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  • Title: Use and accuracy of US guidance for image-guided injections of the temporomandibular joints in children with arthritis.
    Author: Parra DA, Chan M, Krishnamurthy G, Spiegel L, Amaral JG, Temple MJ, John PR, Connolly BL.
    Journal: Pediatr Radiol; 2010 Sep; 40(9):1498-504. PubMed ID: 20204611.
    Abstract:
    BACKGROUND: Juvenile idiopathic arthritis (JIA) has an incidence that ranges from 1 to 22 per 100,000 children worldwide, with involvement of the temporomandibular joint (TMJ) in 17-87% of patients. Intraarticular corticosteroid injections are beneficial in the local treatment of JIA and of other types of arthritis. OBJECTIVE: To describe and assess the accuracy of an US-guided technique for visualization of needle placement within the TMJ in children. MATERIALS AND METHODS: Between January 2000 and November 2007, 180 TMJ injections were performed during 116 encounters in 83 children with arthritis (71 girls, 12 boys; mean age 12.0 years). Access was obtained under sterile conditions using US guidance (linear 15-MHz or curvilinear 8-MHz transducers) in a coronal plane, and confirmed with CT. To minimize radiation, a limited focused CT protocol was developed. RESULTS: A bilateral injection was performed in 65 encounters (57%). Twenty-three children had repeat TMJ injections. All injections were performed using US guidance. CT confirmation was used in 127/180 TMJs (70%). In those confirmed with CT, the needle tip was intra-articular in 91% of cases. Triamcinolone hexacetonide was used in 92% of injections and triamcinolone acetonide in 8%. One major complication was encountered (skin atrophy at the injection site). CONCLUSION: In our experience, TMJ injections using sonographic guidance is a safe, effective and accurate procedure.
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