１．２ｍｍ径硬性関節鏡を用いた顎関節上関節腔有視下洗浄療法の開発

Abstract

We devised a procedure for visually-guided irrigation (VGIR) of the superior joint compartment of the temporomandibular joint (TMJ) for the treatment of closed-lock and other TMJ diseases. A TMJ arthroscopy system using a 1.2-mm diameter rod-lens arthroscope was also developed to perform VGIR under local anesthesia. This paper introduces the arthroscopy system and VGIR procedure. The clinical applicability of VGIR is also discussed on the basis of the quality of arthroscopic findings obtained during VGIR and the incidence and course of complications associated with VGIR, including mechanical trouble.Eighty-five operations involving VGIR were studied. Arthroscopic findings obtained during VGIR were as clear as those obtained by using an arthroscope with a more than 2.0-mm diameter rod-lens, generally used for arthroscopic surgery. The following 7 complications were analyzed: 1) anesthetic trouble, 2) vascular injury, 3) perioperative discomfort, 4) neurological injury, 5) otological injury, 6) infection, 7) mechanical trouble. Complications occurred in 5 of the 85 (5.9%) operations. Two of the 5 complications were postoperative discomfort immediately after VGIR, 1 involved blood clots in the external auditory canal, and 2 were related to instrument breakage. However, no complication required specific treatment or interfered with the VGIR procedure.In conclusion, VGIR is useful clinically because that the procedure is minimally invasive, safe, and provides a highly reliable arthroscopic diagnosis.