Khallaf and Sidebottom Guiding Stent for Temporomandibular Joint Arthrocentesis: A New Era for Joint Space Puncturing Techniques (Registered Technical Note)

Arthrocentesis is becoming the cornerstone of minimally-invasive surgical treatment for internal derangement of the temporomandibular joint (TMJID). Nitzan et al. first described arthrocentesis as the simplest form of surgery in the TMJID. Repeated arthrocentesis up to five times is 91% effective in treating patients with anterior disc displacement without reduction. It depends on lavage of the joint space through placement of two needles inside the superior joint space. The majority of surgeons use conventional puncturing technique (CPT), which is a blind technique for needle placement, in spite of its complications (extra-articular injection, multiple puncturing, facial nerve injury, intracranial penetration).Others use image guided puncturing techniques (CBCT,MSCT, MRI, or US) for superior joint space puncturing, which is proven to be a more accurate and precise technique with fewer complications. We fabricated a new customized guiding stent on a 3D soft and hard tissue model, printed out from MSCT, with adjusted depth and angulation for superior joint space puncturing. The puncturing using this new stent is easy and does not subject patients to imaging each time, as the confirmation of the needle positioning has already been done by the accurate measurements on MSCT. In addition, the procedure no longer requires general anesthesia or deep sedation. Clinically significant differences were noted between the use of IGPT and the present guiding stent, especially on the level of procedural time. These observations confirmed that the use of this stent was a predictable and highly efficient new approach for superior joint space puncturing