title: 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.
  
  
  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).
  
  
  CONCLUSIONS
  In our experience, TMJ injections using sonographic guidance is a safe, effective and accurate procedure.
authors.affiliation: Department of Diagnostic Imaging, Division of Image Guided Therapy, The Hospital for Sick Children, Toronto, Canada. dimitri.parra@sickkids.ca
authors.forename: Dimitri A
authors.initials: DA
authors.lastname: Parra
authors.forename: Melissa
authors.initials: M
authors.lastname: Chan
authors.forename: Ganesh
authors.initials: G
authors.lastname: Krishnamurthy
authors.forename: Lynn
authors.initials: L
authors.lastname: Spiegel
authors.forename: Joao G
authors.initials: JG
authors.lastname: Amaral
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Temple
authors.forename: Philip R
authors.initials: PR
authors.lastname: John
authors.forename: Bairbre L
authors.initials: BL
authors.lastname: Connolly
mesh_terms: D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002648:Child; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D012189:Retrospective Studies; D013704:Temporomandibular Joint / Q000000981:diagnostic imaging*; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional
chemical_list: D005938:Glucocorticoids; D014221:Triamcinolone