Ricardo de Souza Tesch, Esther Rieko Takamori, Rosana Bizon Vieira Carias, Juliana Oliveira de Medeiros Vilela, Thayanne Brasil Barbosa Calcia
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Then, with the patient's mouth closed, a stainless-steel cannula with a concentric trocar was US-guided using an in-plane approach until the perforating tip of the internal trocar touched the lateral pole of the mandibular condyle. Then, the trocar was inserted through the medullary bone, where a posterior injection was made.</p><p><strong>Results: </strong>The technique's precision was confirmed by capturing an iodine contrast solution that imaged the medullary condyle of fresh anatomical specimens processed by computed tomography.</p><p><strong>Conclusion: </strong>The proposed technique was effective in accessing the mandibular condyle subchondral bone in the inferior TMJ space for the simultaneously intra-articular (IA) and intra-osseous (IO) in-plane US-guided injections. Thus, its implementation may represent an important advance in early TMJ-OA treatment. 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引用次数: 0
摘要
目的:颞下颌关节骨关节炎(TMJ-OA)的治疗非常复杂,目前已提出了几种保守和微创方案。针对 OA 的关节内药物注射已经开展,但在某些情况下,这些药物不能直接接触组织病变部位。在此,我们提出一种新的实时超声引导技术,将药物直接注入软骨下骨:方法:使用护理点 Clarius L15 设备进行超声图像筛查。然后,在患者闭口的情况下,在超声引导下使用平面内方法插入带有同心套管的不锈钢套管,直到内部套管的穿孔尖端接触到下颌骨髁状突的外侧极。然后,将套管插入髓质骨,进行后方注射:结果:通过捕捉碘造影剂溶液,对经计算机断层扫描处理的新鲜解剖标本的髓髁部进行成像,证实了该技术的精确性:结论:所提出的技术能有效进入颞下颌关节下间隙的下颌骨髁状突软骨下骨,同时进行关节内(IA)和骨内(IO)平面内 US 引导注射。因此,它的实施可能代表着早期颞下颌关节-OA 治疗的重要进步。这可能是一种很有前景的方法,尤其是在皮质骨仍被保留的 OA 病例中。
Intra-articular and intraosseous approach to temporomandibular joint-targeted injections: a cadaveric investigation.
Purpose: Temporomandibular joint osteoarthritis (TMJ-OA) management is complex, and several conservative and minimally invasive protocols have been proposed. Intra-articular injections of medications directed at OA have been performed, but in some cases, these medications do not directly contact the tissue lesion sites. Here, we propose a new real-time ultrasound-guided technique to inject medications directly into the subchondral bone.
Methods: Ultrasound image screening was carried out with the point-of-care Clarius L15 device. Then, with the patient's mouth closed, a stainless-steel cannula with a concentric trocar was US-guided using an in-plane approach until the perforating tip of the internal trocar touched the lateral pole of the mandibular condyle. Then, the trocar was inserted through the medullary bone, where a posterior injection was made.
Results: The technique's precision was confirmed by capturing an iodine contrast solution that imaged the medullary condyle of fresh anatomical specimens processed by computed tomography.
Conclusion: The proposed technique was effective in accessing the mandibular condyle subchondral bone in the inferior TMJ space for the simultaneously intra-articular (IA) and intra-osseous (IO) in-plane US-guided injections. Thus, its implementation may represent an important advance in early TMJ-OA treatment. This may be a promising approach, especially in OA cases in which the cortical bone is still preserved.
期刊介绍:
The Journal of Ultrasound is the official journal of the Italian Society for Ultrasound in Medicine and Biology (SIUMB). The journal publishes original contributions (research and review articles, case reports, technical reports and letters to the editor) on significant advances in clinical diagnostic, interventional and therapeutic applications, clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and in cross-sectional diagnostic imaging. The official language of Journal of Ultrasound is English.