Superior Compartment Research Articles

Optimising surgical approaches to the orbit — a retrospective analysis of a series of forty orbital tumours

Background: This study aimed to analyse the influence of location, pathology, and approach on the extent of resection of orbital tumours. Material and methods: We have conducted a retrospective analysis of the clinico-radiological features of all orbital tumours operated between January 2012 and December 2019. Frontotemporal craniotomy with orbitotomy was performed for almost all lesions, except those limited to the lateral compartment (lateral orbitotomy), superior compartment (mini-craniotomy), and inferior medial compartment (transconjunctival/endoscopy). Statistical Analysis System (SAS) version 9.4 was used for analysis, and a p-value < 0.05 was considered to be statistically significant. The study was approved by the Institutional Review Board (3/10/2020). Results: Our study group comprised forty patients with a mean age of 40.89 years ± 19 years. Of the forty tumours, 21 (52.5%) cases were primary tumours of the orbit, and 19 (47.5%) were secondary tumours. The majority, 27 (67.5%), of the tumours were extraconal in location. The two most common presenting symptoms were proptosis (36/40; 90%) and visual blurring (30/40; 75%). The majority of the patients could be successfully operated through a fronto-tempero-orbital approach with or without removal of zygoma (28/40; 70%). Meningioma was the most common histology (45%), followed by schwannoma and lacrimal gland tumours (10%). Primary orbital tumours (15/21; 71.6%) and intraconal tumours (9/13; 69.23%)were associated with greater rates of gross total removal (GTR). GTR in sphenoorbital meningiomas was poor (2/17; 11.8%). Conclusion: Intraconal primary benign orbital tumours have a better chance of total gross removal. A frontotempero- orbital approach with or without removal of zygoma provides adequate exposure for the majority of the tumours.

Transjugular liver biopsy for Fontan associated liver disease surveillance: Technique, outcomes and hemodynamic correlation

BackgroundFontan associated liver disease (FALD) is attributed to the limitations of the Fontan circulation, resulting in congestive hepatopathy. The technique and outcomes of transjugular liver biopsies (TJLB) in Fontan patients warrant definition as part of a rigorous FALD surveillance program. MethodFour year review of patients with Fontan physiology who underwent a TJLB during surveillance catheterizations. Biopsy site, technique, histology, angiography, hemodynamics, and complications were reviewed to assess correlation of biopsy scores with simultaneously obtained catheterization hemodynamics. Results125 patients with a TJLB from 10/1/14 to 5/1/18. Median age 17 years (2–50.5). Technical success 100% (125/125), all samples diagnostic. 17% (21) accessed via the left internal jugular vein, secondary to right IJ occlusion or Heterotaxy syndrome. No patients had superior compartment obstruction preventing transjugular approach. 3.2% complication rate (4/125). Complications were early in the experience, including capsular perforation (2), renal hematoma (1) and hemobilia (1), all without long-term effect and all avoidable. After standardized entry/exit angiography was adopted, no further complications noted. There is a significant correlation between the newly described modified Ishak congestive hepatic fibrosis (ICHF) score with mean Fontan pressure, time from Fontan and cardiac index. ConclusionsTJLB is an alternate method for obtaining critical FALD surveillance data, with lower complication rates that traditional techniques. Vascular anomalies in Fontan physiology appear common and warrant pre-biopsy assessment. There is a significant correlation between biopsy score, time from Fontan, mean Fontan pressure and cardiac index.

Collection of Skeletal Muscle Biopsies from the Superior Compartment of Human Musculus Tibialis Anterior for Mechanical Evaluation

Collection of Skeletal Muscle Biopsies from the Superior Compartment of Human Musculus Tibialis Anterior for Mechanical Evaluation

Collection of Skeletal Muscle Biopsies from the Superior Compartment of Human Musculus Tibialis Anterior for Mechanical Evaluation.

The mechanical properties of contracting skeletal fibers are crucial indicators of overall muscle health, function, and performance. Human skeletal muscle biopsies are often collected for these endeavors. However, relatively few technical descriptions of biopsy procedures, outside of the commonly used musculus vastus lateralis, are available. Although the biopsy techniques are often adjusted to accommodate the characteristics of each muscle under study, few technical reports share these changes to the greater community. Thus, muscle tissue from human participants is often wasted as the operator reinvents the wheel. Expanding the available material on biopsies from a variety of muscles can reduce the incident of failed biopsies. This technical report describes a variation of the modified Bergström technique on the musculus tibialis anterior that limits fiber damage and provides fiber lengths adequate for mechanical evaluation. The surgery is an outpatient procedure that can be completed in an hour. The recovery period for this procedure is immediate for light activity (i.e., walking), up to three days for the resumption of normal physical activity, and about one week for wound care. The extracted tissue can be used for mechanical force experiments and here we present representative activation data. This protocol is appropriate for most collection purposes, potentially adaptable to other skeletal muscles, and may be improved by modifications to the collection needle.

Aging Changes of the Superficial Fat Compartments of the Midface Over Time: A Magnetic Resonance Imaging Study.

Studies involving superficial facial fat compartments are few in number with conflicting results. Most of them involved small study groups and compared measurements between different populations of young and old subjects either on cadavers or living subjects. To clarify volumetric and dimensional changes in midfacial superficial fat compartment retrospectively in patients who underwent a repeat magnetic resonance imaging (MRI) without gross pathology. A total of 70 patients with a mean age of 60 years (range: 33-82 years) and a median elapsed time of 44.5 months (range: 32-64 months) between 2 MRIs were included. Magnetic resonance imaging scans were analyzed in the axial and sagittal planes to obtain measurements of the medial part of the superficial cheek fat. Superficial cheek fat was divided into 3 compartments. Thickness, width, and height were measured, and volumes were calculated for each compartment on both hemifaces. Volume and thickness were decreased significantly in all compartments (p < .05). The width was decreased in superior and middle compartments, whereas increased in lower compartment indicating dislocation of the fat tissue (p < .05). Height was also significantly increased (p < .05). A subgroup analysis has shown that there was no significant difference between men and women. This study clarifies that aging is associated with a significant decrease in superficial midfacial fat tissue volume and thickness both in women and men. The decrease in width in upper and middle compartments, but increase in lower compartment suggests a volume shift within superficial fat tissue.

Lateral Rectus Superior Compartment Palsy

Lateral rectus palsy with hypotropia constitutes a portion of sixth nerve palsy cases in which only the superior compartment of the lateral rectus is palsied. We present such a case in a 10-year-old girl who presented with a peculiar appearing right esotropia and hypotropia due to acquired lateral rectus palsy along with apparent ipsilateral superior rectus underaction. Neuroimaging confirmed atrophy of the superior part of lateral rectus as compared to the inferior half. Augmented superior rectus transposition to the lateral rectus along with adjustable bimedial recessions and bilateral inferior oblique myectomies were done to restore her cosmetic appearance.

CLINICAL EVALUATION OF DEXTROSE PROLOTHERAPY FOR MANAGEMENT OF TEMPOROMANDIBULAR JOINT DISORDER

INTRODUCTION: Temporomandibular disorders (TMDs) are clinically significant conditions which can be a source of acute or chronic orofacial pain and dysfunction including limitation of mandibular movement. Simple lysis and lavage in the upper joint space which washes out inflammatory mediators were found to be highly effective in reestablishing normal maximum interincisal opening (MIO), jaw function and relieving the symptoms despite the disc position not have been corrected. OBJECTIVES: To evaluate the efficiency of arthrocentesis, used normal saline, followed by injection of dextrose 50%, in a single injection protocol, for management of patients with TMDs. MATERIALS AND METHODS: This study was conducted on fourteen TMD patients have been diagnosed on the bases of the clinical data and MRI findings. The selected patients were divided equally into two groups, each group comprising of seven patients. The group-A: has been treated by arthrocentesis followed by 2 ml of dextrose 50% injected into the superior compartment of TMJ. The group-B: has been treated with arthrocentesis alone. All patients have been evaluated at the end of the 24 hours, 1st, 2nd, 3rd, 4th, 5th and 6th weeks postoperatively. RESULTS: unassisted mouth opening showed an increase at all time intervals. There was a significant improvement in pain, the range of motion, joint effusion and joint sounds. CONCLUSIONS: Arthrocentesis followed by 50% dextrose injection is superior to arthrocentesis alone in reducing impairment in patients with TMDs on its clinical outcome.

A rare case report of orbital malignant solitary fibrous tumor

A rare case report of orbital malignant solitary fibrous tumor - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.135, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

Protocol development for synchrotron contrast-enhanced CT of human hip cartilage

Understanding hip osteoarthritis requires new investigational tools for quantitative studies of biophysical and biomechanical properties as well as for determination of structure. Three new protocols to study pathological changes in cartilage and to measure cartilage thickness in intact human hips are described using synchrotron contrast enhanced computed tomography (sCECT) with the iodinated contrast agent CA4+. Ten human cadaver hips were prepared and injected with CA4+ using three different methods, all of which included rotation and distraction of the joint. CA4+ diffusion into cartilage was monitored using sCECT. The thickness of acetabular and femoral cartilage was also measured. Diffusion times ranged from 2 h to 75 h, depending on the injection protocol and the cartilage region. Direct single injection of the contrast through the labrum resulted in the fastest diffusion times. The iodine attenuation coefficient, which reflects the contrast agent distribution in the cartilage, ranged from 0.0142/cm to 0.1457/cm. Three injections at the head/neck conjunction area yielded the highest iodine attenuation coefficients in cartilage. The femoral cartilage in the Superior-Medial compartment was significantly thicker than in the other 3 femoral compartments, and femoral cartilage in the Superior-Anterior compartment was significantly thinner than the other 3 femoral compartments. The acetabular cartilage in the Superior compartment was significantly thicker than that in the Superior-Posterior compartment. sCECT with CA4+ allows assessment of hip cartilage thickness with 0.1 mm isotropic voxel size, sufficient for evaluating cartilage pathology and biomechanics.

Challenging Knosp high-grade pituitary adenomas.

Parasellar growth is one of the most important prognostic variables of pituitary adenoma surgery, with adenomas regarded as not completely resectable if they invade the cavernous sinus (CS) but potentially curable if they displace CS structures. This study was conducted to correlate surgical treatment options and outcomes to the different biological behaviors (invasion vs displacement) of adenomas with parasellar extension into the superior or inferior CS compartments or completely encasing the carotid artery (Knosp high grades 3A, 3B, and 4). This was a retrospective cohort analysis of 106 consecutive patients with Knosp high-grade pituitary adenomas with parasellar extension who underwent surgery via a primary endoscopic transsphenoidal approach between 2003 and 2017. Biological tumor characteristics (surgical status of invasiveness and tumor texture, 2017 WHO classification, proliferation rate), extent of resection, and complication rate were correlated with parasellar extension grades 3A, 3B, and 4 on preoperative MRI studies. Invasiveness was significantly less common in grade 3A (44%) than in grade 3B (72%, p = 0.037) and grade 4 (100%, p < 0.001) adenomas. Fibrous tumor texture was significantly more common in grade 4 (52%) compared to grade 3A (20%, p = 0.002), but not compared to grade 3B (28%) adenomas. Functioning macroadenomas had a significantly higher rate of invasiveness than nonfunctioning adenomas (91% vs 55%, p = 0.002). Mean proliferation rate assessed by MIB-1 was > 3% in all groups but without significant difference between the groups (grade 3A, 3.2%; 3B, 3.9%; 4, 3.7%). Rates of endocrine remission/gross-total resection were significantly higher in grade 3A (64%) than in grade 3B (33%, p = 0.021) and grade 4 (0%, p < 0.001) adenomas. In terms of complication rates, no significant difference was observed between grades. According to the authors' data, the biological behavior of pituitary adenomas varies significantly between parasellar extension patterns. Adenomas with extension into the superior CS compartment have a lower rate of invasive growth than adenomas extending into the inferior CS compartment or encasing the carotid artery. Consequently, a significantly higher rate of remission can be achieved in grade 3A than in grade 3B and grade 4 adenomas. Therefore, the distinction into grades 3A, 3B, and 4 is of importance for prediction of adenoma invasion and surgical treatment considerations.

Extension Pathways of Pituitary Adenomas with Cavernous Sinus Involvement and Its Surgical Approaches

Resection and remission rates are low in pituitary adenomas that invade the cavernous sinus (CS) because of the complexity of the region. In this study, the authors describe the invasion patterns and surgical approaches for these corridors. Endoscopic transsphenoidal surgery was performed in 1849 patients between August 1997 and 2017; 381 of these patients were included in the study because of the presence of CS invasion. CS invasion pathways and CS compartments were defined, and these patients were divided into 3 groups according to their invasion corridors. The cases were also categorized according to the Knosp classification. A total of 381 patients were included, 199 of whom were men. The mean follow-up duration was 34 months. In preoperative magnetic resonance imaging measurements, 2 of 381 patients had microadenoma, 350 of 381 had macroadenoma, and 29 of 381 had giant adenoma. When the early postoperative magnetic resonance images were compared with the preoperative images, 91 of 381 (23.9%) patients had subtotal tumor resection, 83 of 381 (21.8%) had near-total tumor resection, and 207 of 381 (54.3%) had gross total tumor resection. Considering the invasion classification with endoscopic confirmation, there were 168 of 381 (44.1%) cases of isolated medial corridor involvement, 74 of 381 (19.4%) cases of isolated lateral corridor involvement, and 139 of 381 (36.5%) cases of total involvement cases. Medial wall defect has no importance in the invasion. Similarly, seeing the existence of pitholes is not an invasion criterion. Pituitary adenomas invade 4 compartments: the superior, anteroinferior, posterior, and lateral compartments of the CS via 2 corridors. Increased experience, novel approaches, and endoscopic developments have contributed immensely to this field.

Functional anatomy of human extraocular muscles during fusional divergence.

We employed magnetic resonance imaging to quantify human extraocular muscle contractility during centered target fusion and fusional divergence repeated with each eye viewing monocularly at 20 cm through 8Δ and at 400 cm through 4Δ base in prism. Contractility, indicated by posterior partial volume (PPV) change, was analyzed in transverse rectus and in medial and lateral superior oblique (SO) muscle compartments and by cross-sectional area change in the inferior oblique (IO). At 20 cm, 3.1 ± 0.5° (SE) diverging eye abduction in 10 subjects was associated with 4.2 ± 1.5% whole lateral rectus (LR) PPV increase ( P < 0.05) and 1.7 ± 1.1% overall medial rectus (MR) PPV decrease attributable to 3.1 ± 1.8% reduction in the superior compartment ( P < 0.025), without change in its inferior compartment or in muscles of the aligned eye. At 400 cm, 2.2 ± 0.5° diverging eye abduction in nine subjects was associated with 6.1 ± 1.3% whole LR PPV increase ( P < 10-5) but no change in MR, with compartmentally similar relaxation in the LR and MR of the aligned eye. Unlike convergence, there were no IO or SO contractile changes for divergence to either target nor any change in rectus pulley positions. Results confirm and extend to proximal divergence the unique role of the superior MR compartment, yet no MR role for far divergence. Corelaxation of aligned eye LR and MR combined with failure of MR relaxation during divergence is consistent with the limited behavioral range of divergence. NEW & NOTEWORTHY Magnetic resonance imaging shows that the lateral rectus muscle must overcome continued contraction by its opponent the medial rectus when humans diverge their visual axes to achieve single, binocular vision. While the upper but not lower compartment of the medial rectus assists by relaxing for near targets, it does not do so when targets are far away. This behavior violates Sherrington's law of reciprocal action of antagonists and conventional assumptions about the ocular motor system.

A modified approach for eminectomy for temporomandibular joint dislocation under local anaesthesia: report on a series of 50 patients

Conventional eminectomy for habitual dislocation of the temporomandibular joint is usually performed under general anaesthesia. This technique was modified for use under local anaesthesia to treat medically compromised patients. Fifty elderly patients (90 joints) were treated, for whom general anaesthesia was considered a serious risk due to systemic diseases; the dislocation was habitual in 39 and long-standing in 11. Following intravenous sedation and local anaesthesia, a 2-cm superficial vertical skin incision was made directly above the articular eminence. Careful and gentle dissection of the subcutaneous tissue was performed until the lateral joint capsule was exposed. The superior compartment was entered, followed by shaving of the articular eminence in a conventional manner. The surgery was successful in all patients, with a mean operative time of 47±12minutes. Intraoperative events occurred in 10 patients (20%). Postoperative complications affected 25 patients (50%), varying from severe (two deaths, due to cardiopulmonary arrest and accidental fall) to mild (local infection, etc.). Eleven patients (22%) had facial nerve palsy limited to the temporal branch; all recovered after 6 months. This approach is useful when general anaesthesia is contraindicated due to existing medical conditions. However, prudent consideration may be required to avoid serious complications when local anaesthesia is used.

Endoscopic endonasal transoculomotor triangle approach for adenomas invading the parapeduncular space: surgical anatomy, technical nuances, and case series.

Pituitary adenomas may extend into the parapeduncular space by invading through the roof of the cavernous sinus. Currently, a transcranial approach is the preferred choice, with or without the combination of an endonasal approach. In this paper the authors present a novel surgical approach that takes advantage of the natural corridor provided by the tumor to further open the oculomotor triangle and resect tumor extension into the parapeduncular space. Six injected specimens were used to demonstrate in detail the surgical anatomy related to the approach. Four cases in which the proposed approach was used were retrospectively reviewed. From a technical perspective, the first step involves accessing the superior compartment of the cavernous sinus. The interclinoid ligament should be identified and the dura forming the oculomotor triangle exposed. The oculomotor dural opening may be then extended posteriorly toward the posterior petroclinoidal ligament and inferolaterally toward the anterior petroclinoidal ligament. The oculomotor nerve should then be identified; in this series it was displaced superomedially in all 4 cases. The posterior communicating artery should also be identified to avoid its injury. In all 4 cases, the tumor invading the parapeduncular space was completely removed. There were no vascular injuries and only 1 patient had a partial oculomotor nerve palsy that completely resolved in 2 weeks. The endoscopic endonasal transoculomotor approach is an original alternative for removal of tumor extension into the parapeduncular space in a single procedure. The surgical corridor is increased by opening the dura of the oculomotor triangle and by working below and lateral to the cisternal segment of the oculomotor nerve.

Relationship Between Intracapsular Fracture Patterns and Arthroscopic Findings

To observe the superior joint compartment (SJC) using ultrathin arthroscopy in intracapsular condylar fracture (ICF) of the temporomandibular joint, describe the changes, and evaluate the relations among fracture pattern, arthroscopic findings, and clinical outcome. Twenty patients with 27 ICFs were the subject group. Thirteen patients had unilateral ICFs and 7 had bilateral ICF. The fracture patterns were classified into 9 categories, and all patients had arthroscopic examination of the traumatized joint at the time of definitive treatment. At 4months after treatment of the injury, all patients had a secondary arthroscopy ofthe ICF joint. In all patients, range of motion (ROM) was measured as the interincisal distance (millimeters) at the first visit to 12months after the first treatment, and the data were statistically evaluated. Intra-articular hyperemia, hypervascularity, and temporal bone damage were found, and 4 patients had disc perforations at the first examination. At the second arthroscopy 4months later, normal healing occurred in 11 joints, all of which had minimally displaced fractures. Fifteen joints showed complete filling of the SJC, all of which had a displaced minor fragment from the fossa. Comparison of the effect of the presence versus absence of SJC fibrosis on ROM showed marked differences from 1 to 12months. The effect of early versus delayed definitive treatment showed marked differences at 4 and 12months. The intra-articular condition at 4months after ICF as observed arthroscopically was related to the minor fragment position. If the minor fragment is nondisplaced, then it will heal to a normal state; however, if the minor fragment is displaced from the fossa, then the SJC shows disc damage and fibrosis. This could lead to fibrous ankylosis.

Endoscopic endonasal transpterygoid approach to petrous pathologies: technique, limitations and alternative approaches.

The endoscopic endonasal transpterygoid approach is a versatile technique, providing direct access to the petrous apex through an anterior surgical corridor. In this review we detail the transpterygoid approach to the petrous apex and highlight its relative indications. Although this approach is a useful strategy for many lesions of the petrous apex, disease extension into lateral, superior, or posterior compartments may limit extent of resection afforded by an anterior approach alone. Based on these considerations, a disease compartment-specific strategy is discussed. The limitations of the transpterygoid approach and indications for lateral and postero-lateral approaches to petrous pathology are reviewed.

In-transit development of color abnormalities in turkey breast meat during winter season

BackgroundThe poultry industry suffers losses from problems as pale, soft and exudative (PSE), and dark, firm and dry (DFD) meat can develop in meat as a result of short- and long-term stress, respectively. These abnormalities are impacted by pre-slaughter animal welfare.MethodsThis work evaluated the effects of open vehicle container microclimate, throughout the 38 ± 10 km journey from the farm to the slaughterhouse, on commercially turkey transported during the Brazilian winter season. The journey was initiated immediately after water bath in truck fitted with portable Kestrel anemometers to measure air ventilation, relative humidity, temperature and ventilation.ResultsThe inferior compartments of the middle and rear truck regions showed highest temperature and relative humidity, and lower air ventilation. In addition, the superior compartments of the front truck regions presented lower temperature and wind chill, and highest air ventilation. The breast meat samples from animals located at the inferior compartments of the middle and rear truck regions and subjected to with water bath (WiB) treatment presented highest DFD-like and had lowest PSE-like meat incidence than those from animals located at other compartments within the container. Lower incidence of PSE-like meat was observed in birds without water bath (WoB).ConclusionsAssessment on turkeys transported under Brazilian southern winter conditions revealed that breast meat quality can be affected by relative humidity, air ventilation, temperature, and transport under subtropical conditions promoting color abnormalities and the formation of simultaneously PSE-like and DFD-like meat.

Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery.

OBJECTIVE Tumors with cavernous sinus (CS) invasion represent a neurosurgical challenge. Increasing application of the endoscopic endonasal approach (EEA) requires a thorough understanding of the CS anatomy from an endonasal perspective. In this study, the authors aimed to develop a surgical anatomy-based classification of the CS and establish its utility for preoperative surgical planning and intraoperative guidance in adenoma surgery. METHODS Twenty-five colored silicon-injected human head specimens were used for endonasal and transcranial dissections of the CS. Pre- and postoperative MRI studies of 98 patients with pituitary adenoma with intraoperatively confirmed CS invasion were analyzed. RESULTS Four CS compartments are described based on their spatial relationship with the cavernous ICA: superior, posterior, inferior, and lateral. Each compartment has distinct boundaries and dural and neurovascular relationships: the superior compartment relates to the interclinoidal ligament and oculomotor nerve, the posterior compartment bears the gulfar segment of the abducens nerve and inferior hypophyseal artery, the inferior compartment contains the sympathetic nerve and distal cavernous abducens nerve, and the lateral compartment includes all cavernous cranial nerves and the inferolateral arterial trunk. Twenty-nine patients had a single compartment invaded, and 69 had multiple compartments involved. The most commonly invaded compartment was the superior (79 patients), followed by the posterior (n = 64), inferior (n = 45), and lateral (n = 23) compartments. Residual tumor rates by compartment were 79% in lateral, 17% in posterior, 14% in superior, and 11% in inferior. CONCLUSIONS The anatomy-based classification presented here complements current imaging-based classifications and may help to identify involved compartments both preoperatively and intraoperatively.

TMJ ARTHROSCOPY: “CAPSULAR MIGRATION” IN INTERNAL DERANGEMENT; IS ARTHROCENTESIS A RELIABLE SUBSTITUTE TO ARTHROSCOPY?

Internal derangement (ID) of the TemporoMandibular Joint (TMJ) is a general orthopedic term implying a mechanical fault that interferes with the smooth action of a joint. Athroscopy and arthrocentesis of superior TMJ compartment are among the commonly used diagnostic and minimally invasive treatment modalities for ID. Arthrocentesis has been considered as the cheaper, simpler and blind substitute for arthroscopy. This study reports arthroscopic outcomes that defy this understanding, and presents a new arthroscopic finding in ID patients: “Capsular Migration”; which changes the criteria of a successful entry into the superior TMJ compartment.

Clinical and radiological outcome of arthrocentesis followed by autologous blood injection for treatment of chronic recurrent temporomandibular joint dislocation.

BackgroundThis study was conducted to evaluate the functional outcome and MRI findings of arthrocentsis followed by autologous blood injection (ABI) into the joint space for management of chronic recurrent TMJ dislocation.Material and MethodsTotal ten patients with bilateral chronic recurrent condylar dislocation were included in the study. Arthrocentesis of both TMJ was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included; thorough history, clinical examination of TMJ, maximal mouth opening, frequency of dislocation, TMJ radiographs (open and closed mouth position), MRI, recurrence and presence of facial nerve paralysis.ResultsAt the end of 3 months follow-up 8 patients (80%) had successful outcome with no further episodes of dislocation, whereas two patients reported with recurrence. Post-operative MRI showed significant improvement after ABI, compared to pre-operative MRI. There were no degenerative changes to the bony and soft tissue components of TMJ.ConclusionsABI is a simple, safe, minimally invasive and cost-effective technique for treatment of chronic recurrent TMJ dislocation. MRI evaluation showed an improvement in the anatomical and spatial relationship of the osseous and soft tissue components of the TMJ. Key words:TMJ lavage, luxation, fibrosis, magnetic resonance imaging.