Abstract
The authors developed and applied clinically a new technique (middle-lateral approach) of inferior joint compartment arthroscopy of the temporomandibular joint, based upon the results of the anatomical study which was reported earlier. The needle arthroscope devised for the inferior compartment was employed, with a diameter of 1.2mm, and a length of 32mm. Five adult fresh cadavers (5 joints) were prepared for the anatomical study and 11 patients (16 joints) received diagnostic arthroscopy of the inferior compartment. The middle-lateral approach was as follows; 1) insertion of an 18 gauge needle from the skin point 7mm inferior to the condylar head, 2) placement of the needle tip to contact the condylar neck perpendicularly, puncturing the inferior compartment along the lateral bone surface from the inferior direction, 3) exchanging the needle for a mandlin by insertion through the needle, 4) insertion of the arthroscopic cannula as a guide of the mandlin, 5) arthroscopic examination of the compartment under distension by saline. Using this technique, all 5 cadavers were punctured successfully without any iatrogenic disk perforation. In the clinical application, all joints were treated with this technique excepted for 2. Both the anterior and posterior recess were successfully examined. However, the medial part of the compartment was limited in arthroscopic detection.
The middle-lateral approach is therefore recommended as a reliable and safe technique for inferior compartment arthroscopy of the temporomandibular joint.
