Puncture points related to the tragal-lateral canthus line in conventional temporomandibular joint arthrocentesis: are t

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ORIGINAL ARTICLE

Puncture points related to the tragal-lateral canthus line in conventional temporomandibular joint arthrocentesis: are they accurate? A cadaver study Luiz Felipe Palma 1,2 & Gabriela de Godoy Froes 3 & Alyne Pereira 3 & Ricardo Yudi Tateno 4 & Luana Campos 4 & Luís Otávio Carvalho de Moraes 1 Received: 25 May 2020 / Accepted: 22 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract Purpose To evaluate the technical success of conventional TMJ arthrocentesis in cadavers, using the tragal-lateral canthus line as an anatomical reference for the puncture points. Methods Ten formalin-treated and 8 fresh cadavers were submitted to the arthrocentesis. A point located 10 mm anteriorly and 2 mm inferiorly to the beginning of the tragal-lateral canthus line (A) and another point 20 mm anteriorly and 10 mm inferiorly (B) were demarked on the cadavers’ skin. Following, 1 mL of methylene blue solution was injected through the needle at point A, and then another needle was placed at point B. Saline solution was injected through the first needle, identifying a free flow of bluish solution. Results Concerning the formalin-treated cadavers, TMJ arthrocentesis was not successfully performed in any case (0%). In the fresh cadavers, the procedure was properly conducted bilaterally in only one case (12.5%) and unilaterally in 3 cases (37.5%), 2 on the left side (25.0%) and one on the right (12.5%). Conclusion The traditional points related to the tragal-lateral canthus line seemed not to be accurate references for the insertion of the needles in conventional TMJ arthrocentesis when 1 mL of solution is used initially and the maximum mouth opening is not achieved. Keywords Temporomandibular joint . Temporomandibular joint disorders . Arthrocentesis

Introduction Temporomandibular disorder (TMD) represents a range of pathological conditions and functional changes that affects directly the temporomandibular joint (TMJ), masticatory muscles, and other maxillofacial structures [1]. Generally, it can be

* Luiz Felipe Palma [email protected] 1

Discipline of Descriptive and Topographic Anatomy, Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, SP, Brazil

2

MSc Dentistry Program, Ibirapuera University, São Paulo, SP, Brazil

3

School of Dentistry, Centro Universitário das Faculdades Metropolitanas Unidas, São Paulo, SP, Brazil

4

Department of Post-Graduation in Implantology, School of Dentistry, University of Santo Amaro, São Paulo, SP, Brazil

divided into three groups: myofascial disorders, internal derangements, and degenerative joint diseases [2]. The worldwide prevalence of TMD varies from 5 to 15% [3]; besides, it is more frequent between the second and fourth decade of life and affects women with a ratio of up to 9:1 [4]. Typical symptoms of TMD, the main reasons for seeking medical assistance, include pain, changes in mandibular mobility, and joint sounds (clicking and crepitation) [5]; however, patients often note them only when irreversible