顎関節に対する微細径ファイバースコープの応用 診断鏡の開発

Abstract

To overcome the operational diffficulty of TMJ arthroscopy, and to reduce injury during the examination a fine needle fiber arthroscope was developed and clinically applied. The equipment is composed of a fine needle arthroscopic probe and a television monitor system with an output for a videorecorder and camera. The characteristics of this optical system are as follows:1) The fine needle arthroscope (0.8mm in diameter, 20 G) can be inserted into the narrow or tiny TMJ spaces, such as the lower joint compartment and also reduced iatrgenic injury to the joint tissues.2) There is no distortion of the picture or breakage of the scope by bending. The picture is clear enough for diagnostic purpose.3) Using this system it is possible to examine the joint both arthrographically, arthroscopically and to treat TMJ diseases, by means of pumping manipulation technique and injection of appropriate medicines. All of these manipulations are possible using only one insertion of the cannule (18 G) for each articular cavity under local anesthesia. 17 patients (19 TMJ) were examined by this system, and the results obtained are as follows:1) Adhesions were generally seen below the articular tubercle, and they were mostly white membrane like fibrous adhesion without blood vessel, similar lesions with debris were also seen in the lower articular cavity. It was possible to perform arthroscopic detachment by using this approach.2) Two types of disk perforation were observed, one without tissue reaction, the other with fibrous adhesion and granulation tissue.As mentioned above, very favorable results were obtained without any complications.