Two-portal arthroscopic subtotal meniscectomy for temporomandibular joint disc perforation.

Abstract

Disc perforation represents an advanced stage of temporomandibular joint (TMJ) internal derangement and is traditionally managed with disc repair techniques or open discectomy when the disc is non-repairable. Although arthroscopic approaches are widely used for minimally invasive management of TMJ disorders, reproducible techniques for arthroscopic disc removal remain limited. This technical note describes the feasibility of a two-portal arthroscopic subtotal meniscectomy for non-repairable TMJ disc perforation. The procedure is performed using a standard posterolateral viewing portal and a single anterolateral working portal. Disc release is achieved sequentially using radiofrequency instrumentation, followed by removal of released disc fragments with arthroscopic grasping forceps through the same working cannula. This repetitive process allows controlled removal of non-functional disc tissue under continuous visualization while minimizing capsular trauma. Due to anatomical constraints inherent to a two-portal approach, a thin residual disc remnant may persist in the medial or posteromedial region and is considered functionally irrelevant. This technique is intended for selected cases with clearly non-repairable disc perforation and aims to simplify portal placement while expanding the arthroscopic surgical options for advanced TMJ internal derangement.