Frontiers in veterinary science2026; 13; 1812140; doi: 10.3389/fvets.2026.1812140

Ultrasound guidance aids in determining the success of equine temporomandibular joint arthrocentesis.

Lopez, DE
·
Carmalt, JL

Abstract: The equine temporomandibular joint (TMJ) is divided into two non-communicating joint (discotemporal DTJ and discomandibular DMJ) compartments. Ultrasound has been extensively used as a diagnostic tool in the horse, but previous work has reported that ultrasound-guidance did not improve the success rate of TMJ arthrocentesis. However, this research focused only on the larger, easily accessed, DTJ compartment. However, most of the osseous pathology of the equine TMJ has been reported to be in the smaller DMJ. Unassigned: To determine whether using ultrasound-guidance would reduce the number of attempts to successfully perform arthrocentesis of the equine TMJ, specifically the DMJ. Unassigned: Experimental study using cadaver animals. Unassigned: The TMJ regions of seven thawed cadaver heads were clipped and cleansed. Arthrocentesis of the left DTJ and DMJ was attempted before repeating the attempts using ultrasound guidance. The number of attempts required to perform successful arthrocentesis of each joint compartment was documented before the second operator performed the same task. The same procedures were then performed on the opposite side of the head. Unassigned: As operators gained experience, their success rate climbed. Statistically, none of the other documented outcome variables significantly affected the number of attempts to obtain successful arthrocentesis. Despite that, ultrasound-guidance allowed immediate unequivocal evidence of successful arthrocentesis into the targeted joint compartment. Unassigned: Low number of normal cadaver horse heads and a lack of randomization of attempt techniques. Unassigned: This study shows that ultrasound-guidance did not reduce the number of attempts required for successful DTJ, or DMJ arthrocentesis. However, it did allow for the immediate unequivocal evidence of successful arthrocentesis into the targeted joint compartment.

Get Full Text

Publication Date: 2026-05-20 PubMed ID: 42245975PubMed Central: PMC13229617DOI: 10.3389/fvets.2026.1812140Google Scholar: Lookup

The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.

Facebook X LinkedIn Email Copy

Summary
Cite This
Publication
Affiliations
Conflict of Interest
References
Citations

Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

This study examined whether using ultrasound guidance helps improve the success rate of arthrocentesis (joint fluid sampling) in the two compartments of the equine temporomandibular joint (TMJ), focusing particularly on the smaller discomandibular joint (DMJ).

Background

The equine TMJ consists of two separate compartments: the discotemporal joint (DTJ) and the discomandibular joint (DMJ), which do not communicate with each other.
Previous ultrasound-guided arthrocentesis studies targeted the larger DTJ and reported no improvement in success rates using ultrasound.
However, most bone-related diseases in horse TMJs occur in the smaller DMJ, which is more challenging to access.
Ultrasound is widely used for diagnostic imaging in horses, but its effectiveness in guiding arthrocentesis of both TMJ compartments, especially the DMJ, had not been fully evaluated.

Objective

To assess whether ultrasound guidance reduces the number of attempts required to successfully perform arthrocentesis of the equine TMJ compartments, focusing on the DMJ.

Methodology

Experimental study conducted on seven thawed equine cadaver heads.
The hair over TMJ regions was clipped and the areas cleansed to prepare for arthrocentesis.
First, arthrocentesis was attempted on the left DTJ and DMJ without ultrasound guidance, recording the number of attempts needed for success.
Then, ultrasound guidance was used for repeat arthrocentesis attempts on the same side.
A second operator repeated the procedures on the left side.
The entire process was then duplicated on the right side of the head.
Success was defined as obtaining joint fluid from the targeted compartment.
Number of attempts per successful puncture and other variables were documented.

Results

Operators’ success rates improved as they gained experience during the procedure.
No statistically significant effect was found from ultrasound guidance on the number of attempts required to successfully perform arthrocentesis in either the DTJ or DMJ compartments.
Ultrasound guidance provided immediate, clear, and unequivocal confirmation that the needle was correctly placed within the targeted joint compartment during arthrocentesis.

Limitations

Small sample size of only seven normal cadaver heads, limiting generalizability.
Lack of randomization in the order of attempts and procedures, which might introduce operator bias or learning effects.
Study performed on cadavers, so clinical conditions and patient reactions were not assessed.

Conclusion

Ultrasound guidance did not reduce the number of attempts needed for successful arthrocentesis in either TMJ compartment (DTJ or DMJ) in cadaver horses.
However, ultrasound provided immediate and definitive visual confirmation of correct needle placement into the targeted joint compartment, which could potentially increase procedural confidence and accuracy in clinical practice.
Overall, while ultrasound may not make the procedure easier or quicker in terms of needle placement attempts, it adds value by confirming success instantly, potentially improving procedure safety and reliability.

Cite This Article

APA

Lopez DE, Carmalt JL. (2026). Ultrasound guidance aids in determining the success of equine temporomandibular joint arthrocentesis. Front Vet Sci, 13, 1812140. https://doi.org/10.3389/fvets.2026.1812140

Publication

Frontiers in veterinary science

ISSN: 2297-1769

NlmUniqueID: 101666658

Country: Switzerland

Language: English

Volume: 13

Pages: 1812140

PII: 1812140

Researcher Affiliations

Lopez, Daniel E

Department of Large Animal Clinical Sciences, Western College of Veterinary, University of Saskatchewan, Saskatoon, Canada.

Carmalt, James L

Department of Large Animal Clinical Sciences, Western College of Veterinary, University of Saskatchewan, Saskatoon, Canada.
Equi-CaRe, Fölziehausen, Germany.

Conflict of Interest Statement

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

This article includes 20 references

Pimentel KL, Carmalt JL. The frequency of communication between the synovial compartments of the equine temporomandibular joint: A contrast-enhanced computed tomographic assessment. Front Vet Sci (2021) 8:753983.
doi: 10.3389/fvets.2021.753983pmc: PMC8573115pubmed: 34760960google scholar: lookup
Warmerdam EP, Klein WR, van Herpen BP. Infectious temporomandibular joint disease in the horse: computed tomographic diagnosis and treatment of two cases. Vet Rec (1997) 141:172–4.
doi: 10.1136/vr.141.7.172pubmed: 9290196google scholar: lookup
Carmalt JL, Wilson DG. Arthroscopic treatment of temporomandibular joint sepsis in a horse. Vet Surg (2005) 34:55–8.
doi: 10.1111/j.1532-950x.2005.00010.xpubmed: 15720597google scholar: lookup
Nagy AD, Simhofer H. Mandibular condylectomy and meniscectomy for the treatment of septic temporomandibular joint arthritis in a horse. Vet Surg (2006) 35:663–8.
doi: 10.1111/j.1532-950X.2006.00205.xpubmed: 17026552google scholar: lookup
Barnett TP, Powell SE, Head MJ, Marr CM, Steven WN, Payne RJ. Partial mandibular condylectomy and temporal bone resection for chronic, destructive, septic arthritis of the temporomandibular joint in a horse. Equine Vet Educ (2014) 26:59–63.
doi: 10.1111/eve.12053google scholar: lookup
Jørgensen E, Christophersen MT, Kristoffersen M, Puchalski S, Verwilghen D. Does temporomandibular joint pathology affect performance?. Equine Vet Educ (2015) 27:126–30.
doi: 10.1111/eve.12268google scholar: lookup
Carmalt JL, Reisbig NA. Arthroscopic treatment of bilateral mandibular condylar cysts and associated osteoarthritis of the temporomandibular joints in a horse. Equine Vet Educ (2022) 34:e352–8.
doi: 10.1111/eve.13602google scholar: lookup
Carmalt JL. Equine poor performance: the logical, progressive, diagnostic approach to determining the role of the temporomandibular joint. J Am Vet Med Assoc (2023) 24:397–404.
doi: 10.2460/javma.23.09.0513pubmed: 38016273google scholar: lookup
Norvall A, Cota JG, Pusterla N, Cissell D. Ultrasound-guided arthrocentesis of the temporomandibular joint in healthy adult horses is equivalent to blind arthrocentesis. Vet Radiol Ultrasound (2020) 61:346–52.
doi: 10.1111/vru.12836pubmed: 31896164google scholar: lookup
Kim CS, Reisbig NA, Carmalt JL. Contrast arthrography of the equine temporomandibular joint. Front Vet Sci (2024) 11:1368131.
doi: 10.3389/fvets.2024.1368131pmc: PMC10983794pubmed: 38562918google scholar: lookup
Weller R, Taylor S, Maierl J, Cauvin ER, May SA. Ultrasonographic anatomy of the equine temporomandibular joint. Equine Vet J (1999) 31:529–32.
doi: 10.1111/j.2042-3306.1999.tb03863.xpubmed: 10596937google scholar: lookup
Frietman SK, van Proosdij ER, Veraa S, de Heer N, Ter Braake F. A minimally invasive partial condylectomy and temporal bone resection for the treatment of a suspected chronic synovial sepsis of the temporomandibular joint in a 35-year-old paint horse gelding. Vet Q (2018) 38:118–24.
doi: 10.1080/01652176.2018.1535216pmc: PMC6830993pubmed: 30773124google scholar: lookup
Weller R, Maierl J, Bowen IM, May SA, Liebich HG. The arthroscopic approach and intra-articular anatomy of the equine temporomandibular joint. Equine Vet J (2002) 34:421–4.
doi: 10.2746/042516402776249155pubmed: 12117118google scholar: lookup
Rosenstein DS, Bullock MF, Ocello PJ, Clayton HM. Arthrocentesis of the temporomandibular joint in adult horses. Am J Vet Res (2001) 62:729–33.
doi: 10.2460/ajvr.2001.62.729pubmed: 11341393google scholar: lookup
Carmalt JL, Kneissl S, Rawlinson JE, Zwick T, Zekas L, Ohlerth S. Computed tomographic appearance of the temporomandibular joint in (1018) asymptomatic horses: a multi-institution study. Vet Radiol Ultrasound (2016) 57:237–45.
doi: 10.1111/vru.12334pubmed: 26773281google scholar: lookup
Cha YH, Park JK, Yang HM, Kim SH. Ultrasound-guided injection into the lower joint space of the temporomandibular jaoint. Int J Oral Maxillofac Surg (2019) 48:540–5.
doi: 10.1016/j.ijom.2018.09.002pubmed: 30287106google scholar: lookup
Carmalt JL, Tucker ML. Arthroscopic approach and intra-articular anatomy of the equine discomandibular joint compartment of the temporomandibular joint. Vet Surg (2020) 49:1326–33.
doi: 10.1111/vsu.13487pubmed: 32633420google scholar: lookup
Antony PG, Sebastian A, Annapoorani D, Varghese G, Mohan S, Jayakumar N. Comparison of clinical outcomes of treatment of dysfunction of the temporomandibular joint between conventional and ultrasound-guided arthrocentesis. Br J Oral Maxillofac Surg (2019) 57:62–6.
doi: 10.1016/j.bjoms.2018.11.007pubmed: 30527515google scholar: lookup
Sivri MB, Ozkan Y, Pekiner FN, Gocmen G. Comparison of ultrasound-guided and conventional arthrocentesis of the temporomandibular joint. Br J Oral Maxillofac Surg (2016) 54:677–81.
doi: 10.1016/j.bjoms.2016.04.004pubmed: 27118616google scholar: lookup
Torres-Gaya J, Bosca-Ramon A, Marques-Mateo M, Valverde-Navarro A, Garcia-San Segundo MM, Puche-Torres M. Temporomandibular joint arthrocentesis guided by ultrasonography: an anatomical study. J Stomatol Oral Maxillofac Surg (2021) 122:e27–31.
doi: 10.1016/j.jormas.2021.03.002pubmed: 33706027google scholar: lookup