Is intra-articular steroid injection to the temporomandibular joint for juvenile idiopathic arthritis more effective and efficient when performed with image guidance?

Publication date: Available online 6 October 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Pouya M. Vakilian, Leonard B. Kaban, Zachary S. Peacock
PurposeTo compare short-term outcomes and procedure times for intra-articular steroid injection (IASI) to the temporomandibular joint (TMJ) with and without the use of intraoperative image guidance for patients with juvenile idiopathic arthritis (JIA).MethodsThis is a retrospective study of children with JIA who underwent TMJ IASI at Boston Children's Hospital. Subjects were divided into groups according to IASI technique: (1) "landmark" group if performed by an oral and maxillofacial surgeon using an anatomic landmark technique with no intraoperative image guidance, and (2) "image-guided" group if performed by an interventional radiologist using intraoperative ultrasound and computed tomography. Predictor variables included IASI technique (landmark vs. image-guided), age, gender, JIA subtype, category of medications for arthritis, and presence of family history of autoimmune disease. Outcome variables were changes in patient-reported pain, maximal incisal opening (MIO), synovial enhancement ratio (ER) and total procedure time.ResultsForty-five subjects with 71 injected TMJs were included. Twenty-two subjects with 36 injected TMJs were in the landmark group, and 23 subjects with 35 injected joints were in the image-guided group. There were no significant differences in age, sex, family history of rheumatologic disease, or disease subtype between groups. There were no differences in resolution of pain (p=1.00), increase in MIO (p=0.975), or decrease in ER (p=0.492) between groups, but procedure times averaged 49 minutes longer for the image-guided group (p<0.008).ConclusionsWe found no significant differences in short-term outcomes but increased procedure times for the image-guided group. While specific indications for use of image guidance may exist, we cannot justify its routine use for this procedure.



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