A Novel Draping Technique for Temporomandibular Joint Arthroscopy: Enhancing Fluid Management and Ergonomics

Temporomandibular joint (TMJ) arthroscopy requires continuous irrigation to maintain visualization during the procedure. Conventional draping methods often fail to contain irrigation fluid effectively, resulting in loss of field control, ergonomic discomfort, and potential contamination of nonsterile areas.

The purpose of this study was to measure and compare fluid control and ergonomic comfort between conventional and a modified draping configuration during TMJ arthroscopy.

The study was designed as a retrospective cohort analysis conducted at Hospital Clínico San Carlos (Madrid, Spain) between January 2021 and December 2023. To ensure standardized intraoperative conditions, only bilateral TMJ arthroscopies were included. Patients with prior open TMJ surgery, craniofacial trauma, systemic inflammatory joint disease, or incomplete operative records were excluded. A total of 100 bilateral arthroscopies were evaluated-50 performed using the conventional draping configuration and 50 using the modified configuration.

The predictor variable was the draping configuration, classified as conventional or modified. The modified configuration incorporated a U-shaped drainage pathway and a suboccipital fluid collection system to optimize irrigation control and minimize overflow into nonsterile areas.

Primary outcomes were 1) frequency of irrigation fluid overflow into nonsterile zones and 2) surgeon-rated ergonomic comfort using a 5-point Likert scale (1 = very uncomfortable, 5 = very comfortable). Secondary outcomes included suction interruptions and the need for redraping.

Covariates included age, sex, diagnosis (internal derangement, disc displacement, or restricted mandibular mobility), and total irrigation volume.

Comparisons between groups were performed using χ² tests for categorical variables and independent-samples t-tests for continuous variables. Two-sided P values < .05 were considered statistically significant.

The sample comprised 100 bilateral procedures performed on 78 (78%) female and 22 (22%) male patients, with a mean age of 34.2 ± 8.1 years. Fluid overflow occurred in 32 (64%) conventional cases versus 4 (8%) modified cases (P < .001). Suction interruptions occurred in 21 (42%) versus 6 (12%) (P = .002), and redraping was required in 15 (30%) versus 1 (2%) (P < .001). Mean ergonomic comfort scores were higher with the modified configuration (4.6 ± 0.5 vs 3.1 ± 0.8; P < .001). No intraoperative complications were observed.

The modified draping configuration significantly improved fluid containment and ergonomic comfort compared with conventional methods. These findings support its routine clinical use and warrant prospective validation.