Temporomandibular joint arthrography: negative pressure, nontomographic techniques.
The injection of contrast material through a catheter under direct fluoroscopic vision seems to be more informative than blind injection technique. Injection of a controlled amount of Renografin can diminish the likelihood of overfill and allow more complete opening of the mouth. If overfilling is suspected, after waiting approximately 15 minutes for absorption, the patient will then be able to move his condyle more freely. The use of a 100 mm. camera will provide good films and eliminate the need for tomograms. A catheter is preferred over a steel needle, and its position is more accurately assessed by using the negative pressure technique. Catheterization of the superior joint space is not done if the lower compartment injection shows obvious anterior subluxation of the meniscus. In certain borderline cases, the upper compartment filling may yield more positive diagnotic information. It is within the scope of this article to present a technique, not to indicate the usefulness or necessity of TMJ arthrography or tomography. The role of arthrography in the diagnosis and subsequent decision as to whether surgical or nonsurgical modalities should be performed will become evident only when the state of the art is defined.