Use and accuracy of US guidance for image-guided injections of the temporomandibular joints in children with arthritis.

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.

• Authors: Dimitri A Parra, Melissa Chan, Ganesh Krishnamurthy, Lynn Spiegel, Joao G Amaral, Michael J Temple, Philip R John, Bairbre L Connolly
• Journal: Pediatric radiology (Pediatr Radiol) Vol. 40 Issue 9 Pg. 1498-504 (Sep 2010) ISSN: 1432-1998 [Electronic] Germany
• PMID: 20204611 (Publication Type: Journal Article)

Chemical References

• Glucocorticoids
• Triamcinolone

Topics

• Arthritis, Juvenile (diagnostic imaging, drug therapy)
• Child
• Female
• Glucocorticoids (administration & dosage)
• Humans
• Injections, Intra-Articular
• Male
• Retrospective Studies
• Temporomandibular Joint (diagnostic imaging)
• Temporomandibular Joint Disorders (diagnostic imaging, drug therapy)
• Tomography, X-Ray Computed
• Treatment Outcome
• Triamcinolone (administration & dosage)
• Ultrasonography, Interventional