A comparative study of the versatility of various entry points for double-puncture TMJ arthrocentesis: A randomized controlled study.

Although various authors employed various entry points for the double-puncture technique (DPT) for arthrocentesis, the literature is devoid of any comparative studies. Therefore, the current prospective study aimed to evaluate the versatility of these different points. A total of 144 TMJs in 108 patients were included and randomly divided into two categories according to ID stage: category I (disc displacement without reduction with limitation), and category II (disc displacement without reduction without limitation). Patients in every category were randomly divided into 3 groups according to the site of entry point of the second needle: group 1 (20-10 point: 20 mm anterior to the tragus and 2 mm inferior to the cantho-tragus line), group 2 (20-1 point), and group 3 (7-2 point). For all patients, the first entry point was 10-2, and the upper joint cavity was irrigated with 150 ml of Ringer's solution without subsequent intra-articular injections. Group 3 had better results than group 2 and further than group 1 in categories I and II with regard to the number of second needle relocations, ease of the procedure, duration of the procedure, and nature of the outflow, as well as pain at rest and pain on function at 1, 3, and 6 post-operative months. For the maximum mouth opining, group 3 had better results than group 2 and further than group 1 only in category I. Therefore, techniques depending on the superior posterior entry points (such as 7-2 point) were recommended.