Role of Computed Tomography–guided Arthrocentesis in Treating Temporomandibular Joint Dysfunction

Purpose or Learning Objective: To highlight the role of computed tomography in treating temporomandibular joint dysfunction by computed tomography–guided arthrocentesis.

Methods or Background: A 59-year-old woman presented with localized right temporomandibular joint pain of 3 months duration. She was seen by the oral maxillofacial team, and an orthopantomogram was performed that was noted as unremarkable. She was then initially managed conservatively with jaw exercises and laser therapy with a mixed response. Upon referral to the interventional radiology team, she then underwent dynamic magnetic resonance imaging of the temporomandibular joint that revealed an anteriorly displaced right disk with absence of disk recapture on the close mouth view in keeping with temporomandibular joint dysfunction and minimal joint effusion.

Results or Findings: Patient was then counseled for a computed tomography–guided arthrocentesis procedure that was performed under sedation and sterile conditions. A 23G needle was inserted into the anterosuperior aspect, and a 21G needle was positioned into the inferoposterior aspect of the temporomandibular joint followed by infusion of local anesthesia (lignocaine 2%), followed by 5 mL Hartmann's solution, and finally triamcinolone 40 mg into the joint space. At the review 2 weeks after the procedure, the patient was noted to be pain free with no residual dysfunction.

Conclusion: Current standard of practice of temporomandibular joint arthrocentesis is to perform the procedure without imaging or in some instances under fluoroscopic guidance. Utilizing a computed tomography–guided technique has the advantage of being less traumatic, more precise, and provides better clinical outcomes for patients.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
02 June 2025