Contrast arthrography of the equine temporomandibular joint

Clara S. Kim Nathalie A. Reisbig James L. Carmalt

Background

Disorders affecting the equine temporomandibular joint (TMJ) can cause significant clinical issues. While osseous abnormalities within the TMJ can be highlighted through specialist radiographic projections, assessing intra-articular soft tissue structures has been limited to computed tomography (CT) or magnetic resonance imaging (MRI), which are both costly and not widely accessible. This study aims to develop and validate a technique for contrast arthrography in the equine TMJ, potentially offering a more accessible method to investigate intra-articular soft tissues.

Methods

This descriptive, experimental study was carried out in two phases. In Phase I, contrast arthrography was performed on 12 cadaveric equine heads, focusing on the discomandibular and discotemporal joint compartments using needles inserted into caudal pouches. Techniques from previously published studies were employed, alongside modifications such as opening the mouth and injecting air for a double-contrast study. Phase II involved applying the refined technique to three live horses to assess its feasibility in living subjects.

Results

The study demonstrated that single and double-contrast arthrography could successfully delineate the dorsal and ventral surfaces of the intra-articular disc, as well as fill the rostral and caudal joint pouches. However, contrast extravasation and iatrogenic disc penetration, which could lead to false diagnosis of pathologic disc perforation, were identified as potential issues. The technique was well tolerated in live horses, indicating its practical viability.

Limitations

The study acknowledges a low number of horses as a primary limitation, which may affect the generalizability of the findings.

Conclusions

Contrast arthrography provides a valuable method for interpreting intra-articular soft tissue structures within the equine TMJ, though it requires caution in diagnosing disc perforation due to potential iatrogenic injury. Despite the challenges in accessing the discomandibular joint, the study supports the use of contrast arthrography as a useful diagnostic tool, with the necessity of careful performance to avoid misinterpretation.

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