Arthrocentesis of the temporomandibular joint (TMJ) was first described by Nitzan et al. in 1991, and is regarded as a simple, minimally invasive, inexpensive, and highly efficient procedure. Various techniques to make the procedure even less invasive have been proposed. Apart from the technique described by Nitzan et al., nine other arthrocentesis methods for lysis and lavage of the TMJ have been published in the literature. Each of these methods has a different name or stated description. If additional techniques are reported, this will become even more complex. On further examination of these techniques it appears that all gain entry to the upper joint space of the TMJ from either one point or two.
In 2008, Guarda-Nardini et al. proposed the single-needle arthrocentesis in which inflow and outflow are through the same cannula. This cannula is inserted through one puncture site. However, a publication by Rehman and Hall entitled “Single needle arthrocentesis” refers to the use of a cannula that has two ports and lumens. Which of these is the correct description of single-needle arthrocentesis? TMJ arthrocentesis was first described by Nitzan et al. in 1991 and this is known as the traditional procedure. Tozoglu et al. refer to this procedure as two-needle arthrocentesis. Rehman and Hall performed arthrocentesis with a Shepard cannula, which has two ports and lumens. Can this procedure also be termed two-needle arthrocentesis? Which is the correct description?
In order to avoid these and other possible complexities we propose a new classification for TMJ arthrocentesis techniques. According to this classification, TMJ arthrocentesis techniques are divided into two groups. These groups are (1) single-puncture arthrocentesis, in which a cannula is inserted through one puncture site into the joint space, and (2) double-puncture arthrocentesis ( Fig. 1 ), in which two needles are inserted through two separate puncture sites. In addition to this, single-puncture arthrocentesis is divided into two subgroups – types 1 and 2. Type 1 is a single-needle cannula method, in which inflow and outflow are through the same cannula and lumens, as first described by Guarda-Nardini et al. Type 2 is a double- or dual-needle cannula method, in which inflow and outflow are through the same cannula but different ports and lumens ( Fig. 2 ).