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Pediatr Radiol. 2010 Sep;40(9):1498-504. doi: 10.1007/s00247-010-1581-2. Epub 2010 Mar 4.

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

Author information

1
Department of Diagnostic Imaging, Division of Image Guided Therapy, The Hospital for Sick Children, Toronto, Canada. dimitri.parra@sickkids.ca

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.

PMID:
20204611
DOI:
10.1007/s00247-010-1581-2
[Indexed for MEDLINE]

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