Needle-based Level II temporomandibular joint arthroscopy under local anesthesia

Objective To describe a novel office-based Level II temporomandibular joint (TMJ) arthroscopy technique performed using only two 16-gauge needle punctures, achieving the same level of invasiveness as conventional arthrocentesis while allowing direct visualization and therapeutic intervention. Methods This technical note describes a minimally invasive arthroscopic approach performed under intravenous sedation and local anesthesia using two 16-gauge needle portals. A 0.7-mm diameter fiber-optic endoscope is introduced through one needle for visualization, while a 600-µm optical fiber connected to a 450 nm diode laser (TheraBlue®, DMC, Brazil) is introduced through the second needle for controlled retrodiscal tissue ablation under direct visualization. Results This technique enables Level II arthroscopic capabilities while maintaining needle-level invasiveness. The procedure can be performed in an office setting under local anesthesia, reducing the need for hospital-based infrastructure. Conclusion Office-based Level II TMJ arthroscopy using 16-gauge needle portals represents a minimally invasive evolution of arthrocentesis, enabling visualization and targeted therapeutic intervention with minimal morbidity.