A technical note on establishment of a high hydraulic outflow in arthrocentesis of the temporomandibular joint

Abstract

The aim of the current study was to describe a simple strategy highlighting the help of correct positioning of bevels at irrigation tips to ensure an appropriate lavage with high hydraulic pressure in the arthrocentesis of the temporomandibular joint. Two simple markings on both needle hubs could be helpful in ensuring appropriate lavage with high hydraulic pressure in the arthrocentesis of the TMJ. Arthrocentesis of the temporomandibular joint (TMJ) is a simple and minimally invasive treatment option in the management of patients with internal derangement of the TMJ [1]. The main goals of the procedure are lysis and lavage of the upper joint space to eliminate inflammatory mediators, release disc adhesions, and increase the mouth opening by mobilization/expansion of the TMJ [2]. Arthrocentesis can be performed either under low pressure using elevated infusion sets or under pressure using a syringe. In cases with fibrous adhesions or restricted upper joint space secondary to structural discrepancies of the TMJ, the puncture and lavage could be difficult or impossible. In addition, lysis of fibrous adhesions could only be ensured by a high-pressure-lavage [3]. Despite the simplicity of the surgical procedure, anatomical knowledge and experience of the surgeon play a key role in the sufficient lysis/lavage of the upper joint space. Elimination of the technical difficulties due to displacement of the needles during the irrigation and difficulty of inserting the outflow needle in the right place has been the subject of many studies. Various techniques have been determined to establish a proper and quick lavage; an elongated operation time or repeated punctures could negatively influence the therapy results [4]. The current technical note describes the help of simple markings to ensure a sufficient lavage with high hydraulic pressure in arthrocentesis of the TMJ. Surgical technique