Guide device to assist in performing arthroscopic surgery of the temporomandibular joint—a preliminary study

Background: Arthroscopic surgery of the temporomandibular joint (TMJ) requires inserting an arthroscope and a working cannula into the joint cavity. Working cannula introduction and positioning require high levels of expertise. Methods: A randomized controlled trial was performed on patients with closed lock of the TMJ who underwent arthroscopic lysis and lavage. A total of 15 subjects participated in this study, with 6 in the study group using the Locator-Positioner guide device (LOPO) and 9 in the control group using triangulation. The main outcomes included: (1) Number of attempts necessary for successful cannula insertion. (2) The time between arthroscope insertion and the appearance of the working cannula on the monitor, and (3) Overall surgery duration. Results: A successful cannula insertion took an average of 2.1 attempts in the study group compared with 3 attempts in the control group (p = 0.045). Study group arthroscope insertion to monitor appearance of cannula took 2.3 minutes, whereas control group took 4 minutes (p = 0.039). A total of 14 minutes was spent on surgery in the study group compared to 16.5 minutes in the control group (p = 0.009). Conclusions: LOPO device improved both the insertion of the working cannula into the TMJ and its positioning relative to the arthroscope throughout surgery. It reduced insertion attempts and shortened the surgery duration. Clinical Trial Registration: the study was registered at clinicaltrials.gov, identifier: NCT 06520917.

Arthroscopy; Arthroscopic surgery; Temporomandibular joint; TMJ; Internal derangement; Guide device

[1] McCain JP, Montero J, Ahn DY, Hakim MA. Arhroscopy and arthrocentesis of the temporomandibular joint. In Miloro M, Ghali GE, Larsen P, Waite P (eds.) Peterson’s principles of oral and maxillofacial surgery (pp. 1569–1624). 4th edn. Springer: Cham, Switzerland. 2022.

[2] Liu X, Zheng J, Cai X, Abdelrehem A, Yang C. Techniques of Yang’s arthroscopic discopexy for temporomandibular joint rotational anterior disc displacement. International Journal of Oral and Maxillofacial Surgery. 2019; 48: 769–778.

[3] Abboud W, Yahalom R, Givol N. Treatment of intermittent locking of the jaw in Wilkes Stage II derangement by arthroscopic lysis and lavage. Journal of Oral and Maxillofacial Surgery. 2015; 73: 1466–1472.

[4] John B, Poorna TA, Joshna EK. Optimal depth of penetration to access the superior joint space in temporomandibular joint arthroscopy: a single institutional retrospective study. Journal of Maxillofacial and Oral Surgery. 2024; 23: 285–289.

[5] González-García R. Categorizing temporomandibular joint arthroscopic procedures for a better clinical practice and teaching. Journal of Stomatology, Oral and Maxillofacial Surgery. 2024; 125: 101808.

[6] Ward CKB, Hakim MA. Pearls and pitfalls of temporomandibular joint arthroscopy. In Amin D, Marwan H (eds.) Pearls and pitfalls in oral and maxillofacial surgery (pp. 275–282). Springer: Cham, Switzerland. 2024.

[7] Mc Cain JP, De La Rua H. A modification of the double puncture technique in temporomandibular joint arthroscopy. Journal of Oral and Maxillofacial Surgery. 1990; 48: 760–761.

[8] Murakami K, Hoshino K. Regional anatomical nomenclature and arthroscopic terminology in human temporomandibular joints. Okajima’s Japanese Journal of Anatomy. 1982; 58: 745–760.

[9] Del Castillo Pardo de Vera JL, Pampín Martínez M, Aragón Niño I, Navarro Cuéllar C, Cebrián Carretero JL. Navigation in surgical arthroscopy of the temporomandibular joint. British Journal of Oral and Maxillofacial Surgery. 2022; 60: 999–1001.

[10] Zubiate Illarramendi I, Cabello A, Martínez-Sahuquillo Rico Á, Cariati P, Garcia Medina B. An exchange technique in temporomandibular joint (TMJ) arthroscopy to insert a larger operative cannula to facilitate advanced procedures. British Journal of Oral and Maxillofacial Surgery. 2024; 62: 97–100.

[11] de Melo LA, Bezerra de Medeiros AK, Campos MFTP, Bastos Machado de Resende CM, Barbosa GAS, de Almeida EO. Manual therapy in the treatment of myofascial pain related to temporomandibular disorders: a systematic review. Journal of Oral & Facial Pain and Headache. 2020; 34: 141–148.

[12] Garrigós-Pedrón M, La Touche R, Navarro-Desentre P, Gracia-Naya M, Segura-Ortí E. Effects of a physical therapy protocol in patients with chronic migraine and temporomandibular disorders: a randomized, single-blinded, clinical trial. Journal of Oral & Facial Pain and Headache. 2018; 32: 137–150.

[13] Abboud WA. Novel guide device for temporomandibular joint arthroscopy. International Journal of Oral and Maxillofacial Surgery. 2020; 49: 1217–1219.

[14] Abboud W, inventor; Tel Hashomer Medical Research Infrastructure and Services Ltd. Ramat Gan (IL), assignee. Guide device suitable for performing temporomandibular joint arthroscopy. Israel: USPTO; US11517348B2. 29 November 2022.

[15] González LV, López JP, Díaz-Báez D, Martin-Granizo López R. Intraoperative complications in temporomandibular joint arthroscopy: A retrospective observational analysis of 899 arthroscopies. Journal of Cranio-Maxillo-Facial Surgery. 2022; 50: 651–656.

[16] Ângelo DF, Araújo RAD, Sanz D. Surgical complications related to temporomandibular joint arthroscopy: a prospective analysis of 39 single-portal versus 43 double-portal procedures. International Journal of Oral and Maxillofacial Surgery. 2021; 50: 1089–1094.

[17] González-García R, Monje F. Complications of temporomandibular joint arthroscopy. A critical appraisal of the literature. Journal of Cranio-Maxillo-Facial Surgery. 2024; 52: 1122–1132.

[18] Murakami KI. Current role of arthrocentesis, arthroscopy and open surgery for temporomandibular joint internal derangement with inflammatory/degenerative disease; -pitfalls and pearls-. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2022; 34: 1–11.

[19] Murakami K, Ono T. Temporomandibular joint arthroscopy by inferolateral approach. International Journal of Oral and Maxillofacial Surgery. 1986; 15: 410–417.

[20] Talaat WM, McGraw TA, Klitzman B. Relationship between the canthal-tragus distance and the puncture point in temporomandibular joint arthroscopy. International Journal of Oral and Maxillofacial Surgery. 2010; 39: 57–60.

[21] Caminiti MF, Driesman V, DeMontbrun S. The oral and maxillofacial objective structured assessment of technical skills (OMOSATS) examination: a pilot study. International Journal of Oral and Maxillofacial Surgery. 2021; 50: 277–284.

[22] Verde L, Muñoz-Guerra MF, Rodríguez-Campo FJ, Escorial V. Temporomandibular joint: approach to the intermediate space by triangulation with transillumination reference. Journal of Oral and Maxillofacial Surgery. 2023; 81: 684–688.

[23] Danquah S, Choi D. Can remote learning and low fidelity simulation trainers improve confidence and fundamental skills in temporomandibular joint arthroscopy? International Journal of Oral and Maxillofacial Surgery. 2024; 52: 176–177.

[24] Chou J, Tenaglia M, Ho A, Valenti J, Davis C, Choi D. Can a low-fidelity arthroscopic simulator improve technical expertise in performing temporomandibular joint arthroscopy? Journal of Oral and Maxillofacial Surgery. 2024; 82: 1203–1211.

[25] Monje Gil F, Hernandez Vila C, Moyano Cuevas JL, Lyra M, Pagador JB, Sanchez Margallo FM. Validation of a simulator for temporomandibular joint arthroscopy. International Journal of Oral and Maxillofacial Surgery. 2016; 45: 836–841.

[26] Peserico-DalFarra P, Gagliardi-Lugo AF. Training simulation for oral and maxillofacial surgeons based on the techniques of arthroscopy in the temporomandibular joint. British Journal of Oral and Maxillofacial Surgery. 2019; 57: 929–931.

[27] Foo QC, Hariri F, Abdul Rahman ZA. Fabrication of a three-dimensional temporomandibular joint model for arthrocentesis and arthroscopy simulation. International Journal of Oral and Maxillofacial Surgery. 2021; 50: 1095–1099.

[28] Ângelo DF. Temporomandibular joint arthroscopy: inverted portal technique for more effective retrodiscal coblation. International Journal of Oral and Maxillofacial Surgery. 2022; 51: 1074–1077.

[29] Slavin AB. Comments on “single-cannula technique for operative arthroscopy using holmium:YAG laser”. Journal of Oral and Maxillofacial Surgery. 2012; 70: 1014.

[30] Stringer DE, Park CM. Single-cannula technique for operative arthroscopy using holmium:YAG laser. Journal of Oral and Maxillofacial Surgery. 2012; 70: 49–50.

[31] Martínez-Gimeno C, García-Hernández A, Martínez-Martínez R. Single portal arthroscopic temporomandibular joint discopexy: technique and results. Journal of Cranio-Maxillofacial Surgery. 2021; 49: 171–176.

[32] Liu Y, Wang P, Telha W, Jiang N, Bi R, Zhu S. Arthroscopic reduction and rigid fixation of the anteriorly displaced temporomandibular joint disc without reduction using titanium screw: a case series. Clinical Oral Investigations. 2024; 28: 156.

[33] Abboud WA, Givol N, Yahalom R. Arthroscopic lysis and lavage for internal derangement of the temporomandibular joint. Annals of Maxillofacial Surgery. 2015; 5: 158–162.

[34] Badri O, Davis CM, Warburton G. Arthroscopic management and recent advancements in the treatment of temporomandibular joint disorders. British Journal of Oral and Maxillofacial Surgery. 2024; 62: 820–825.

[35] Abboud W, Nadel S, Yarom N, Yahalom R. Arthroscopy of the temporomandibular joint for the treatment of chronic closed lock. The Israel Medical Association Journal. 2016; 18: 397–400.