Temporomandibular Joint: Approach to the Intermediate Space by Triangulation With Transillumination Reference

Arthroscopy of the temporomandibular joint is a minimally invasive surgical procedure. Nowadays, 3 levels are described depending on the complexity. Level I involves a single puncture with an anterior irrigating needle for outflow. Level II involves a double puncture using triangulation in order to be able to perform minor operative maneuvers. Subsequently, it is possible to progress to Level III and perform more advanced techniques, through multiple punctures, involving the arthroscopic canula and 2 or more working cannulas. However, in cases of advanced degenerative pathology or re-arthroscopy, it is common to observe advanced fibrillation, severe synovitis, adhesions, or articular obliteration which makes conventional triangulation difficult. On these cases, we propose a simple and effective technique that facilitates approach to the intermediate space by means of triangulation with transillumination reference.