Ultrasound-Guided Intra-articular and Intraosseous Injections for the Temporomandibular Joint: A Cadaveric Study

Temporomandibular joint osteoarthritis (TMJ-OA) presents significant challenges in management, with various conservative and minimally invasive treatments being employed. Intra-articular injections have been used to target osteoarthritic lesions; however, these injections sometimes fail to directly contact the affected tissue areas. To address this issue, a new real-time ultrasound-guided technique has been developed to inject medications directly into the subchondral bone. This approach was tested using the Clarius L15 ultrasound device. With the patient’s mouth closed, a stainless-steel cannula with a concentric trocar was guided via ultrasound using an in-plane method until it touched the lateral pole of the mandibular condyle. The trocar was then inserted through the medullary bone, enabling medication injection. To validate the precision of this technique, iodine contrast solution was injected, and computed tomography confirmed that the solution successfully reached the medullary condyle of fresh cadaveric specimens. The results showed that this ultrasound-guided method could precisely access the subchondral bone in the inferior space of the TMJ for simultaneous intra-articular and intraosseous injections. This technique holds potential for advancing the early treatment of TMJ-OA, particularly in cases where cortical bone remains intact, and could improve the efficacy of therapeutic interventions aimed at osteoarthritic lesions in the TMJ.