Background/Purpose:

Temporomandibular joint (TMJ) arthritis frequently occurs in juvenile idiopathic arthritis (JIA). Only sparse information is available concerning the inflammatory activity and the underlying biology and course of arthritis in the TMJ in JIA patients, although it is known to cause severe growth disturbances of the dentofacial complex. Studies evaluating the synovial fluid may lead to a better understanding of the interaction between synovial inflammation, cartilage condition, and the influence on condylar bone formation. TMJ synovial fluid sampling and intraarticular steroid injections are procedures useful to elucidate this issue and to control inflammation. However, the TMJ is also known to be a vulnerable joint where functional disorders also can cause growth disturbances when mandibular function is impaired. Therefore, it is crucial that no or only transient side effects occurs from intervening procedures. The aim of this study was to evaluate safety issues in relation to a synovial sampling technique and to determine the variation in needle position by cone beam computerized tomography (CBCT).

Methods:

Twenty healthy, adult volunteers were examined for TMJ dysfunction and mandibular movements were assessed before and after a sample of synovial fluid were taken in local anesthesia using the push-pull technique described previously (1). Samples were obtained from both TMJs and a CBCT-scanning was done to evaluate the needle position in the upper joint compartment. The study was approved by the ethical committee.

Results:

All volunteers reported slight TMJ pain after sampling (mean 13.0 on a VAS-scale (from 0-100)). Pain disappeared in all participants after 1-2 days maximum. Objectively, mandibular range of motion was not affected by the procedure. The cannula was clearly visible in 3D in relation to the osseous tissues on the CBCT. The scanning showed a large variety in cannula position. The CBCT scanning lasted approximately 20 sec.

Conclusion:

The synovial fluid sampling technique was found to be safe resulting in only minor, transient symptoms. However, the technique visualized in 3D is applicable in studies on TMJ pathology responsible for dentofacial growth abnormalities in growing individuals. A considerable variation was found in needle position and as a therapeutic approach, injection of steroids should be done with caution. CBCT confirmation of cannula position can be advised to substitute medical CT thereby greatly reducing patient radiation exposure.

Ref: 1. Alstergren P, Kopp S, Theodorsson E. Synovial fluid sampling from the temporomandibular joint: sample quality criteria and levels of interleukin-1 beta and serotonin. Acta Odontol Scand 1999, 57: 16-22.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-procedure-safety-and-cannula-position-in-temporomandibular-joint-puncture-evaluated-by-cone-beam-computerized-tomography/