Technique for placement of a discal traction suture during temporomandibular joint arthroscopy.

Abstract

As temporomandibular joint (TMJ) arthroscopy has developed, so have arthroscopic techniques designed to permit surgical manipulation of the structures within the joint. Initially, TMJ arthroscopy was described by Ohnishi’ in 1980 as a diagnostic procedure. In 1986 Sanders2 and Merrill3 reported on the therapeutic potential of arthroscopic lysis and lavage of the TMJ. Bronstein4 and Merrill’ have used a technique involving posterior repositioning of the disc by performing mandibular manipulation (the mandible is distracted inferiorly and moved into the opposite lateral excursion) while arthroscopically applying inferior traction on the retrodiscal tissues with a blunt probe. McCai# has described an arthroscopic technique in which an anterior releasing incision is made in the disc and electrocoagulation of the retrodiscal tissues is performed to hold the disc posteriorly. In spite of the variety of techniques available, control of discal position by arthroscopic surgery is quite difficult. Piper7 performed intraoperative Carm arthrography to assess discal position following arthroscopic manipulation of discal tissue. He found that 14 of 15 joints showed no evidence of improvement in discal position after arthroscopic surgery. In our experience, postoperative magnetic resonance imaging (MRI) images following arthroscopic manipulation of the disc do not show relocation of the disc to a normal position. We have now developed an arthroscopic technique that can be used in patients with internal derangements in which a suture is passed through the discal tissues. Posterior and lateral traction is then