上外側穿刺法による顎関節鏡視診断について

Abstract

In arthroscopic procedure, there are several methods to approach into the superior joint cavity of TMJ. However, it is difficult to obtain total vision of the superior joint cavity by a single approach. Here, we present a supero-mid-lateral approach by which almost all of the supeior joint cavity can be visualized. In this technique the point of insersion of trocar is perpendicular to the skin and at the highest point of lateral aspect of mandibular fossa. Arthroscope can be moved along the transverse axis of both the anterior and posterior synovial pouch, and longitudinally along the lateral discal groove in the superior joint cavity.This approach was applied in 24 joints of 15 closed-lock cases. Anterior displacement of the disk was observed in all 24 joints. Among these there were antero-medial disk rotation in 19 joints and antero-lateral in one joint. Disk adhesions were observed in 24 joints at lateral area, 23 joints at anterior synovial pouch, 11 joints at medial area and 4 joints at posterior synovial pouch. Nineteen perforations were observed in 18 joints of 11 cases. Sixteen of these perforations were in the lateral aspect of the disk and the remaining three were in posterior and medial aspects.The results of the presented cases suggest that the supero-mid-lateral approach is highly effective in tempromandibular joint arthroscopy.