The Frequency of Communication Between the Synovial Compartments of the Equine Temporomandibular Joint: A Contrast-Enhanced Computed Tomographic Assessment.
Authors: Pimentel Karen L, Carmalt James L
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: TMJ Compartment Communication in Horses Pimentel and Carmalt (2021) investigated whether the two synovial compartments of the equine temporomandibular joint—the discotemporal joint (DTJ) and discomandibular joint (DMJ)—normally communicate with one another, since this distinction carries significant implications for how clinicians approach intra-articular diagnosis and treatment. Using contrast-enhanced computed tomography on 20 cadaver heads with no history of TMJ disease (40 joints total), with randomised injection protocols and blinded image interpretation by two observers, the researchers found no physiological communication between compartments in the apparently healthy population, though two joints did demonstrate pathological communication associated with intra-articular disc perforations in the caudomedial fibrous expansion region. These findings suggest that effective management of TMJ disease may require injection of both compartments rather than assuming therapeutic fluid will diffuse between them, whilst also highlighting the diagnostic value of contrast-enhanced imaging for detecting anatomical abnormalities in this challenging region. Although the study's limitations include a modest sample size and reliance on cadaverous tissue, the results provide useful evidence base for clinical decision-making regarding diagnostic arthrocentesis protocols and intra-articular medication delivery in horses presenting with TMJ pathology.
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Practical Takeaways
- •When treating intra-articular TMJ disease, inject both joint compartments separately during therapeutic procedures, as no normal communication exists between them
- •Disc perforation in the caudomedial region is a pathological finding that may warrant advanced imaging (MRI) and potential arthroscopic evaluation
- •Contrast-enhanced CT is a valuable diagnostic tool for assessing equine TMJ compartment integrity and detecting abnormal communications
Key Findings
- •No physiological communication between discotemporal and discomandibular joint compartments was found in 18 of 20 equine cadaver TMJs
- •Two joints demonstrated pathological communication associated with perforation of the intra-articular disc in the caudomedial fibrous expansion
- •Contrast-enhanced CT imaging effectively visualized synovial compartment anatomy and communication
- •One horse with compartment communication showed mild anterior disc displacement on MRI imaging