Needle-based level II temporomandibular joint arthroscopy under local anesthesia

Area of Science:

• Minimally invasive surgical techniques
• Temporomandibular joint (TMJ) disorders
• Arthroscopy and laser treatments

Background:

• Conventional TMJ arthroscopy can be invasive.
• Arthrocentesis offers limited visualization and intervention capabilities.
• There is a need for less invasive TMJ procedures with direct visualization.

Purpose of the Study:

• To describe a novel, office-based Level II TMJ arthroscopy technique.
• To achieve Level II arthroscopy using only two 16-gauge needle punctures.
• To enable direct visualization and therapeutic intervention with minimal invasiveness.

Main Methods:

• A minimally invasive arthroscopic approach using two 16-gauge needle portals.
• Intravenous sedation and local anesthesia were employed.
• A 0.7-mm endoscope for visualization and a 600-µm optical fiber with a 450 nm diode laser for retrodiscal tissue ablation were used.

Main Results:

• The technique provided Level II arthroscopic capabilities with needle-level invasiveness.
• Significant improvement in TMJ pain (VAS 8 to 1) and maximum interincisal mouth opening (33 mm to 42 mm) at 6-month follow-up.
• No complications were observed; the procedure was performed in an office setting under local anesthesia.

Conclusions:

• Office-based Level II TMJ arthroscopy with 16-gauge needle portals is a feasible, minimally invasive alternative to arthrocentesis.
• The technique allows for visualization and targeted therapeutic intervention with low morbidity.
• Further controlled studies with larger patient cohorts are needed to establish broader clinical implications.