Arthroscopy-Assisted Inferior Compartment Arthrocentesis of the Temporomandibular Joint

Purpose Arthroscopic lysis and lavage of the temporomandibular joint (TMJ) is an established treatment for internal derangements (ID). Conventional techniques are limited to the superior compartment, although pathologies and translational movement frequently involve the inferior compartment. This study describes and evaluates a reproducible needle-based arthroscopic-assisted technique for lysis and lavage of the inferior compartment. Methods Twenty patients with Wilkes IV, anterior disc displacement without reduction, and condylar resorption confirmed on MRI/CT were prospectively treated. Two 18G needles were introduced through arthroscopic view on the lateral discal transitional zone into the inferior compartment, enabling lavage with 100 mL of Ringer’s solution. Superior compartment lavage were subsequently performed, followed by injection of high-molecular-weight hyaluronic acid. Outcomes included pain (Visual Analog Scale, VAS) and mandibular motion (maximum mouth opening and laterality). Results VAS scores decreased from 5.55 ± 2.92 preoperatively to 0.35 ± 0.92 postoperatively (Δ − 5.20; p < 0.001). A ≥ 3-point pain reduction was achieved in 85% of patients, and 95% ended ≤ 2. Maximum mouth opening improved by + 4.25 ± 4.19 mm (95% CI 2.32–6.18). Right and left laterality improved by + 3.45 ± 2.89 mm and + 2.55 ± 2.31 mm, respectively, with 85–90% of patients showing increased excursions. No major complications occurred. Conclusion Arthroscopy-assisted technique provides safe and effective access to the inferior TMJ compartment, yielding significant improvements in pain and motion. It avoids greater damage to fibrocartilage, is a cost-effective and reproducible technique, and expands minimally invasive therapeutic options for advanced internal derangements.