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British Journal of Oral and Maxillofacial Surgery 53 (2015) 662–663
Technical note
Mini-instruments for minimally invasive arthroscopy of the temporomandibular joint: a technical note V. Machon a,∗ , J. Levorova a , R. Foltan a , D. Hirjak b , A. Sidebottom c a b c
Department of Oral Maxillofacial Surgery, 1st Charles University and Faculty Hospital Prague, Czech Republic Department of Oral Maxillofacial Surgery, Faculty Hospital Bratislava, Ruzinov, Slovakia Maxillofacial Unit, Nottingham University Hospitals, Nottingham, UK
Accepted 15 April 2015 Available online 6 June 2015 Keywords: Arthroscopy; Mini-instruments
Arthroscopy of the temporomandibular joint can be either by diagnostic lysis and lavage (visually-guided irrigation) or by dual portal entry and intra-articular surgery. Visually-guided irrigation enables visualisation and lavage of the joint simultaneously. This is useful for diagnostic purposes, to flush out inflammatory mediators and loose particles from the joint space, and for lysis of minor adhesions (caused by the flow of fluid). A 1.2 mm disposable arthroscope is used, and an 18–19 gauge needle is inserted for outflow of the irrigating fluid.1,2 Arthroscopic surgery requires a double-port technique using a second trocar to insert the instruments (scissors, grasper, knife, and hook) and consecutive removal of adhesions and hyperplastic synovial tissue, or repositioning of the disc. Insertion of an electrocautery tip, fibre laser, or probe, which are used for the grading of chondromalacia, is also possible. Introduction of the second port, the diameter of which is either 1.9 or 2.1 mm, however, increases the risk of intra-articular damage.1,2 We suggest the use of alternative mini-instruments during visually-guided irrigation, which are made from pretensioned stainless steel wire 0.5 mm in diameter (similar to that used for intermaxillary fixation) (Fig. 1). The wire is 80 mm long with a small loop or hook at the end (Fig. 2). The wire is
∗ Corresponding author at: Department of Oral Maxillofacial Surgery, 1st Charles University and Faculty Hospital Prague, U nemocnice str 2, 120 00 Prague, Czech Republic. E-mail address: [email protected] (V. Machon).
prebent preoperatively and subsequently sterilised, or produced directly in the operating theatre. The wire instruments are inserted through the irrigating needle during visuallyguided irrigation, and permit the grading of chondromalacia and removal of adhesions. The advantage of using wire instru-
Fig. 1. Preparation of the mini-instruments.
http://dx.doi.org/10.1016/j.bjoms.2015.04.015 0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
V. Machon et al. / British Journal of Oral and Maxillofacial Surgery 53 (2015) 662–663
663
Fig. 2. The mini-instruments.
Fig. 4. A mini-instrument in the upper joint space.
easy manufacture of the instruments and the reduced cost (Fig. 4).
Conflict of interest We have no conflict of interest.
Ethics statement/confirmation of patient permission Not required.
Fig. 3. Clinical view.
ments through the needle port (Fig. 3) is that there is less risk of intra-articular damage than with standard 1.9 or 2.1 mm port instruments. A further advantage is the availability and
References 1. McCain JP. Principles and practice of temporomandibular joint arthroscopy. St Louis: Mosby; 1996. 2. Sembronio S, Besozzi C, Baj A, et al. Minimally invasive arthroscopy of the temporomandibular joint. Ital J Maxillofac Surg 2010;21(3 Suppl. 1): 29–37.
British Journal of Oral and Maxillofacial Surgery 53 (2015) 662–663
Technical note
Mini-instruments for minimally invasive arthroscopy of the temporomandibular joint: a technical note V. Machon a,∗ , J. Levorova a , R. Foltan a , D. Hirjak b , A. Sidebottom c a b c
Department of Oral Maxillofacial Surgery, 1st Charles University and Faculty Hospital Prague, Czech Republic Department of Oral Maxillofacial Surgery, Faculty Hospital Bratislava, Ruzinov, Slovakia Maxillofacial Unit, Nottingham University Hospitals, Nottingham, UK
Accepted 15 April 2015 Available online 6 June 2015 Keywords: Arthroscopy; Mini-instruments
Arthroscopy of the temporomandibular joint can be either by diagnostic lysis and lavage (visually-guided irrigation) or by dual portal entry and intra-articular surgery. Visually-guided irrigation enables visualisation and lavage of the joint simultaneously. This is useful for diagnostic purposes, to flush out inflammatory mediators and loose particles from the joint space, and for lysis of minor adhesions (caused by the flow of fluid). A 1.2 mm disposable arthroscope is used, and an 18–19 gauge needle is inserted for outflow of the irrigating fluid.1,2 Arthroscopic surgery requires a double-port technique using a second trocar to insert the instruments (scissors, grasper, knife, and hook) and consecutive removal of adhesions and hyperplastic synovial tissue, or repositioning of the disc. Insertion of an electrocautery tip, fibre laser, or probe, which are used for the grading of chondromalacia, is also possible. Introduction of the second port, the diameter of which is either 1.9 or 2.1 mm, however, increases the risk of intra-articular damage.1,2 We suggest the use of alternative mini-instruments during visually-guided irrigation, which are made from pretensioned stainless steel wire 0.5 mm in diameter (similar to that used for intermaxillary fixation) (Fig. 1). The wire is 80 mm long with a small loop or hook at the end (Fig. 2). The wire is
∗ Corresponding author at: Department of Oral Maxillofacial Surgery, 1st Charles University and Faculty Hospital Prague, U nemocnice str 2, 120 00 Prague, Czech Republic. E-mail address: [email protected] (V. Machon).
prebent preoperatively and subsequently sterilised, or produced directly in the operating theatre. The wire instruments are inserted through the irrigating needle during visuallyguided irrigation, and permit the grading of chondromalacia and removal of adhesions. The advantage of using wire instru-
Fig. 1. Preparation of the mini-instruments.
http://dx.doi.org/10.1016/j.bjoms.2015.04.015 0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
V. Machon et al. / British Journal of Oral and Maxillofacial Surgery 53 (2015) 662–663
663
Fig. 2. The mini-instruments.
Fig. 4. A mini-instrument in the upper joint space.
easy manufacture of the instruments and the reduced cost (Fig. 4).
Conflict of interest We have no conflict of interest.
Ethics statement/confirmation of patient permission Not required.
Fig. 3. Clinical view.
ments through the needle port (Fig. 3) is that there is less risk of intra-articular damage than with standard 1.9 or 2.1 mm port instruments. A further advantage is the availability and
References 1. McCain JP. Principles and practice of temporomandibular joint arthroscopy. St Louis: Mosby; 1996. 2. Sembronio S, Besozzi C, Baj A, et al. Minimally invasive arthroscopy of the temporomandibular joint. Ital J Maxillofac Surg 2010;21(3 Suppl. 1): 29–37.
