Arthroscopy-assisted inferior compartment arthrocentesis of the temporomandibular joint

Arthroscopic lysis and lavage of the temporomandibular joint (TMJ) is an established treatment for internal derangements (ID). Conventional techniques are limited to the superior compartment, although pathologies and translational movement frequently involve the inferior compartment. This prospective pilot case series describes and evaluates a reproducible needle-based arthroscopy-assisted technique for lysis and lavage of the inferior compartment, with no superior-compartment-only control group.

Twenty patients with Wilkes stage IV anterior disc displacement without reduction and condylar resorption confirmed on MRI/CT were prospectively treated. Follow-up ranged from 12 to 24 months (mean 18.0 ± 5.2 months). Two 18G needles were introduced under arthroscopic guidance through the lateral discal transitional zone into the inferior compartment, enabling lavage with 100 mL of Ringer's solution. Superior compartment lysis and lavage were subsequently performed, followed by injection of high-molecular-weight hyaluronic acid. Outcomes included pain (Visual Analog Scale, VAS) and mandibular motion (maximum mouth opening and laterality).

VAS scores (left side) decreased from 5.15 ± 3.00 preoperatively to 0.40 ± 0.99 postoperatively. VAS scores (right side) decreased from 4.65 ± 3.01 to 0.50 ± 0.76. Maximum mouth opening improved by + 4.25 ± 4.19 mm (95% CI 2.32-6.18). Right and left laterality improved by + 3.45 ± 2.89 mm and + 2.55 ± 2.31 mm, respectively, with 85-90% of patients showing increased excursions. No major complications occurred.

This pilot series suggests that arthroscopy-assisted needle-based access to the inferior TMJ compartment appears feasible and safe, yielding clinically meaningful improvements in pain and motion. The technique is cost-effective and reproducible, and may expand minimally invasive therapeutic options for advanced internal derangements. Controlled comparative studies are required to establish its incremental benefit over superior compartment arthroscopy alone.