Image-Guided Minimally Invasive Surgical Access to the Temporomandibular Joint: A Preliminary Report

Yeung, Richie W.K.; Xia, James J.; Samman, Nabil

doi:10.1016/j.joms.2005.10.039

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Volume 64, Issue 10 , Pages 1546-1552, October 2006

Image-Guided Minimally Invasive Surgical Access to the Temporomandibular Joint: A Preliminary Report

Richie W.K. Yeung, BDS, MB, ChB, FRACDS, FRCS (Ed)
- Assistant Professor, Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
- Address correspondence and reprint requests to Dr Yeung: Assistant Professor, Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong SAR, China
James J. Xia, MD, PhD
- Director, Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute; and Assistant Professor, Division of Pediatric Surgery, Department of Surgery, Medical School, The University of Texas Health Science Center at Houston, Houston, TX.
Nabil Samman, FRCS (Ed), FDSRCS
- Professor, Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.

Purpose

To establish a protocol for image-guided minimally invasive surgical access to the temporomandibular joint (TMJ).

Materials and Methods

This study involved 2 patients with TMJ pain and mandibular motion dysfunction. Axial magnetic resonance imaging (MRI) of the TMJ was obtained and loaded into an intra-operative navigation system to guide joint space injection. With a navigated syringe, 1 mL synvisc Hylan G-F 20 was directly injected into the superior and inferior joint spaces under navigation guidance.

Results

With the assistance of an intraoperative navigational system, the TMJ MRI images were visualized in 3 dimensions and enabled guiding a needle into the superior and inferior joint spaces for therapeutic injection. The treatment outcome for both patients was satisfactory with improvement in pain score and mandibular motion.

Conclusions

A protocol for image-guided minimally invasive surgical access to the TMJ was established. This could provide the technical basis for evaluation of accurate joint space intervention as a form of treatment of appropriate TMJ disorders.