Arthroscopy of the temporomandibular joint (TMJ) was first reported by Ohnishi [1]. Arthroscopy is useful to detect early changes of intra-articular space in the temporomandibular joint (TMJ) that can not be detected with magnetic resonance imaging (MRI) and computed tomography (CT) [2].
Arthrocentesis is regarded as being less invasive than arthroscopic lysis and lavage. In addition, the effectiveness of arthrocentesis has been shown to be clinically acceptable [3] and not different from that of arthroscopic surgery. However, conventional TMJ arthrocentesis does not provide any information in joint pathosis [4]. Operative arthroscopy provides benefits over arthrocentesis because of the ability to visualize the joint for diagnostic purposes and perform surgical maneuvers and it offers a good success rate [5]. Recently fiber ultra-thin arthroscopy is developed which is useful and valuable in examination of the pathologic TMJ, however the resolution of the view is unclear [6].
In this report, we propose a simple diagnostic and therapeutic method of operative ultra-thin rigid arthroscopy combination with arthrocentesis through the Chung's needle (16 gauge needle size).
Chung’s needle and Arthroscopy
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1)
Chung's needle (Fig. 1)
Chung’s needle has 66.20 mm of total length, 43.50 mm of available length, 1.65 mm of external diameter, and 8.30 mm of irrigation port. Rigid arthoscope can be inserted through the Chung’s needle.
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2)
Ultra-thin rigid arthroscopy (Fig. 1)
The ultra-thin rigid arthroscopy (Endostar-Nanoscopy System(Hanseo Medics Co.,Ltd., Seoul, Korea)) for TMJ procedure consists of 167 mm of total length, 57.5 mm of available length, a 0.8mm diameter fiber optic nanoscope, and a 16 Gauge Needle trocar with irrigation port and a Digital CCD Camera system with S/D card for recording, a 80W LED Light Source, and a 19-inch Kostec Color Video Monitor were used as the monitoring and recording system
Surgical technique
The patient is prepared and draped in the standard fashion for arthrocentesis. The technique involves a conventional arthroscopic technique through the postero-lateral approach with Chung's needle (16 gauge needle size) under local anesthesia. Approximately 1.0-1.5 mL(pathologic TMJ about less than 1.0 ml) of lactated Ringer solution is injected into the superior joint space with Chung’s needle (16-gauge needle size). After pumping manipulation, closing the needle with 3 way coke for enlarging the superior joint space, and then another 16 G or 18 G needle inserts to the superior joint space for emitting the irrigation solution. With ultra-thin rigid arthroscopy view, joint space has been inspected and arthrocentesis was performed.
For the arthrocentesis, approximately more than 300 ml solution wash out the joint space and then ultra-thin rigid arthroscopy is inserted through the Chung’s needle for inspecting the joint space. When encountering the adhesion, resolve with trocar through the Chung’s needle and then instruct the mouth opening exercise during irrigation. When encountering the habitual dislocation, injure to the retrodiscal tissue by radiofrequncy (RF) surgery instrument.
After a sufficient range of movement has been achieved, the joint cavity is evaluated with arthroscopy. Finally, sodium hyaluronate (Seikagaku Kogyo Co, Tokyo, Japan) is injected into the superior joint space after joint irrigation, and removed the Chung’s needle. A mandibular motion exercise regimen was begun immediately after procedure.