Temporomandibular joint arthroscopy: inverted portal technique for more effective retrodiscal coblation

Temporomandibular joint (TMJ) retrodiscal tissue coblation is regularly performed as part of level 2 arthroscopy. It is usually performed with a coblator probe, which is introduced into the joint via an anterior working portal and visualized with an arthroscope connected to the posterior cannula. Coblation with the traditional landmarks is relatively easy in the medial, posterior, and anterior parts of the TMJ upper compartment; however, TMJ arthroscopy cannot access the entire upper compartment. Using the classical technique, it was estimated that surgeons can reach approximately 50-65% of the joint, and it is almost impossible to access the lateral and posterolateral areas. This technical note describes a simple and effective technique that improves access to the posterolateral area of the capsule for optimal retrodiscal coblation, increasing the treatment area by an estimated 10-15% without the need for any additional puncture.