Arthroscopy of the temporomandibular joint: technique and operative images

Over the years, little has changed in the preoperative indications and treatment for these patients. They must have failed a course of nonsurgical care, including physical therapy and medication up to 6 months. They must have had imaging done confirming intra-articular joint pathology (disc displacement, disc immobility for the most part, and joint effusions in some instances). Important technical issues include the use of two cannulas placed approximately 1 cm apart. Cannulas are not routinely placed initially into the anterior recess. Heavy downward pressure applied to the posterior ligament with a blunt obturator is used to assure mobility of the disc, and electrocautery or laser energy is used on the surface of the posterior ligament synovium for hemostasis and denervation (pain control). Corticosteroids are used infrequently. To avoid scuffing or damaging the joint surfaces unnecessarily, lysis is done using triangulation methods. Advanced instrumentation is used as the need arises but not used routinely. These patients can expect a predictably successful outcome with minimal recovery time and complications.