJs with anterior disc displacement with reduction. A 3D PSG was designed for each patient to lead the inlet and outlet needles into the superior joint space of the TMJ. The PSGs were implemented, and their accuracy for guiding the needles into the superior joint space was assessed.

RESULTS

Both arthroscopic verification and clinical evaluation revealed that direct access to all the predetermined anatomic locations inside the TMJs had been obtained, except for 1 case, during which the patient had failed to maintain the maximum mouth opening during computed tomography scanning.

CONCLUSIONS

The virtual computer-initiated PSGs were beneficial for directing the passage of the needles into the superior joint space.

Ultrasound-guided arthrocentesis using single-puncture, double-lumen, single-barrel needle for patients with temporomandibular joint acute closed lock internal derangement

PURPOSE

Temporomandibular joint (TMJ) disc derangement is defined as a malpositioning of the articular disc relative to the condyle and eminence. Arthrocentesis of the TMJ is considered by many as the first-line surgical treatment for patients who do not respond to conservative treatment. The aim of this study is to assist needle insertion for temporomandibular joint arthrocentesis using ultrasonography.

MATERIALS AND METHOD

Twenty patients who required arthrocentesis of the TMJ were randomly assigned to two groups A and B undergoing single-puncture arthrocentesis with modified double-lumen single-barrel needle and ultrasound-guided single-puncture arthrocentesis using modified double-lumen single-barrel needle (n = 10 in each group). The number of attempts of needle manipulation, duration of the operative procedural time, and visual analog (VAS) scale score for pain to assess surgical discomfort were the main outcome variables.

RESULTS

None of the patients in either group developed any complication with no significant difference in VAS score for pain between the two study groups. The number of attempts for needle manipulation (mean ± SD) for group A was 2.20 ± 0.789, and for group B, it was 1.10 ± 0.316 (p value, 0.0007); operative procedural time (mean ± SD) for group A was 18.5 ± 3.171 min, and for group B, it was 13.1 ± 1.663 (p value, 0.0002) which was significantly lesser in group A than in group B. The sentence signifies that the number of attempts that was required to re-insert the needle to enter the joint space in Ultrasound guided and conventional method of arthrocentesis.

CONCLUSION

Ultrasound-guided single-puncture arthrocentesis using a customized needle is a promising method to perform joint lavage with minimal trauma and in a precise manner.

Augmented reality for temporomandibular joint arthrocentesis: a cadaver study

Temporomandibular joint (TMJ) arthroscopic procedures require the identification of a skin puncture point. The puncture point is conventionally estimated using the surface anatomy of the canthal-tragus line. However, the conventional puncture technique has been reported to fail at the first attempt in 18% of cases. We propose an augmented reality (AR) system-based method to identify the puncture point on the skin. A three-dimensional virtual model was reconstructed from computed tomography images of a cadaver head, and its rendered image was superimposed on the cadaver head before skin puncture. The skin puncture point was marked on the skin under the guidance of the AR system. The TMJ was punctured through the mark and the endoscope was introduced through the puncture point. The outcome of the procedure was classified as successful or unsuccessful based on the visualization of the TMJ. The system was applied on the left and right sides of three cadaver heads. Puncture with the AR method was successful in all six cases. This study presents a system to provide AR visualization during TMJ arthrocentesis to increase the precision of skin puncture. However, a comparative study of the AR method with the conventional method is required to evaluate its advantages.

Comparison of clinical outcomes of treatment of dysfunction of the temporomandibular joint between conventional and ultrasound-guided arthrocentesis

Patients with disorders of the temporomandibular joint (TMJ) who do not respond to non-operative treatment may require invasive procedures such as arthrocentesis and arthroscopy. We divided 80 patients with dysfunction of the TMJ into two groups: a control group who were treated by conventional arthrocentesis, and an experimental group who were treated by ultrasound-guided arthrocentesis. Both groups were monitored three days, one week, and one month postoperatively and the clinical outcomes compared. The experimental group had a significant reduction in the degree of pain in the immediate postoperative period (p=0.015). However, ultrasound-guided arthrocentesis showed no significant improvement in symptoms overall compared with conventional arthrocentesis. Both techniques seem to be effective in the management of dysfunction of the TMJ.

Temporomandibular joint diagnostics using CBCT

The present review will give an update on temporomandibular joint (TMJ) imaging using CBCT. It will focus on diagnostic accuracy and the value of CBCT compared with other imaging modalities for the evaluation of TMJs in different categories of patients; osteoarthritis (OA), juvenile OA, rheumatoid arthritis and related joint diseases, juvenile idiopathic arthritis and other intra-articular conditions. Finally, sections on other aspects of CBCT research related to the TMJ, clinical decision-making and concluding remarks are added. CBCT has emerged as a cost- and dose-effective imaging modality for the diagnostic assessment of a variety of TMJ conditions. The imaging modality has been found to be superior to conventional radiographical examinations as well as MRI in assessment of the TMJ. However, it should be emphasized that the diagnostic information obtained is limited to the morphology of the osseous joint components, cortical bone integrity and subcortical bone destruction/production. For evaluation of soft-tissue abnormalities, MRI is mandatory. There is an obvious need for research on the impact of CBCT examinations on patient outcome.

Can puncture increase the risk of intra-articular adhesion in the temporomandibular joint?

PURPOSE

This study aims to compare the incidence and severity of intra-articular adhesion under arthroscopy between patients with and without a history of joint puncture.

PATIENTS AND METHODS

Eighty-nine patients with internal derangements of TMJ who underwent arthroscopic disc repositioning and suturing surgery from February 2008 to September 2008 were included in this study. Patients were divided into 2 groups based on whether the patient had undergone joint puncture before surgery or not. The diagnosis of intra-articular adhesion was made according to the manifestation under arthroscopy. Incidence and severity of intra-articular adhesion between these 2 groups was compared.

RESULTS

The incidence of intra-articular adhesion in the patients with a history of puncture was 69.23%, which was higher than that in the patients without a history of puncture (24.36%). The difference was statistically significant (P < 0.05). The incidence of severe adhesions in patients with a history of joint puncture was also higher than that in patients without a history of puncture (26.09% vs. 2.56%, P < 0.01).

CONCLUSIONS

Puncture may increase the risk of intra-articular adhesion in patients with internal derangement.

Evaluation of the usefulness of magnetic resonance imaging in the assessment of the thickness of the roof of the glenoid fossa of the temporomandibular joint

OBJECTIVE

The aim of this study was to evaluate the usefulness of magnetic resonance imaging (MRI) in measuring thickness of the roof of the glenoid fossa (RGF) of the temporomandibular joint (TMJ).

STUDY DESIGN

Minimum RGF thickness in 95 TMJs of 59 patients with temporomandibular disorders were measured and compared on both sagittal-section MRI and cone-beam computed tomography (CBCT). RGF thickness on MRI was also compared with MRI, CBCT, and arthrographic findings.

RESULTS

Minimum RGF thickness was greater on MRI (1.46 mm) than on CBCT (0.90 mm). Spearman's correlation coefficient by rank for these 2 types of measurements was 0.63. RGF thickness on MRI differed significantly between those with and without degenerative joint changes (1.69 vs 1.32 mm; P < .01) and between those with and without disk displacement (1.58 vs 1.35 mm; P = .04), but showed no associations with disk deformity, joint effusion, or disk perforation.

CONCLUSIONS

MRI is useful in measuring RGF thickness from diagnostic as well as radiation protection standpoints.