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

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


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.

MeSH terms

  • Arthritis, Juvenile / diagnostic imaging
  • Arthritis, Juvenile / drug therapy*
  • Child
  • Female
  • Glucocorticoids / administration & dosage*
  • Humans
  • Injections, Intra-Articular
  • Male
  • Retrospective Studies
  • Temporomandibular Joint / diagnostic imaging*
  • Temporomandibular Joint Disorders / diagnostic imaging
  • Temporomandibular Joint Disorders / drug therapy*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Triamcinolone / administration & dosage*
  • Ultrasonography, Interventional*


  • Glucocorticoids
  • Triamcinolone