Dimitri Alejandro Parra MD, Presenter: Nothing to Disclose

Melissa Chan, Abstract Co-Author: Nothing to Disclose

Ganesh Krishnamurthy MBBS, Abstract Co-Author: Nothing to Disclose

Lynn Spiegel MD, Abstract Co-Author: Nothing to Disclose

Michael John Temple MD, Abstract Co-Author: Nothing to Disclose

Bairbre Louise Connolly MD, Abstract Co-Author: Nothing to Disclose

Joao Guilherme Amaral MD, Abstract Co-Author: Nothing to Disclose

Philip John MBChB, FRCR, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

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. Corticosteroid joint injections are beneficial in the local treatment of JIA. The main purpose of this presentation is to describe and assess the accuracy of an ultrasound (US) guided technique for visualization of needle placement within the TMJ in children.  

Between January 2000 and November 2007, 182 TM joint injections were performed, during 116 procedures, in 83 patients (71 girls, 12 boys; mean age 11.9 years). Access was obtained under sterile conditions using US guidance (linear 15MHz or curvilinear 8MHz probe) in a coronal plane and confirmed with computed tomography (CT) which was available after 2001. To minimize radiation, a limited focused CT protocol was developed.

A bilateral injection was performed in 66 procedures (57%). 24 patients had repeat procedures. 181 were performed using US guidance. CT confirmation was used in 126 /181 TM joints (69%). In 91 % of the injections the needle was within the joint. Triamcinolone hexacetonide was used in 92% of injections. One major complications was encountered (skin atrophy at the site of injection).

In our experience, TMJ injections using sonographic guidance, combined with a limited CT, is a safe, effective and accurate procedure.

Sonography is a safe and effective guidance for TMJ injections in children. 

Parra, D, Chan, M, Krishnamurthy, G, Spiegel, L, Temple, M, Connolly, B, Amaral, J, John, P, et al, , Use and Accuracy of Ultrasound for Image-guided Injections of the Temporomandibular Joints in Pediatric Patients with Juvenile Idiopathic Arthritis.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6021105.html