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. 2024 Dec;27(4):979-985.
doi: 10.1007/s40477-024-00942-4. Epub 2024 Aug 8.

Intra-articular and intraosseous approach to temporomandibular joint-targeted injections: a cadaveric investigation

Ricardo de Souza Tesch  1   2 , Esther Rieko Takamori  3 , Rosana Bizon Vieira Carias  3 , Juliana Oliveira de Medeiros Vilela  3 , Thayanne Brasil Barbosa Calcia  3   4
Affiliations

Intra-articular and intraosseous approach to temporomandibular joint-targeted injections: a cadaveric investigation

Ricardo de Souza Tesch et al. J Ultrasound. 2024 Dec.

Abstract

Purpose: Temporomandibular joint osteoarthritis (TMJ-OA) management is complex, and several conservative and minimally invasive protocols have been proposed. Intra-articular injections of medications directed at OA have been performed, but in some cases, these medications do not directly contact the tissue lesion sites. Here, we propose a new real-time ultrasound-guided technique to inject medications directly into the subchondral bone.

Methods: Ultrasound image screening was carried out with the point-of-care Clarius L15 device. Then, with the patient's mouth closed, a stainless-steel cannula with a concentric trocar was US-guided using an in-plane approach until the perforating tip of the internal trocar touched the lateral pole of the mandibular condyle. Then, the trocar was inserted through the medullary bone, where a posterior injection was made.

Results: The technique's precision was confirmed by capturing an iodine contrast solution that imaged the medullary condyle of fresh anatomical specimens processed by computed tomography.

Conclusion: The proposed technique was effective in accessing the mandibular condyle subchondral bone in the inferior TMJ space for the simultaneously intra-articular (IA) and intra-osseous (IO) in-plane US-guided injections. Thus, its implementation may represent an important advance in early TMJ-OA treatment. This may be a promising approach, especially in OA cases in which the cortical bone is still preserved.

Keywords: Osteoarthritis; Subchondral bone; Temporomandibular joint disorder; Ultrasonography; Ultrasound-guided injection.

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Conflict of interest statement

The authors declare that they have no conflicts of interest to declare that are relevant to the content of this article. The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Bone marrow-like lesions (BMLs) present under preserved cortical bone. Magnetic resonance image (MRI) in T2 acquisition showing a hypersignal on the right (a) and left (b) condyle in the absence of irregularities on mandibular cortical bone in a patient with temporomandibular joint osteoarthritis (TMJ-OA). This presentation is characteristic of an osseous phenotype of osteoarthritis (OA) when the disease emerges from the medullary bone. ad articular disc; ae articular eminence; bml bone marrow-like lesion; co condyle; gf glenoid fossa
Fig. 2
Fig. 2
Real-time ultrasound (US)-guided TMJ intra-articular and intraosseous injection. a Portable US device with linear transductor placed parallel to the mandibular ramus. b Position of the inserted device toward the portable US. Trocar was inserted at a 30-degree inclination from the skin. c US image of the inserted device on the lateral pole of the condyle. White arrow indicates the needle and co indicates the condyle
Fig. 3
Fig. 3
Confirmation of therapy deposit after intraosseous injection. a Coronal view of temporomandibular joint (TMJ) before procedure. b Intraosseous lesions were delimited by the blue line. c Contrast solution deposit in the medullary bone region after intraosseous injection through the lateral pole. White lines delimit the deposit of the iodine contrast solution. d Trocar entrance evidenced by a white line. e Sagittal view of the condyle showing the contrast solution deposited into the inferior joint space and intraosseous space. f The red line delimits the inferior joint space; the blue line delimits the articular disc
See this image and copyright information in PMC

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