title: Image-guided puncture technique for the superior temporomandibular joint space: value of cone beam computed tomography (CBCT).
abstract: OBJECTIVE
  Temporomandibular joint (TMJ) disk perforation or adhesion requires arthrographic examination. However, puncture of the TMJ may result in damaging penetration of the middle cranial fossa. We investigated the effectiveness of penetrating the superior TMJ space using a safe image-guided puncture technique (IGPT).
  
  
  METHODS
  Fifty-two patients underwent cone beam computed tomography (CBCT) examination. Optimum angles and distances from the puncture site to the thinnest point of the glenoid fossa to penetrate the superior joint space were measured using three-directional images.
  
  
  RESULTS
  Puncturing the superior articular cavity was immediately successful in 50 cases. Image measurements gave an average horizontal angle of 8.0 degrees (standard deviation [SD]: 9.2), an average coronal angle of 16 degrees (SD: 11.3), and an average distance of 27 mm (SD: 2.8).
  
  
  CONCLUSIONS
  Variation in puncture angle among individuals indicated that CBCT examination is necessary preceding TMJ puncture. Preliminary clinical application has demonstrated the safety of IGPT using CBCT.
authors.affiliation: Department of Oral Radiology and Division of Advanced Dental Treatment, Dental Research Center, Nihon University, School of Dentistry, Tokyo, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Honda
authors.forename: Tore
authors.initials: T
authors.lastname: Bjørnland
mesh_terms: D000328:Adult; D000368:Aged; D001175:Arthrography / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods*; D011861:Radiography, Dental / Q000379:methods; D012449:Safety; D025321:Surgery, Computer-Assisted; D013704:Temporomandibular Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods