Arthrocentesis - Dr. Paul Mirdamadi DDS

TMJ arthrocentesis is based on the hydraulic pressure created by a lavage solution to remove inflammatory mediators and degradation products present in the synovial fluid, decrease the negative pressure within the joint, and break intra-articular adhesions formed between the mandibular fossa and the articular disc
Tragal-lateral canthus line (Holmlund-Hellsing line) is a line from the lateral canthus of the eye to the tip of the mid-portion of the ipsilateral tragus. Puncture points:
- 10mm anterior and 2 mm inferior
- 20mm anterior and 10mm inferior

Puncture landmarks for arthrocentesis are established with reference to a line connecting the tragus and lateral canthus. The initial puncture should be 10 mm anterior to the tragus and 2 mm below the canthaltragal line.
Modified condylotomy is capable of effecting disc reduction in 80% of joints with anterior disc displacement with reduction (Wilkes stage II) or with discs that have recently progressed to non-reducing disc status (Wilkes early stage III).
Temporomandibular joint arthrocentesis includes lavage of the upper joint space, hydraulic distension, manipulation, and instillation of a corticosteroid. Arthrocentesis is indicated for acute or chronic limitation of motion due to anterior disc displacement without reduction and hypomobility due to restriction of condylar translation in the superior joint space.